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Progestin Androgenic Activity

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41. British Association for Sexual Health and HIV national guideline for the management of vulvovaginal candidiasis

of antifungal susceptibility testing should take into account the acid pH of the vagina compared with the neutral pH at which testing is usually performed; the activity of azole antifungals is reduced in acidic environment and clinical resistance may occur despite the isolate being microbiologically susceptible. Treatment: • Oral azoles – continue to avoid in pregnancy, at risk of pregnancy and whilst breastfeeding • Ketoconazole is no longer recommended for the treatment of VVC • Non-azole therapies (...) • It is useful to know that standard in vitro susceptibility testing for Candida spp. is performed at pH 7.0 and that activity of most azole antifungals, particularly those for non-albicans species, is significantly decreased in acidic environment. 68, 69 • In cases of VVC, the vaginal pH is usually in the range of 4 to 4.5, therefore, isolates with elevated MICs are unlikely to respond to standard doses of azole treatment despite still designated as susceptible: o e.g. C. glabrata has variable intrinsic

2019 British Association for Sexual Health and HIV

42. Testosterone replacement in menopause

be prescribed before a trial of testosterone, there are trial data in women with HSDD which indicate that testosterone used without systemic estrogen, is equally effective and safe. Note 3: Tibolone is weakly androgenic, progestogenic and estrogenic – although it is an option for women with low sexual desire it is not sufficiently androgenic nor estrogenic in many women. The progestogenic effect is not required in hysterectomised women and may cause unnecessary adverse effects. Note 4: Compounded (...) . Testosterone deficiency can also contribute to a reduction in general quality of life, tiredness, depression, headaches, cognitive problems, osteoporosis and sarcopenia. 4 What other effects can testosterone have in the post-menopause? After the menopause, estrogen levels fall to undetectable levels. Consequently, the small amount of remaining testosterone may predispose to androgenic symptoms, especially acne, increased facial hair growth and male pattern baldness. Personal genetics are key

2019 British Menopause Society

43. An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of PCOS in Adolescence Full Text available with Trip Pro

suggested that the follicles in a PCOS ovary inherently differ from follicles in a normal ovary [ ]. Theca cells obtained from women with PCOS retain their phenotype with increased androgen secretion from increased CYP17A1 expression or P450c17 activity [ ]. Immunohistochemical studies have indicated that proteins involved in the alternate “backdoor pathway” of steroidogenesis are more highly expressed in PCOS theca cells [ ]. Genome-wide association studies (GWAS) directed investigation to a specific (...) [ ]. Insulin can also decrease the hepatic synthesis of SHBG increasing circulating free androgens [ ]. Additionally, insulin may directly stimulate the activity of ovarian P450c17 and P450scc enzymes to promote ovarian androgen steroidogenesis [ ]. In addition, pancreatic beta cell secretory dysfunction has been described in a subset of women with PCOS; this subset probably has the highest risk of developing carbohydrate intolerance and type 2 diabetes [ ]. Other potential mechanisms, including pubertal

2019 Pediatric Endocrine Society

44. Contraceptive Choices for Young People

with depot medroxyprogesterone acetate (DMPA) use but there is little evidence of a causal association between other progestogen-only methods and weight gain. iii CEU GUIDANCE C C C C C C C B C © FSRH 2010Addressing Young People’s Health Concerns and Risks (continued) Acne Young people may be advised that combined oral contraception (COC) use can improve acne. Young women whose acne fails to improve with COC may wish to consider switching to a COC containing a less androgenic progestogen or one (...) not be dismissed, other lifestyle factors such as levels of physical activity and diet should be explored. The provision of information on diet and physical activity may be useful for young women who are concerned about weight gain. Young people may be advised that there is no evidence of weight gain with COC use. Young people may be advised that weight gain can occur with DMPA use but there is little evidence of a causal association between other progestogen-only methods and weight gain. 5.2 Acne COC use may

2019 Faculty of Sexual & Reproductive Healthcare

45. Management of Infertility

between tamoxifen and clomiphene Low (Iimprecise) Active Acupuncture + Clomiphene vs. Control Acupuncture + Clomiphene vs. Active Acupuncture + Placebo vs. Control Acupuncture + Placebo Live birth 1 RCT 96 (1000) Improvement: Live birth

