scholarly journals Approach to the Patient: Pharmacological Management of Trans and Gender Diverse Adolescents

2021 ◽  
Author(s):  
Michele Ann O’Connell ◽  
Thomas P Nguyen ◽  
Astrid Ahler ◽  
S Rachel Skinner ◽  
Ken C Pang
Keyword(s):  
Ethical Decision Making ◽  
Treatment Options ◽  
Current Treatment ◽  
Therapeutic Interventions ◽  
Sex Characteristics ◽  
Therapeutic Area ◽  
Pharmacological Management ◽  
Gender Diverse ◽  
And Gender ◽  
Prospective Longitudinal

Abstract Internationally, increasing numbers of children and adolescents with gender dysphoria are presenting for care. In response, gender affirming therapeutic interventions that seek to align bodily characteristics with an individual’s gender identity are more commonly being employed. Depending on a young person’s circumstances and goals, hormonal interventions may aim to achieve full pubertal suppression, modulation of endogenous pubertal sex hormone effects and/or development of secondary sex characteristics congruent with their affirmed gender. This is a relatively novel therapeutic area and, while short-term outcomes are encouraging, longer-term data from prospective longitudinal adolescent cohorts are still lacking, which may create clinical and ethical decision-making challenges. Here we review current treatment options, reported outcomes, and clinical challenges in the pharmacological management of trans and gender diverse adolescents.

scholarly journals The Influence of Religion, Spirituality, and Purpose in Life for Resilience among Trans and Gender Diverse Individuals

2021 ◽  
pp. 1-31
Author(s):  
Jessamyn Bowling ◽  
Anne Mbugua ◽  
Sarah Piperato
Keyword(s):  
Social Support ◽  
Qualitative Analysis ◽  
Religious Affiliation ◽  
Identity Negotiation ◽  
Purpose In Life ◽  
Therapeutic Interventions ◽  
Religion And Spirituality ◽  
Gender Diverse ◽  
And Gender ◽  
Mental And Physical Health

Abstract Religion, spirituality, and purpose in life have benefits for mental and physical health, yet religious environments can be stigmatizing for trans and gender diverse (TGD) individuals. This study aimed to examine the influences of religion, spirituality and purpose in life for resilience among TGD individuals. This study included photo-elicited interviews (35 longitudinal interviews, 21 individuals) and surveys (n=108). Religious affiliation was significantly associated with increased levels of social support but was not significantly associated with other variables. Strategies found in themes from the qualitative analysis foster resilience strategies, including spirituality to overcome challenges, purpose in life, and social support. Yet strategies in the themes also utilize resilience strategies, including discrimination, strategies in response to discrimination, social support, and identity negotiation. As participants did make sense of religion and spirituality in how they conceived of their resilience, findings may inform therapeutic interventions and pastoral approaches.

scholarly journals Selective Estrogen Receptor Modulators: A Potential Option For Non-Binary Gender-Affirming Hormonal Care?

2021 ◽  
Vol 12 ◽  
Author(s):  
Jane Y. Xu ◽  
Michele A. O’Connell ◽  
Lauren Notini ◽  
Ada S. Cheung ◽  
Sav Zwickl ◽  
...  
Keyword(s):  
Estrogen Receptor ◽  
Treatment Guidelines ◽  
Hormonal Treatment ◽  
Selective Estrogen Receptor Modulators ◽  
Sex Characteristics ◽  
Estrogen Receptor Modulators ◽  
Gender Diverse ◽  
Puberty Suppression ◽  
And Gender ◽  
Receptor Modulators

Gender dysphoria describes the distress associated with having a gender identity that differs from one’s birth-assigned sex. To relieve this distress, transgender, and gender diverse (henceforth, trans) individuals commonly undergo medical transition involving hormonal treatments. Current hormonal treatment guidelines cater almost exclusively for those who wish to transition from male to female or vice versa. In contrast, there is a dearth of hormonal options for those trans individuals who identify as non-binary and seek an androgynous appearance that is neither overtly male nor female. Though prolonged puberty suppression with gonadotrophin releasing hormone agonists (GnRHa) could in theory be gender-affirming by preventing the development of unwanted secondary sex characteristics, this treatment option would be limited to pre- or peri-pubertal adolescents and likely have harmful effects. Here, we discuss the theoretical use of Selective Estrogen Receptor Modulators (SERMs) for non-binary people assigned male at birth (AMAB) who are seeking an androgynous appearance through partial feminization without breast growth. Given their unique range of pharmacodynamic effects, SERMs may represent a potential gender-affirming treatment for this population, but there is a lack of knowledge regarding their use and potentially adverse effects in this context.

