Podcasts about gnrh

Send us a textIn this episode of Taco Bout Fertility Tuesday, Dr. Mark Amols breaks down one of the most commonly overlooked causes of infertility: elevated prolactin levels, also known as hyperprolactinemia.If you've ever been asked about nipple discharge at a fertility consult and thought, “What does that have to do with getting pregnant?”—this episode is for you.Dr. Amols dives into:What prolactin is and why your body produces itHow elevated prolactin shuts down ovulation by disrupting GnRH, FSH, and LHThe connection between dopamine and prolactin controlCauses of high prolactin—including prolactinomas, medications, thyroid issues, and even stress or exerciseDiagnostic steps: when to repeat the test, when to order an MRI, and how to rule out macroprolactinFirst-line treatments (cabergoline, bromocriptine) and what to expect during recoveryHow untreated hyperprolactinemia affects IUI, Clomid, Letrozole, and IVF outcomesLearn how to identify this hormone imbalance, when to treat it, and how correcting it can restore ovulation and dramatically improve your chances of pregnancy.Thanks for tuning in to another episode of 'Taco Bout Fertility Tuesday' with Dr. Mark Amols. If you found this episode insightful, please share it with friends and family who might benefit from our discussion. Remember, your feedback is invaluable to us – leave us a review on Apple Podcasts, Spotify, or your preferred listening platform. Stay connected with us for updates and fertility tips – follow us on Facebook. For more resources and information, visit our website at www.NewDirectionFertility.com. Have a question or a topic you'd like us to cover? We'd love to hear from you! Reach out to us at TBFT@NewDirectionFertility.com. Join us next Tuesday for more discussions on fertility, where we blend medical expertise with a touch of humor to make complex topics accessible and engaging. Until then, keep the conversation going and remember: understanding your fertility is a journey we're on together.

Dr. Natalie Crawford, double board certified OBGYN and REI, breaks down the complex world of reproductive hormones, providing you with a comprehensive guide to understanding their menstrual cycle, hormone function, and reproductive health. Key Topics Covered: 1. Hormone Basics -The HPO (Hypothalamus-Pituitary-Ovary) Axis -How hormones communicate in the body -Roles of key hormones: GnRH, FSH, LH, Estrogen, Progesterone 2. The Menstrual Cycle Explained -Egg development and ovulation process -Hormone fluctuations throughout the cycle -Normal cycle length and characteristics 3. Hormone Health Insights -Identifying normal vs. abnormal cycles -Impact of prolactin and thyroid hormones -Importance of hormone testing 4. Common Misconceptions -Estrogen dominance -Hormone balance -Effects of biotin on hormone testing Want to receive my weekly newsletter? Sign up at ⁠⁠⁠⁠nataliecrawfordmd.com/newsletter⁠⁠⁠⁠ to receive updates, Q&A, special content and freebies If you haven't already, please rate, review, and follow the podcast to be notified of new episodes every Tuesday. Plus, be sure to follow along on Instagram ⁠⁠⁠⁠@nataliecrawfordmd,⁠⁠⁠⁠ check out ⁠⁠⁠⁠Natalie's YouTube channel Natalie Crawford MD⁠⁠⁠⁠, and if you're interested in becoming a patient, check out ⁠⁠⁠⁠Fora Fertility. Join the Learn at Pinnacle app to earn FREE CE Credit for listening to this episode! This episode is brought to you by The Pinnacle Podcast Network! Learn more about Pinnacle at learnatpinnacle.com Learn more about your ad choices. Visit megaphone.fm/adchoices

Hola :)En el episodio de hoy os intento explicar por qué el estrés crónico (tanto mental como físico) puede afectar a nuestro eje reproductivo directamente y a la misma vez a través de afectación indrecta de otros ejes hormonales como el eje tiroideo y la prolactina contribuir a empeorar los sintomas reproductivos asociados al estrés perpetuando el ciclo de estres--> falta de adecuada sintesis de GnRh--> FSH y LH--> menstruaciones regulares, ovulación producción de testosterona...Asimismo os hablo de varios complementos que SIEMPRE  van detras de las medidas dle estilo de vida, no sustituyen a éstas y son:Estres: magnesio, omega 3, glicina, theanina, reishi, rhodiola, schizandra, ashwagandha, SAME vitaminas del grupo B como B12, B6, B9...Función tiroidea: myoinositol, coQ10, selenio, yodo, vitamina B1 y B3..Prolactina: vitex agnus (sauzgatillo) y magnesioOjala os sirva :) un besitoPara mas información ya sabéis que me tenéis en mi instagram @isabelvina dónde te comparto contenido diario Mi TikTok @isabelvinabas En mi canal de YouTube https://www.youtube.com/channel/UC-dfdxLBcvfztBvRAKZSXGQY los suplementos formulados por mi https://ivbwellness.com