2019 Effective Health Care Program (AHRQ)

46. Long-Term Drug Therapy and Drug Holidays for Osteoporosis Fracture Prevention: A Systematic Review

/progestin reduced clinical fractures (high SOE) and hip fractures (moderate SOE). After 3–5 years of prior treatment, continuation of zoledronate or alendronate versus drug holiday inconsistently reduced incident vertebral fracture outcomes (radiographic only for zoledronate [low SOE], clinical only for alendronate [moderate SOE]), but did not reduce nonvertebral fractures (low SOE). Hormone therapies increased cardiovascular events, mild cognitive impairment or dementia, and other harms. Observational (...) studies showed that long-term bisphosphonates may increase atypical femoral fractures (AFF) (low SOE) and osteonecrosis of the jaw (low SOE in 2 comparisons, insufficient in 1). Limitations. Most data were from white, healthy, postmenopausal women, limiting generalizability. Trials often had low power for incident clinical fractures. No trials compared active treatments, sequential treatments, or different durations of drug holidays. Harms and controls were inconsistently defined. Conclusions. Long

2019 Effective Health Care Program (AHRQ)

47. Overweight, Obesity and Contraception

, sexual activity, contraceptive use and unintended pregnancy among women with raised BMI 3 5 Suitability of contraceptive methods for women who are overweight or women with obesity 4 5.1 Intrauterine contraception (IUC) 6 5.1.1 IUC effectiveness 6 5.1.2 IUC safety 7 5.1.3 Weight gain with IUC 8 5.1.4 Health benefits of IUC 8 5.1.5 Practical considerations with IUC 8 5.2 Progestogen-only implants (IMP) 8 5.2.1 Implant effectiveness 9 5.2.2 Implant safety 11 5.2.3 Weight gain with implants 11 5.2.4 (...) oral contraception/contraceptive Cu-IUD copper intrauterine device CVD cardiovascular disease DMPA depot medroxyprogesterone acetate DSG desogestrel EC emergency contraception EE ethinylestradiol ENG etonogestrel FSRH Faculty of Sexual & Reproductive Healthcare GDG guideline development group HCP healthcare practitioner HFI hormone-free interval HMB heavy menstrual bleeding HR hazard ratio IMP progestogen-only implant IUC intrauterine contraception/contraceptive LARC long-acting reversible

2019 Faculty of Sexual & Reproductive Healthcare

48. Psychiatric Aspects of Infertility

and anxiety during infertility treatment are often social © Copyright, American Psychiatric Association, all rights reserved. concerns; wanting to conform to social expectations by becoming a parent, loss of sexual self-esteem and enjoyment; scheduling sexual activity, fear of advancing age, financial concerns due to expense of treatments, and impairment in quality of life (Lakatos et al. 2017; Gdanska et al. 2017). Often these stressors peak around 4-6 years after diagnosis of infertility and after (...) reproductive cycles (Schmidt et al. 1998). Fertility medications target these same hormones in the hypothalamic pituitary ovarian axis and can have similar effects on mood (Garcia-Velasco & Fatemi 2015; Merari et al. 1992). Commonly used medications in fertility treatment alter levels of thyroid hormone, prolactin, estradiol, progestogens, GnRH, and gonadotrophs. Hypothyroidism and hyperprolactinemia are treatable causes of infertility. Thyroid replacement hormone reduces depressive symptoms (Redmond 2004

2019 American Psychiatric Association

49. Management of genitourinary syndrome of menopause in women with or at high risk for breast cancer: consensus recommendations from The North American Menopause Society and The International Society for the Study of Women’s Sexual Health

to patient responses: ‘‘Tell me about it.’’ 23 This demonstratesthattheclinicianthinksdiscussingsexualhealth isimportantandnormalizesanduniversalizessexualconcerns for women. 24 Clinicians can also ask a direct screening question such as, ‘‘Do you have any problems or concerns related to sex or pain with sexual activity?’’ Structuredapproachestoincorporatingsexualityintoclini- cal practice provide strategies for identification, assessment, management, and/or referral for sexual health concerns. The From (...) and Psy- chiatry, Case Western Reserve University School of Medicine, Cleve- land, OH. This CME activity is supported through unrestricted educational grants from Amag Pharmaceuticals, Aytu BioScience, Inc., and Cynosure. Funding was also provided by The International Society for the Study of Women’s Sexual Health. Address correspondence to: The North American Menopause Society; 30100 Chagrin Blvd., Suite 210; Pepper Pike, OH 44124. E-mail: info@menopause.org. Website: www.menopause.org. CONTINUING

