RESUMO
CONTEXT.: Transgender women experience health disparities in all areas of medicine. Within surgical pathology, knowledge gaps relating to the concepts of transgender care exist. Medical transition for transgender women and transfeminine persons may involve hormone therapy and/or surgery to feminize the body. Understanding the common histologic changes in specimens from feminizing surgeries, as well as other specimens from patients on feminizing hormone therapy, will aid surgical pathologists in providing better care to this unique patient population. OBJECTIVE.: To summarize histologic findings in surgical pathology specimens from transgender women taking feminizing hormones. DATA SOURCES.: A systematic review of the OVID Medline and PubMed databases was performed to identify all studies describing histologic findings in surgical pathology specimens from transgender women from 1946 to 2019. CONCLUSIONS.: Much of the literature to date describing histologic findings in transgender women comes from the examination of genitourinary specimens removed during feminizing surgeries. Common benign changes associated with feminizing hormone therapy include the development of acini and lobules in the breast, testicular tubular changes, and squamous metaplasia of the prostate and urethra. Neoplastic cases include breast adenocarcinoma and fibroepithelial lesions, testicular germ cell tumors, prostatic adenocarcinoma, anal squamous cell carcinoma, pituitary adenomas, and meningiomas. Additional studies assessing the findings in other organ systems as well as population-based studies assessing rates of neoplasia are needed. However, future research relies on engagement within the surgical pathology community as well as collaboration with clinicians and patients to achieve optimal results.
Assuntos
Patologia Cirúrgica , Pessoas Transgênero , Transexualidade , Mama , Feminino , Hormônios/efeitos adversos , Humanos , Masculino , Transexualidade/tratamento farmacológico , Transexualidade/cirurgiaAssuntos
Pessoal de Saúde/estatística & dados numéricos , Planejamento em Saúde/métodos , Hormônios/efeitos adversos , Pessoas Transgênero/psicologia , Atitude Frente a Saúde , Efeitos Psicossociais da Doença , Atenção à Saúde/legislação & jurisprudência , Feminino , Identidade de Gênero , Pessoal de Saúde/educação , Hormônios/uso terapêutico , Humanos , Masculino , Policitemia/induzido quimicamente , Qualidade de Vida , Fatores de Risco , Caracteres Sexuais , Trombose/induzido quimicamenteRESUMO
The number of gender diverse and transgender youth presenting for treatment are increasing. This is a vulnerable population with unique medical needs; it is essential that all pediatricians attain an adequate level of knowledge and comfort caring for these youth so that their health outcomes may be improved. There are several organizations which provide clinical practice guidelines for the treatment of transgender youth including the WPATH and the Endocrine Society and they recommend that certain eligibility criteria should be met prior to initiation of gender affirming hormones. Medical intervention for transgender youth can be broken down into stages based on pubertal development: pre-pubertal, pubertal and post-pubertal. Pre-pubertally no medical intervention is recommended. Once puberty has commenced, youth are eligible for puberty blockers; and post-pubertally, youth are eligible for feminizing and masculinizing hormone regimens. Treatment with gonadotropin releasing hormone agonists are used to block puberty. Their function is many-fold: to pause puberty so that the youth may explore their gender identity, to delay the development of (irreversible) secondary sex characteristics, and to obviate the need for future gender affirmation surgeries. Masculinizing hormone regimens consists of testosterone and feminizing hormone regimens consist of both estradiol as well as spironolactone. In short term studies gender affirming hormone treatment with both estradiol and testosterone has been found to be safe and improve mental health and quality of life outcomes; additional long term studies are needed to further elucidate the implications of gender affirming hormones on physical and mental health in transgender patients. There are a variety of surgeries that transgender individuals may desire in order to affirm their gender identity; it is important for providers to understand that desire for medical interventions is variable among persons and that a discussion about individual desires for surgical options is recommended.