Ethical Issues in Gender-Affirming Care for Youth

2021 ◽  
pp. 55-63
Author(s):  
Laura L. Kimberly ◽  
Kelly McBride Folkers ◽  
Phoebe Friesen ◽  
Darren Sultan ◽  
Gwendolyn P. Quinn ◽  
...  
Keyword(s):  
Gender Dysphoria ◽  
Ethical Decision Making ◽  
Rapid Development ◽  
Treatment Options ◽  
Young Patients ◽  
Adverse Outcomes ◽  
Surgical Interventions ◽  
Gender Nonconforming ◽  
And Gender

Transgender and gender-nonconforming (TGNC) youth who suffer from gender dysphoria are at a substantially elevated risk of numerous adverse physical and psychosocial outcomes compared with their cisgender peers. Innovative treatment options used to support and affirm an individual’s preferred gender identity can help resolve gender dysphoria and avoid many negative sequelae of nontreatment. Yet, despite advances in these relatively novel treatment options, which appear to be highly effective in addressing gender dysphoria and mitigating associated adverse outcomes, ethical challenges abound in ensuring that young patients receive appropriate, safe, affordable treatment and that access to this treatment is fair and equitable. Ethical considerations in gender-affirming care for TGNC youth span concerns about meeting the obligations to maximize treatment benefit to patients (beneficence), minimizing harm (nonmaleficence), supporting autonomy for pediatric patients during a time of rapid development, and addressing justice, including equitable access to care for TGNC youth. Moreover, although available data describing the use of gender-affirming treatment options are encouraging, and the risks of not treating TGNC youth with gender dysphoria are evident, little is known about the long-term effects of both hormonal and surgical interventions in this population. To support ethical decision-making about treatment options, we encourage the development of a comprehensive registry in the United States to track long-term patient outcomes. In the meantime, providers who work with TGNC youth and their families should endeavor to offer ethically sound, patient-centered, gender-affirming care based on the best currently available evidence.

scholarly journals Encapsulating Peritoneal Sclerosis: Pathophysiology and Current Treatment Options

2019 ◽  
Vol 20 (22) ◽  
pp. 5765 ◽  
Author(s):  
Rajesh M. Jagirdar ◽  
Andreas Bozikas ◽  
Sotirios G. Zarogiannis ◽  
Maria Bartosova ◽  
Claus Peter Schmitt ◽  
...  
Keyword(s):  
Intestinal Obstruction ◽  
Animal Studies ◽  
Clinical Symptoms ◽  
Treatment Options ◽  
Renin Angiotensin System ◽  
Mtor Inhibitors ◽  
Current Treatment ◽  
Therapeutic Interventions ◽  
Ultrafiltration Failure

Encapsulating peritoneal sclerosis (EPS) is a life-threatening complication of long-term peritoneal dialysis (PD), which may even occur after patients have switched to hemodialysis (HD) or undergone kidney transplantation. The incidence of EPS varies across the globe and increases with PD vintage. Causative factors are the chronic exposure to bioincompatible PD solutions, which cause long-term modifications of the peritoneum, a high peritoneal transporter status involving high glucose concentrations, peritonitis episodes, and smoldering peritoneal inflammation. Additional potential causes are predisposing genetic factors and some medications. Clinical symptoms comprise signs of intestinal obstruction and a high peritoneal transporter status with incipient ultrafiltration failure. In radiological, macro-, and microscopic studies, a massively fibrotic and calcified peritoneum enclosed the intestine and parietal wall in such cases. Empirical treatments commonly used are corticosteroids and tamoxifen, which has fibrinolytic properties. Immunosuppressants like azathioprine, mycophenolate mofetil, or mTOR inhibitors may also help with reducing inflammation, fibrin deposition, and collagen synthesis and maturation. In animal studies, N-acetylcysteine, colchicine, rosiglitazone, thalidomide, and renin-angiotensin system (RAS) inhibitors yielded promising results. Surgical treatment has mainly been performed in severe cases of intestinal obstruction, with varying results. Mortality rates are still 25–55% in adults and about 14% in children. To reduce the incidence of EPS and improve the outcome of this devastating complication of chronic PD, vigorous consideration of the risk factors, early diagnosis, and timely discontinuation of PD and therapeutic interventions are mandatory, even though these are merely based on empirical evidence.

scholarly journals Current management of choroidal melanoma in Serbia

2018 ◽  
Vol 146 (1-2) ◽  
pp. 9-11
Author(s):  
Anica Bobic-Radovanovic
Keyword(s):  
Treatment Options ◽  
Local Treatment ◽  
Choroidal Melanoma ◽  
Current Treatment ◽  
Beam Radiation ◽  
Recommended Treatment ◽  
Clinical Center ◽  
Proton Beam Radiation ◽  
And Gender ◽  
Observation Period

