The Ethics of Elective Growth Hormone Therapy in Children with Idiopathic Short Stature.

In this article, we analyze the ethics of elective growth hormone (GH) therapy in children with idiopathic short stature (ISS). We discuss recent clinical research regarding the efficacy, side-effects, and risks of GH therapy, and argue that GH therapy is ethically unjustifiable for most children with ISS.

How sociophenomenology of the body problematises the 'problem-oriented approach' to growth hormone treatment.

This article examines how people who are shorter than average make sense of their lived experience of embodiment. It offers a sociophenomenological analysis of 10 semistructured interviews conducted in the Netherlands, focusing on if, how, and why height matters to them. It draws theoretically on phenomenological discussions of lived and objective space, intercorporeality and norms about bodies. The analysis shows that height as a lived phenomenon (1) is active engagement in space, (2) coshapes habituated ways of behaving and (3) is shaped by gendered norms and beliefs about height. Based on this analysis, the article challenges what we label as the 'problem-oriented approach' to discussions about growth hormone treatment for children with idiopathic short stature. In this approach, possible psychosocial disadvantages or problems of short stature and quantifiable height become central to the ethical evaluation of growth hormone treatment at the expense of first-hand lived experiences of short stature and height as a lived phenomenon. Based on our sociophenomenological analysis, this paper argues that the rationale for giving growth hormone treatment should combine medical and psychological assessments with investigations of lived experiences of the child. Such an approach would allow considerations not only of possible risks or disadvantages of short stature but also of the actual ways in which the child makes sense of her or his height.

Use of hormone therapy for menopausal symptoms and quality of life in breast cancer survivors. Safe and ethical?

Breast cancer is the most prevalent cancer in women and presently, the breast cancer survivors are an important group of women that faced the several consequences of estrogen deficiency, which is especially common in women after chemotherapy. The most bothersome is the vasomotor symptoms, which are effectively relieved by hormonal therapy (HT). Also, the increased risk of osteoporosis and coronary artery disease is major problem to be resolved in pos of maintaining a good quality of life. Fearing cancer recurrence, most physicians do not offer HT to women with a history of breast cancer. Over this issue reviews the available evidence of the use of HT and tibolone in women treated for breast cancer.

The Assessment of Readiness and Consent for Hormone Therapy: A Semi-structured Interview for Use With Transgender and Gender Nonconforming Individuals.

BACKGROUND: Evaluations to determine one's readiness to initiate hormone therapy are often requested by endocrinologists or institutions who provide gender-affirming hormone therapy for transgender adults. Unfortunately, many mental health providers report unfamiliarity in working with gender-nonconforming individuals and with the needs of this population, and do not feel equipped to conduct these evaluations. OBJECTIVES: The purpose of this paper is to introduce an instrument that can guide providers to conduct a hormone readiness evaluation that is consistent with the current best practices model of care put forth by the World Professional Association for Transgender Health Standards of Care. METHODS: Development of the Assessment of Readiness and Consent for Hormone Therapy (ARCH) was informed by published literature and consultation with subject matter experts. The tool has been revised through an iterative approach based on provider experience and client feedback. RESULTS: The ARCH has been used as part of a national training initiative in transgender healthcare and favorable feedback has been received. Providers have reported that using the ARCH has increased their confidence in their ability to provide sensitive care that is consistent with best practice recommendations. CONCLUSIONS: Use of the ARCH has the potential to enhance care for a population that often encounters poor access to culturally competent providers and treatments. The focused nature of the interview helps providers support and advocate for their clients by providing and gathering information necessary to make meaningful recommendations that will help hormone treatment candidates enhance their gender related quality of life.

[38 year-old patient with suspected congenital hormonal dysfunction]. / 38-jähriger Patient mit Verdacht auf eine angeborene hormonelle Störung.

We present the case of a patient with suspected congenital hypopituitarism first diagnosed at the age of 38 years. Despite partial insufficiency of all pituitary-regulated hormonal axes, the patient never suffered from severe health problems. However, the patient was disfigured, and his intellectual and physical capacities were clearly impaired. The initiation of a hormone replacement therapy with hydrocortisone and thyroid hormones is essential in such a patient, but the substitution of sex hormones can create ethical problems.

Informing patients of the risks and benefits of hormone replacement therapy: nephrologists' ethical obligation.

As consultants, nephrologists are often in a position to observe and diagnose nonrenal illnesses as well as identify potential complications of previously prescribed therapies. The decision to discuss these types of issues with patients can be complicated by the fear of offending the patient's primary care physician. When such situations pose potential harm to patients, they become ethical issues and the nephrologist's responsibility to inform patients of potentially harmful exposure is clear. Given recent research findings, the use of hormone replacement therapy by many of the patients referred to nephrologists should be reviewed and discussed with the patient and the referring physician. All potential benefits and harms should be clearly stated.