Assuntos
Atenção à Saúde , Relações Médico-Paciente , Pessoas Transgênero/psicologia , Custos de Medicamentos , Feminino , Hormônios/administração & dosagem , Hormônios/efeitos adversos , Humanos , Masculino , Programas de Rastreamento , Cirurgia de Readequação SexualRESUMO
Although the acronym LGBTQ is often used as a catchall label for sexual and gender minorities, transgender people have unique and individual health needs and unfortunately experience significant health disparities. This article reviews essential terminology and concepts relevant to discussions of gender and gender identity, practical tips for changes that can be made on the clinical and institutional levels in order to create a welcoming and safe environment for transgender patients, as well as current recommendations for the provision of gender-affirming medical therapy.
Assuntos
Competência Cultural , Identidade de Gênero , Disparidades em Assistência à Saúde , Hormônios/uso terapêutico , Procedimentos de Readequação Sexual/métodos , Pessoas Transgênero , Competência Cultural/educação , Competência Cultural/organização & administração , Feminino , Hormônios/efeitos adversos , Humanos , Masculino , Comportamento Sexual , Pessoas Transgênero/psicologiaRESUMO
In order to reduce gender dysphoria and combat stigma, transgender women often affirm their gender through social and medical transition, which may include cross-sex hormone therapy. This study examined associations between medically monitored hormone use and hormone misuse (non-prescribed hormone use including "fillers"), structural inequities (access to housing, health insurance, and income), and social network dynamics among 271 transgender women in Los Angeles. Hormone use status was coded trichotomously (hormone use, hormone misuse, no hormone use), and robust multinomial logistic regression as well as novel social network analysis was conducted to examine associations. Results demonstrated that younger, African-American/Black transgender women were most likely to engage in hormone misuse compared to transgender women who were older or non-African-American/Black. One-third of the sample reported sex work as a main source of income, and this group was more likely to misuse hormones than those with another primary source of income. Transgender women with access to stable housing and health insurance were most likely to engage in medically monitored hormone use. Social network analysis revealed that transgender women with a greater number of hormone-using network alters were most likely to misuse hormones, but that using the Internet to find transgender friends mitigated this association. Results demonstrate the multifaceted risk profile of transgender women who use and misuse hormones, including that social networks play an important role in hormone usage among transgender women.
Assuntos
Hormônios/efeitos adversos , Hormônios/uso terapêutico , Comportamento Sexual/psicologia , Pessoas Transgênero/psicologia , Adulto , Feminino , Identidade de Gênero , Hormônios/farmacologia , Humanos , Los Angeles , Masculino , Rede Social , TransexualidadeRESUMO
Acne vulgaris is a very common condition affecting up of 93% of adolescents. Although rare, this disease may persist in adulthood. In adult women with acne (those older than 25 years old), this condition is particularly relevant because of the refractory to conventional therapies, which makes acne a challenge for dermatologists in this group of patients. In order to its potential risk for chronicity and the involvement of visible anatomical sites such as face and upper torso, acne has been associated with a wide spectrum of psychological and social dysfunction such as depression, anxiety, suicidal ideation, somatization, and social inhibition. In particular, adult women with acne have been shown to be adversely impacted by the effect of acne on their quality of life. For the last four decades, dermatologists have used hormonal therapies for the management of acne vulgaris in adult women, which are considered a rational choice given the severity and chronicity of this condition in this group of patients. The aim of this work is to review the hormonal drugs for management of acne.
Assuntos
Acne Vulgar/tratamento farmacológico , Fármacos Dermatológicos/uso terapêutico , Hormônios/uso terapêutico , Acne Vulgar/diagnóstico , Acne Vulgar/psicologia , Adulto , Anticoncepcionais Orais Hormonais/uso terapêutico , Efeitos Psicossociais da Doença , Acetato de Ciproterona/uso terapêutico , Fármacos Dermatológicos/efeitos adversos , Feminino , Flutamida/uso terapêutico , Hormônios/efeitos adversos , Humanos , Qualidade de Vida , Indução de Remissão , Espironolactona/uso terapêutico , Resultado do TratamentoRESUMO
Many people have weak bones and this is a global public health concern. Lifestyle factors can reduce bone density, as can some common drugs. This article describes some of these drugs, the conditions for which they may be prescribed and how they can threaten bone health. Strategies to reduce the risk of fracture and weak bones are outlined.