2019 The North American Menopause Society

50. Screening and Management of the Hyperandrogenic Adolescent

active) testosterone. Although most data about the treatment of hyperandrogenism are on OCPs, similar effects have been shown with the patch and vaginal ring formulations (17, 18). Among the formulations, OCPs that contain third- generation progestins, such as desogestrel, gestodene, and norgestimate, have less androgenic activity when compared withsecond-generationprogestins(levonorgestrel).Drospir- enone, a progestin derived from spironolactone, has anti (...) ,whichconvertstestosteronetothe highly potent dihydrotestosterone. Varying expression of enzyme activity within the pilosebaceous unit leads to a lack of clear correlation between serum androgens and the presence or severity of acne and hirsutism. There also may be ethnic and familial variability (5). Polycystic ovary syndrome is the most common cause of persistent hyperandrogenism beyond early puberty in adolescent girls and women and is estimated to affect 6– 15% of reproductive-aged women (6). In this syndrome

2019 American College of Obstetricians and Gynecologists

51. Male Infertility

Obstet Gynecol, 2009. 21: 223. 57. Baccetti, B., et al. Ultrastructural studies of spermatozoa from infertile males with Robertsonian translocations and 18, X, Y aneuploidies. Hum Reprod, 2005. 20: 2295. 58. Miyagawa, Y., et al. Outcome of gonadotropin therapy for male hypogonadotropic hypogonadism at university affiliated male infertility centers: a 30-year retrospective study. J Urol, 2005. 173: 2072. 59. Ferlin, A., et al. Male infertility and androgen receptor gene mutations: clinical features (...) and identification of seven novel mutations. Clin Endocrinol (Oxf), 2006. 65: 606. 60. Gottlieb, B., et al. Molecular pathology of the androgen receptor in male (in)fertility. Reprod Biomed Online, 2005. 10: 42. 61. Rajender, S., et al. Phenotypic heterogeneity of mutations in androgen receptor gene. Asian J Androl, 2007. 9: 147. 62. Tincello, D.G., et al. Preliminary investigations on androgen receptor gene mutations in infertile men. Mol Hum Reprod, 1997. 3: 941. 63. Giwercman, A., et al. Preserved male

2019 European Association of Urology

52. Risk factors for breast cancer: A review of the evidence 2018

progestogen only 76 4.6.3 Menopausal hormone therapy—combined 77 4.6.4 Menopausal hormone therapy—oestrogen only 80 4.6.5 Hormonal infertility treatment 82 4.6.6 DES in utero 84 4.6.7 DES maternal exposure 86 4.7 Lifestyle factors 88 4.7.1 Adiposity 88 4.7.2 Adiposity—weight gain 91 4.7.3 Adiposity—weight loss 92 4.7.4 Alcohol consumption 94 4.7.5 Bras 96 4.7.6 Coffee, tea, caffeine 97 4.7.7 Diet—calcium 99 4.7.8 Diet—dairy 101 4.7.9 Diet—dietary fibre 102 4.7.10 Diet—fruit 104 4.7.11 Diet—vegetables 106 (...) 4.7.12 Diet—foods high in carotenoids 108 4.7.13 Diet—Mediterranean diet 110 4.7.14 Diet—phytoestrogens 112 Breast cancer risk factors: A review of the evidence iv 4.7.15 Diet—glycaemic index 114 4.7.16 Diet—total energy 115 4.7.17 Diet—sugar 117 4.7.18 Diet—fat 118 4.7.19 Diet—processed meat 119 4.7.20 Diet—red meat 121 4.7.21 Environmental tobacco smoke 123 4.7.22 Tobacco smoking 125 4.7.23 Physical activity 127 4.7.24 Shift work disrupting circadian rhythm 130 4.8 Medical factors 133 4.8.1 Aspirin