Promoting "low T": a medical writer's perspective.

Despite progress in raising the level of transparency about funding, conflicts of interest, and ghostwriting, drug companies remain free to pursue subtle and, therefore, effective means of marketing. Continuing medical education programs and "consensus" panels continue to be funded by companies selling products directly tied to the messages being conveyed by the resulting "educational" materials. And patient education materials continue to be created that, while factually accurate, subtly shift attitudes by including only selected facts and/or omitting ideas that would undermine the funder's preferred paradigm.

Ethical problems with bioidentical hormone therapy.

The term 'bioidentical' hormone replacement therapy (BHRT) is widely misunderstood by the patient population and misrepresented in patient literature. Within the clinical community, BHRT is currently being prescribed by some as an 'innovative therapy' with no published evidence in peer-reviewed journals that it is better than the current standard of care; in at least one case, BHRT is being used as a study agent in unregulated and unethical research involving very high doses of estrogen and progesterone. Additionally, professional ethics problems abound within the prescribing population, since those claiming expertise and training in BHRT vary widely in competencies, may cross practice boundaries, and may have overt conflicts of interest if they are selling or promoting their own for-profit recipes of BHRT on commercial forums. Ultimately, BHRT presents clinical, research and professional ethics problems that are discussed in depth.

Incontinencia de orina y menopausia / Urinary incontinence and menopause

La asociación entre incontinencia de orina (IU) y menopausia es controvertida, si bien algunos autores encuentran asociación, otros no. Los estudios epidemiológicos que si la encuentran, generalmente no es en todos los tipos, sino que describen aumentos de un tipo (IU mixta y de urgencia), e incluso en ocasiones descenso de otro (IU de esfuerzo) (1). La IU es un problema complejo y multifactorial, cuya prevalencia aumenta con la edad, y si bien el déficit estrogénico, característico de la menopausia, pudiera estar en relación con la IU, también existen otros factores que la pueden causar o favorecer

The association between urinary incontinence (UI) and menopause is controversial, though some authors find association, others not. The epidemiological studies that if they find her, generally it is not in all the types, but they describe increases of a type (mixed UI and of urgency), and even in occasions decrease of other one (UI of effort) (1). The UI is a complex problem and multifactorial, whose prevalencia increases with the age, and though the deficit estrogénico, typical of the menopause, could be in relation with the UI, also there exist other factors that they can cause or favor

Posibilidades terepéuticas en la menopausia / Therapeutic possibilities in the menopause

El aumento de la esperanza de vida y la búsqueda de su mejor calidad ha dado lugar a un interés creciente por esta etapa de la vida. En la última década han aparecido múltiples tratamientos enfocados a mejorar la calidad de vida durante la menopausia que incluso en algunos casos, parecían tener un efecto beneficioso sobre otros órganos como el hueso y el corazón. Con el tiempo se ha demostrado que el balance beneficio/riesgo de algunas terapéuticas no era tan favorable como se pensó en un principio. Por ello en la actualidad debemos descartar el tratamiento hormonal sistemático de las pacientes postmenopáusicas. En la actualidad parece evidente que el tratamiento en este período de la vida debe ser individualizado y consensuado con la paciente, de acuerdo con la sintomatología, los objetivos terapéuticos y los riesgos de cada tratamiento en el que es imprescindible incluir una serie de medidas higiénico dietéticas

The increase of the life expectancy and the search of his better quality has given place to an increasing interest for this stage of the life. In the last decade multiple treatments have appeared focused when the quality of life improved during the menopause that enclosed in some cases, they seemed to take a beneficial effect on other organs as the bone and the heart. With the time risk has been demonstrated that I benefit the balance/of therapeutic some it was not so favorable as it was thought about a beginning. For it at present we must discard the hormonal systematical treatment of the postmenopausal patients. At present it seems to be evident that the treatment in this period of the life must be individualized and agreed by consensus with the patient, in agreement with the symptomatology, the therapeutic aims and the risks of every treatment in the one that is indispensable to include a series of measurements hygienic dietetics

Evidencia científica del tratamiento hormonal sustitutivo en la actualidad / Scientific evidence of the hormonal substitute treatment at present

Hasta épocas recientes, en España la sintomatología que acontecía durante el periodo de la menopausia (sofocos, sudores, cambios en el carácter, etc) se consideraban como achaques propios de la edad y por tanto sin necesidad de tratamiento, sin tener en cuenta que la menopausia por el contrario es una larga etapa de la mujer que en muchas ocasiones precisa de tratamiento. Se ha insistido reiteradamente que la Terapia Hormonal Sustitutiva (THS) es enormemente eficaz en la osteoporosis y en la cardiopatía isquémica. España es uno de los países de la Unión Europea con menor porcentaje de uso de THS, aproximadamente un 5% de la población susceptible de tratamiento, a diferencia de la media Europea establecida en un 20%. Se analiza en este estudio la evidencia científica publicada sobre el uso de THS