Assuntos
Densidade Óssea/efeitos dos fármacos , Osso e Ossos/efeitos dos fármacos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Corticosteroides/efeitos adversos , Anticonvulsivantes/efeitos adversos , Heparina/efeitos adversos , Hormônios/efeitos adversos , Humanos , Hipoglicemiantes/efeitos adversos , Inibidores da Bomba de Prótons/efeitos adversos , Gestão de RiscosAssuntos
Rotulagem de Alimentos , Alimentos Orgânicos/economia , Animais , Antibacterianos/efeitos adversos , Qualidade de Produtos para o Consumidor , Custos e Análise de Custo , Contaminação de Alimentos , Hormônios/efeitos adversos , Humanos , Praguicidas/efeitos adversos , Estados Unidos , United States Department of AgricultureRESUMO
BACKGROUND: Recent studies show that nearly half of the hospitalized patients are readmitted within 6 months from discharge. No data exist about the relationship between adverse drug reactions (ADRs) and readmittance to a department of internal medicine. OBJECTIVES: The primary aims of the study were to determine if ADRs could be used as predictors for recurrent hospitalizations in internal medicine and to evaluate the economic impact of ADRs on hospitalization costs. DESIGN AND SETTING: A cohort-based, prospective, 18-month pharmacoepidemiological survey was conducted in the Department I of Internal Medicine at the University Hospital of Erlangen. All patients were intensively monitored for ADRs by a pharmacoepidemiological team. ADRs were evaluated for their offending drugs, probability, severity, preventability and classified by WHO-ART. During a 6-month period ADR-positive patients were matched to non-ADR patients applying diagnosis-related group categorization in order to measure the impact of ADRs on the duration and frequency of hospitalization. RESULTS: Of 1000 admissions 424 patients had single admissions and 206 patients had recurrent readmissions (min 1, max 9). The prevalence of readmissions was 37% (n = 370). In 145 (23%) of 630 patients, 305 ADRs were observed. The ADR incidence was similar in first admissions and readmissions. ADRs were not found to predict further readmissions and lack of ADRs did not preclude readmissions. ADRs caused hospitalizations in 6.2% of first admissions and in 4.2% of readmissions. According to the Schumock algorithm 135 (44.3%) ADRs were found to be preventable. The occurrence and numbers of ADRs per admission were found to prolong hospitalization period significantly (r = 0.48 and 0.51, P < 0.001, n = 135). Of 9107 treatment days 20% were caused by in-house (1130 days) and community-acquired ADRs (669 days). In admissions and readmissions 11% (>973 days) of all treatment days were judged to be preventable. CONCLUSIONS: Intensified drug monitoring supported by information technology in internal medicine is essential for early detecting and prevention of ADRs and saving hospital resources.
Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Readmissão do Paciente/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Infecciosos/efeitos adversos , Fármacos Cardiovasculares/efeitos adversos , Fármacos do Sistema Nervoso Central/efeitos adversos , Tratamento Farmacológico/economia , Eletrólitos/efeitos adversos , Fármacos Gastrointestinais/efeitos adversos , Hormônios/efeitos adversos , Humanos , Tempo de Internação , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de TempoRESUMO
BACKGROUND: Workers involved in the manufacture of pharmaceutical products are exposed in the course of their work to the active pharmaceutical ingredient (API) in the products. Such APIs are designed to produce biological change in the human body, which is an unacceptable outcome in the pharmaceutical worker. AIM: To review the evidence for the presence of the health effects of APIs in the pharmaceutical industry. METHOD: The study employed a literature review based on a systematic search of the MEDLINE database. RESULTS: Studies have shown that such biological effects can be produced, particularly in personnel working with potent compounds such as steroids, compounds with capacity to cause cumulative damage such as cytotoxic anti-cancer drugs and antibiotics, unless careful risk assessment and appropriate control measures are implemented. CONCLUSION: There is limited epidemiological evidence for increased mortality and morbidity in this population, but adverse effects on health from exposure to potent agents, such as corticosteroids, sex hormones and antibiotics, can occur. The protection of workers from the potential harmful effects of APIs poses a significant challenge for the pharmaceutical industry.