2018 Cancer Australia

53. Breast Cancer: Medication Use to Reduce Risk

mass index or height, estrogen and progestin use, history of breastfeeding, menopause status or age, smoking, alcohol use, physical activity, education, breast density, and diet. Several models have been tested in large US populations in good-quality studies that reported only low to modest accuracy. The Breast Cancer Surveillance Consortium model was derived from more than 11,638 breast cancer cases that developed among a cohort of almost 2.4 million women. The Rosner-Colditz model was derived (...) -sensitive epithelial cells where breast cancer can develop. These medications have been approved by the US Food and Drug Administration for risk reduction of breast cancer. Aromatase inhibitors inhibit conversion of androgen to estrogen and can reduce risk of ER-positive breast cancer by decreasing the amount of estrogen available to bind to estrogen-sensitive epithelial cells. Aromatase inhibitors have been evaluated for risk reduction of breast cancer in clinical trials, although they are primarily

2019 U.S. Preventive Services Task Force

54. Hormonal Contraceptives

. Consider referral if the patient has more than one of the following: Age over 40 years Overweight, obesity (BMI >30 kg/m 2 ) Smoker (any amount) under 35 years if age Diabetes (controlled) Dyslipidemia Migraine without aura under 35 years of age Blood pressure >140/90 3. Contraindications to progestin-only contraceptives Active liver disease or history of/or actual benign or malignant liver tumours Breast cancer Undiagnosed abnormal vaginal bleeding Progestin-only preparations for contraception (...) Edema Oily skin and scalp Acne Hirsutism High androgen Lower androgenic activity (eg. 3 rd and 4 th generation COCs – see product chart) Adapted from RxFiles, 10th edition, Hormonal Contraception Chart B) Transdermal or intra-vaginal estrogen Same efficacy as oral contraceptives Main advantage of transdermal or intra-vaginal estrogen over oral contraceptives: daily action not required, may enhance compliance in some patients leading to better efficacy (however, real-world failure rates are similar

2018 medSask

55. Acne - Guidelines for Prescribing Topical Treatment

at their lesions. A hallmark sign of this are scars in the absence of cysts or nodules, or hyperpigmentation of an area that can last years. Mechanical acne is the result of physical irritation to an area leading to the acne lesions, such as a sweat band rubbing against the forehead. Drug-induced acne. Medications that can cause/worsen acne: glucocorticoids (oral, inhaled, and topical), androgens, oral contraceptives containing progestins with more potent androgenic actiivity (norethindrone, levonorgestrel (...) for acne and/or recommended by reputable and reliable guidelines are considered for these guidelines. Only the active ingredients in the "products" section are approved for pharmacist prescribing. e-therapeutics+ - Acne. Available at (Free access, registration required) Emedicine - . (Free access, registration required). Merck Manual Professional: (Free access) RxFiles. Acne Pharmacotherapy Comparison Chart. Available at Uptodate: Pathogenesis, clinical manifestations, and diagnosis of acne vulgaris

2018 medSask

56. Utian Translational Science Symposium report: New Ttherapies for Leiomyomas: When Surgery May Not Be the Best Option

leiomyomas include uncontrollable fac- tors such as increasing age, early menarche, late menopause, black ethnicity, and genetics. Lifestyle factors include obe- sity, dietary habits, and reduced physical activity, as well as early use of oral contraceptives (OCs). Increased parity and injectable progestins reduce the incidence. 4 Thediagnosisofuterineleiomyomasismadeafteracareful and thorough history and physical examination. Unusual complaints may include pain from ureteric obstruction, acute pain (...) . Womenwithsymptomaticuterineleiomyomasexperienceheavyuterinebleeding,bulksymptoms,miscarriages, and pregnancy complications. Surgical therapies such as myomectomy or hysterectomy are highly effective; however, medical therapy with progestin-predominant contraceptives or gonadotropin-releasing hormone (GnRH) agonists are in many ways inadequate to address the unmet need for better, noninvasive, and cost-effective treatments. Recent advances in medical treatment, such as selective progesterone receptor modulators, new oral GnRH analogs