Introduction/Objective. Uveal melanoma is the most common primary malignant intraocular tumor in adults, and approximately 90% of uveal melanomas originate from the choroid. Nowadays, different treatment options for choroidal melanoma are available and an increasing tendency toward eye-sparing therapies is evident. The aim of this paper is to analyze the current treatment of choroidal melanoma in Serbia. Methods. This was a retrospective, observational study. Included patients were those with choroidal melanoma diagnosed at the Clinic for Eye Disease, Clinical Center of Serbia in Belgrade, between January 2014 and December 2016. Information on patients? age and gender and suggested and performed therapy was analyzed. Results. During the observation period, a diagnosis of choroidal melanoma was established in 148 patients, 71 (48%) males and 77 (52%) females. Recommended treatment was enucleation in 108 (72.9%), brachytherapy in 24 (16.2%), and proton beam radiation in 16 (10.8%) patients. Fifteen (10.1%) patients did not accept the suggested therapy, 10 (6.8%) patients refused any treatment at all, and five patients insisted on enucleation instead of advised eye-sparing therapies. Conclusion. In our country, choroidal melanoma is usually detected late, when the possibility of an efficient local treatment with preservation of the eye and its function is limited and when the patient?s prognosis is poor. A periodic fundus examination in mydriasis in persons after the age of 50 years plays an important role in early diagnosis of a disease.

scholarly journals Pharmacological Management of Idiopathic Pulmonary Fibrosis

2021 ◽  
Author(s):  
Ladan Panahi ◽  
George Udeani ◽  
Andrew Scott Tenpas ◽  
Theresa Ofili ◽  
Elizabeth Marie Aguilar ◽  
...  
Keyword(s):  
Drug Therapy ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Kinase Inhibitor ◽  
Treatment Options ◽  
Progression Free Survival ◽  
Current Treatment ◽  
Pharmacological Management ◽  
Free Survival ◽  
Traumatic Injuries

Idiopathic pulmonary fibrosis (IPF) is a common interstitial lung disease (ILD) caused by environmental exposures, infections, or traumatic injuries and subsequent epithelial damage. Since IPF is a progressively fatal disease without remission, treatment is both urgent and necessary. The two medications indicated solely for treatment include the tyrosine kinase inhibitor nintedanib (Ofev®) and the anti-fibrotic agent pirfenidone (Esbriet®). This chapter discusses in detail the current treatment options for clinical management of IPF, specifically the mentioned two pharmacotherapeutic agents that decrease physiological progression and likely improve progression-free survival. The chapter also discusses the evolution of drug therapy in IPF management and the drawbacks and limitations learned throughout historical trials and observational studies.

An Overview of Dementias

2012 ◽  
Vol 21 (3) ◽  
pp. 75-84
Author(s):  
Venkata Vijaya K. Dalai ◽  
Jason E. Childress ◽  
Paul E Schulz
Keyword(s):  
Clinical Presentation ◽  
Treatment Options ◽  
Current Treatment ◽  
Great Variability ◽  
Health Concern ◽  
Public Health Concern ◽  
Life Threatening ◽  
The Common ◽  
Neurodegenerative Dementias ◽  
Made In

Dementia is a major public health concern that afflicts an estimated 24.3 million people worldwide. Great strides are being made in order to better diagnose, prevent, and treat these disorders. Dementia is associated with multiple complications, some of which can be life-threatening, such as dysphagia. There is great variability between dementias in terms of when dysphagia and other swallowing disorders occur. In order to prepare the reader for the other articles in this publication discussing swallowing issues in depth, the authors of this article will provide a brief overview of the prevalence, risk factors, pathogenesis, clinical presentation, diagnosis, current treatment options, and implications for eating for the common forms of neurodegenerative dementias.

Preventing Premature Weaning: Management Options for Common Lactation Conditions, Including OMT

2020 ◽  
pp. 20-25
Author(s):  
Denise Sackett ◽  
Tala Dajani ◽  
David Shoup ◽  
Uzoma Ikonne
Keyword(s):  
Postpartum Depression ◽  
Family Physician ◽  
Treatment Options ◽  
World Health ◽  
Management Options ◽  
Pharmacological Management ◽  
Control And Prevention ◽  
Lactational Mastitis ◽  
One Year ◽  
Health Organization

The benefits of breastfeeding are well established. The World Health Organization and the Centers for Disease Control and Prevention recommend that mothers breastfeed infants for at least one year, but most children are not breastfed that long because of many factors. Breastfeeding mothers face many challenges to continued breastfeeding, including medical conditions that arise during this period, such as postpartum depression and lactational mastitis. Because of a perceived lack of consistent guidance on medication safety, it can be difficult for the family physician to treat these conditions while encouraging mothers to continue breastfeeding. The purpose of the current review is to summarize and clarify treatment options for the osteopathic family physician treating lactating mothers. We specifically focus on the pharmacological management of contraception, postpartum depression, and lactational mastitis.

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