Assuntos
Indústria Farmacêutica , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Doenças Profissionais/induzido quimicamente , Exposição Ocupacional/efeitos adversos , Antineoplásicos/efeitos adversos , Dermatite Ocupacional/etiologia , Hormônios/efeitos adversos , HumanosRESUMO
Acromegaly was the first pituitary disease to be recognised as a clinical entity, although initially it was not clear whether the eosinophilic adenomas causing pituitary enlargement were causative or just a manifestation of the syndrome itself. Following the documented clinical improvement of patients with acromegaly after partial hypophysectomy, it was proven that the pituitary adenomas were aetiological. The treatment of acromegaly has changed during the last decades; the introduction of the somatostatin (SMS) analogue octreotide has had major implications. Octreotide was the first SMS analogue to become available for clinical use. It is generally well tolerated, but is associated with the development of gallstones in 15 to 20% of patients. Other adverse effects include transient injection-site pain, abdominal, diarrhoea, gastritis (long term therapy) and loss of scalp hair. No long haematological or biochemical adverse effects have been reported. Desensitisation to the beneficial effects of octreotide therapy is highly unusual. A long-acting formulation of octreotide is being studied, and should be available by the end of 1997.
Assuntos
Acromegalia/tratamento farmacológico , Hormônios/efeitos adversos , Hormônios/uso terapêutico , Octreotida/efeitos adversos , Octreotida/uso terapêutico , Acromegalia/radioterapia , Acromegalia/cirurgia , Humanos , Medição de RiscoAssuntos
Bovinos/fisiologia , Indústria de Laticínios/economia , Hormônio do Crescimento/administração & dosagem , Lactação/efeitos dos fármacos , Animais , Computadores , Feminino , Hormônio do Crescimento/efeitos adversos , Hormônio do Crescimento/análogos & derivados , Hormônios/administração & dosagem , Hormônios/efeitos adversos , Hormônio do Crescimento Humano , Gravidez , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/efeitos adversosAssuntos
Indústria Farmacêutica , Doenças Profissionais/epidemiologia , Aborto Espontâneo/induzido quimicamente , Feminino , Hormônios/efeitos adversos , Humanos , Masculino , Doenças Profissionais/induzido quimicamente , Gravidez , Hipersensibilidade Respiratória/epidemiologia , Esteroides/efeitos adversosRESUMO
PIP: In both 1975 and 1977, the Committee on Safety of Medicines reported an association between hormonal pregnancy tests (HPTs) and subsequent congenital abnormalities and stated that such tests should no longer be used. Despite these findings, the Secretary of State declined to ban the proprietary drug involved (Primodos). Following the 1977 warning, 600 consecutive abortion patients at 6 branches of the British Pregnancy Advisory Service (BPAS) were asked whether they had been given HPTs. 12 patients (2%) indicated they had received such tests. Since most women had not consulted a general practitioner before coming to BPAS, this figure is probably an underestimate of actual use. Although a few doctors may have prescribed an HPT in the belief that the pregnancy would be terminated anyway, some HPTs were administered by doctors who subsequently refused to refer the patient for an abortion. If banning Primodos is considered an unacceptable infringement of professional freedom, the Department of Health and Social Security should consider making it a controlled drug, with the requirement that physicians ascertain through an immunological test that the recipient is not pregnant.^ieng