2018 The North American Menopause Society

57. Evaluation and Treatment of Hirsutism in Premenopausal Women Full Text available with Trip Pro

on hirsutism of OCs containing antiandrogens [cyproterone acetate (CPA) and drospirenone (DSP)] vs other OCs, and OCs containing levonorgestrel (the most androgenic progestin) vs other OCs. The results of the network analysis were consistent with the previous meta-analyses, showing that OCs, antiandrogens, and the combination of OCs plus antiandrogens were all more effective than placebo and led to reduction in hirsutism scores. The addition of antiandrogens to OCs was slightly more effective than OCs (...) . The task force commissioned two systematic reviews and used the best available evidence from other published systematic reviews and individual studies. Consensus Process Group meetings, conference calls, and e-mail communications facilitated consensus development. Endocrine Society committees, members, and cosponsoring organizations reviewed and commented on preliminary drafts of the guidelines. Conclusion We suggest testing for elevated androgen levels in all women with an abnormal hirsutism score. We

2018 The Endocrine Society

58. Male Infertility

Obstet Gynecol, 2009. 21: 223. 57. Baccetti, B., et al. Ultrastructural studies of spermatozoa from infertile males with Robertsonian translocations and 18, X, Y aneuploidies. Hum Reprod, 2005. 20: 2295. 58. Miyagawa, Y., et al. Outcome of gonadotropin therapy for male hypogonadotropic hypogonadism at university affiliated male infertility centers: a 30-year retrospective study. J Urol, 2005. 173: 2072. 59. Ferlin, A., et al. Male infertility and androgen receptor gene mutations: clinical features (...) and identification of seven novel mutations. Clin Endocrinol (Oxf), 2006. 65: 606. 60. Gottlieb, B., et al. Molecular pathology of the androgen receptor in male (in)fertility. Reprod Biomed Online, 2005. 10: 42. 61. Rajender, S., et al. Phenotypic heterogeneity of mutations in androgen receptor gene. Asian J Androl, 2007. 9: 147. 62. Tincello, D.G., et al. Preliminary investigations on androgen receptor gene mutations in infertile men. Mol Hum Reprod, 1997. 3: 941. 63. Giwercman, A., et al. Preserved male

2018 European Association of Urology

59. Anamorelin (Adlumiz) - Anorexia, Cachexia, Non-Small-Cell Lung Carcinoma

interventions largely preclude significant reversal of muscle wasting. No widely approved drug for the treatment of cancer cachexia is available. However, steroid hormones have been shown to be effective in stimulating appetite, with corticosteroids and progestins being more effective than androgens; however, corticosteroids are associated with additional side effects and their positive effects are generally short-lasting. About the product Anamorelin is an orally active, high-affinity, selective ghrelin (...) . Quality aspects 10 2.2.1. Introduction 10 2.2.2. Active Substance 10 2.2.3. Finished Medicinal Product 13 2.2.4. Discussion on chemical, pharmaceutical and biological aspects 15 2.2.5. Conclusions on the chemical, pharmaceutical and biological aspects 15 2.2.6. Recommendations for future quality development 15 2.3. Non-clinical aspects 15 2.3.1. Introduction 15 2.3.2. Pharmacology 16 2.3.3. Pharmacokinetics 21 2.3.4. Toxicology 25 2.3.5. Ecotoxicity/environmental risk assessment 33 2.3.6. Discussion

2017 European Medicines Agency - EPARs

60. Cardiovascular Disease and Breast Cancer: Where These Entities Intersect: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

exposure to estrogen and androgens, insulin-related factors, adipokines, and inflammation. , A meta-analysis of 29 observational studies found a significant reduction in breast cancer risk among the most physically active compared with the least active women. A more recent meta-analysis of 22 studies involving 123 574 participants found an inverse relationship between physical activity and breast cancer events and deaths. Compared with those who reported low or no lifetime recreational prediagnosis (...) factors ( ). Cardiovascular clinical care and research have focused on risk factors for >60 years, because it is believed that ≈80% of CVD can be prevented through risk factor modifications such as promoting a healthy diet, physical activity, and a healthy weight; abstinence from tobacco; blood pressure control; diabetes mellitus management; and a good lipid profile. Adherence to a larger number of ideal cardiovascular health behaviors or factors from the American Heart Association’s Life’s Simple 7

2018 American Heart Association

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