Until recent times, in Spain the symptoms that happened during the periodo f the menopause (hot flashes, sweating, change in the character, etc) they were considered like ailments characteristics of the age and therefore without treatment necessity, without keeping in mind that the menopause on the contrary is the woman’s long stage that she specifies treatment in many occasions. Repeatedly has been insisted that the Hormone Replacement Therapy. It is vastly effective in the Osteoporosis and in the coronary heart disease. Spain is one of the countries of the European Union with smaller percentage of user of THS, approximately the susceptible population’s of treatment 5%, contrary to the European stocking settled down in 20%. There is analyzed in this study the scientific evidence published on THS’s use

Tratamiento hormonal sustitutivo en pacientes con cáncer / Hormonal replacement therapy in cancer patients

Cada año cientos de miles de mujeres son diagnosticadas y tratadas de un tumor maligno. Muchos de ellas se encuentran en la menopausia en el momento del diagnóstico mientras que otras tienen una función ovárica normal. Algunas de estas últimos van a necesitar un tratamiento cuyo efecto secundario previsible sea una menopausia yatrógena. El progreso de las técnicas de diagnóstico y de las armas terapéuticas en los últimos años ha hecho que el tratamiento del cáncer obtenga unos resultados cada vez más alentadores. En otras palabras, nuestras pacientes oncológicas sobreviven cada vez más tiempo. Es por esto que muchas mujeres que sobreviven al cáncer sufren síntomas a corto y largo plazo derivados de deprivación de estrógenos, empeorando su calidad de vida. Al mismo tiempo en la mayoría de los casos, tanto el oncólogo como el ginecólogo son reacios a aconsejar un tratamiento hormonal sustitutivo en estas pacientes, independientemente del tipo de tumor o estadio de la enfermedad a la que se enfrenta la paciente. Parece lógico pensar que en aquellos casos en los que se sospecha una relación causa-efecto entre el tratamiento hormonal sustitutivo (THS) y la oncogénesis de un determinado tumor exista una cierta prevención contra el uso THS. Sin embargo en los tumores en los que no existe ningún tipo de correlación hormonal este planteamiento es difícilmente explicable. El ejemplo típico es la mujer joven que ha sido sometida a dosis altas de quimioterapia tras haber sido diagnosticado un tumor hematológico. En estas pacientes el daño por el déficit de estrógenos a medio o a largo plazo, puede ser mucho mayor que el posible efecto negativo que produzca el tratamiento en la enfermedad. Ese tema por tanto es realmente un controvertido y existen muy pocos resultados epidemiológicos y clínicos que avalen una u otra postura. Intentaremos por tanto tras revisar la literatura y sacar conclusiones que nos orienten sobre la relación que existe entre los tumores más frecuentes y uso de THS

Every year thousands of women are diagnosed and treated due to an oncological disease. Many of then have a menopausal status at the time of diagnosis. Some of them will need a specific treatment that may change their hormonal status. During the last three decades cancer treatment has achieved better and better outcomes thank to the progress of new diagnostic tools and therapeutic weapons. In other words, our cancer patients survive longer. Therefore, currently, many cancer survivors suffer the side effects of the hormonal deprivation. At the same time in many cases, medical oncologists and gynecologists are reluctant to recommend HRT in these patients, independently the type or the stage of the tumor that has been diagnosed. It seems logical to observe precaution in those cases in which a cause-effect relationship is suspected between the HRT and the oncogenesis of a certain tumor. Nevertheless in tumors in which it does not exist a hormonal dependence this approach can not be supported. The typical example is the young woman who has been treated with high doses of chemotherapy after being diagnosed of a hematological neoplasia. In these patients the estrogen deprivation produces a worse long term effect that the questionable negative consequences that may produce the HRT. This subject is really controversial and exists very few epidemiological and clinical publications that guarantee one or another position. We will try to review the international literature on this topic and o draw conclusions that allow us to understand the relationship between the most frequent tumors and the hormonal replacement therapy

Orientações de enfermagem à mulher climatérica quanto à terapia de reposição hormonal: uma abordagem ética / Nursing orientation to climacteric woman as regards hormonal replacement therapy: an ethical approach

Nas últimas décadas, a utilização da terapia de reposição hormonal para a mulher climatérica, tem sido questionada pelos estudiosos da área no que concerne as vantagens da referida terapêutica. Daí, a necessidade de uma reflexão ética no tocante às orientações dos profissionais de saúde envolvidos na assistência ao climatério...