In this episode, Stephanie Boyles-Griffin, Jessica Tegt, Steve Demarais, and Bronson Strickland discuss the complexities of urban deer management, exploring the challenges posed by growing deer populations in urban areas. While recreational hunting remains the most effective and practical tool for population control in most settings, an increasing number of circumstances—especially in urban and suburban areas—render it unfeasible. Stephanie and Jessica, both from the Botstiber Institute, outline non-lethal and alternative methods commonly used to manage deer in these environments and walk through the series of decisions required to evaluate which techniques are appropriate and how likely they are to succeed.  Below, Stephanie and Jessica have provided resources if you are interested in learning more. Check out the MSU Deer Lab's online seminar series (here) and choose the Natural Resources option from the Categories drop down menu.  You will have to create an account to view the seminars.  The seminars are free unless you are seeking professional educational credits. Also, be sure to visit our YouTube channel (here)   Resources: Contact information Stephanie Boyles-Griffin: boylesgriffinadvisor@botstiber.org Jessica Tegt: jtegt@botstiber.org   Urban Deer Conflict Management Planning Resources   https://www.humaneworld.org/sites/default/files/docs/HSUS%20Deer%20Conflict%20Mgt%20Plan_FINAL.pdf https://ecommons.cornell.edu/server/api/core/bitstreams/b297ac45-d908-4fd9-b06f-95cd5376907d/content https://www.fishwildlife.org/application/files/8816/1297/6730/Methods_for_Managing_Human-Deer_Conflicts_in_Urban_Suburban_and_Exurban_Areas.pdf   BIWFC - https://wildlifefertilitycontrol.org/ - https://digitalcommons.usu.edu/cgi/viewcontent.cgi?article=1871&context=hwi - https://wildlifefertilitycontrol.org/webinars/webinar-surgical-solutions-innovations-in-nonlethal-deer-management/ - https://wildlifefertilitycontrol.org/webinar-11-blacktail-deer/ - https://wildlifefertilitycontrol.org/webinar-denicola/   Surgical - https://www.whitebuffaloinc.org/ - DeNicola, A. J., and V. L. DeNicola. 2021. Ovariectomy as a management technique for suburban deer populations. Wildlife Society Bulletin 45:445–455.   https://wildlife.onlinelibrary.wiley.com/doi/epdf/10.1002/wsb.1218 - Staten Island Story Map https://storymaps.arcgis.com/stories/e3a5f6d544594690a313693d1e88d9ef - DeNicola, V., Mezzini, S., Bursać, P. et al. Effects of vasectomy on breeding-related movement and activity in free-ranging white-tailed deer. Mov Ecol 13, 34 (2025). https://doi.org/10.1186/s40462-025-00554-5   Nonsurgical Naugle, R. E., A. T. Rutberg, H. B. Underwood, J. W. Turner, Jr., and I. K. M. Liu. 2002. Field testing of immunocontraception on white-tailed deer (Odocoileus virginianus) at Fire Island National Seashore, New York, USA. Reproduction Supplement 60:143–153. https://wildlifefertilitycontrol.org/wp-content/uploads/2002/01/Naugle-et-al-2002-Field-testing-of-immunocontraception-at-Fire-Island.pdf Rutberg, A. T., R. E. Naugle, L. A. Thiele, and I. K. M. Liu. 2004. Effects of immunocontraception on a suburban population of white-tailed deer Odocoileus virginianus. Biological Conservation 116:243–250. https://www.wildlifefertilitycontrol.org/wp-content/uploads/2019/02/Rutberg-et-al-2004-Biol-Cons-NIST.pdf Gionfriddo. J. P., A. J. DeNicola, L. Miller, and K. A. Fagerstone. 2011. Efficacy of GnRH immunocontraception of wild white-tailed deer in New Jersey. Wildlife Society Bulletin 35(3):149–160. Rutberg, A. T., R. E. Naugle, J. W. Turner, Jr., M. Fraker, D. Flanagan, and I. K. M. Liu. 2013. Tests of one-treatment immunocontraceptive vaccines on white-tailed deer (Odocoileus virginianus) on Fripp Island, SC. Wildlife Research 40:281–288. https://wildlifefertilitycontrol.org/wp-content/uploads/2013/06/Rutberg-et-al-2013-Wildlife-Research.pdf Walker, M.J., Shank, G.C., Stoskopf, M.K., Minter, L.J. and DePerno, C.S. (2021), Efficacy and Cost of GonaCon™ for Population Control in a Free-ranging White-tailed Deer Population. Wildl. Soc. Bull., 45: 589-596. https://doi.org/10.1002/wsb.1237 https://wildlife.onlinelibrary.wiley.com/doi/abs/10.1002/wsb.1237

Pour accéder à l'intégralité de ce podcast et écouter chaque semaine un nouvel épisode du Quart d'Heure Véto, c'est très simple, il vous suffit de vous abonner en cliquant sur ce lien : https://m.audiomeans.fr/s/S-yUNSBZSR Notes et référencesArticle : Wolf, N.; Hahn, J.A.; Walter, I.; Zablotski, Y.; Zerbe, H.; Witte, T.S. Pathohistological Findings after Bilateral Ovariectomy in Mares with Behavioral Problems. Animals 2024, 14, 2899. https://doi.org/10.3390/ani14192899Retrouvez toute la synthèse sur la fiche podcast juste ici : https://audmns.com/bonXJzZPour nous suivre :1. Abonnez-vous à notre chaine pour profiter de l'intégralité des épisodes : Le Quart d'Heure Véto : décrypte et résume en moins de 15 min un article de biblio véto - Sur abonnement uniquementLe Véto du Mois : Partagez le temps d'une interview l'expérience de vétérinaires emblématiques de notre milieu, des rencontres conviviales, comme si nous étions dans votre salon au coin du feu. Podcasts bonus au fil des inspirations... 2. Le ScopeNous partageons avec vous nos dernières découvertes, inspirations, pistes de réflexion, nouveautés… À découvrir et utiliser dès maintenant, TOUT DE SUITE, dans votre quotidien de vétérinaire, de manager, de vie personnelle, de chef d'entreprise… Et tout cela en moins de 5 minutes top chrono un à 2 mardis par mois ! Je souhaite recevoir mon Scope : https://vetmasterclass.com/lescope/ 3. Contactez-nous, suivez-nous et donnez nous votre avis ! Des sujets que vous souhaiteriez approfondir, des références à partager, ou nous faire part de vos feed-backs :Abonnez-vous à notre chaine, donnez nous des étoiles, un commentaire et partagez autour de vous !Sur notre site : https://vetmasterclass.com/Sur Facebook : https://www.facebook.com/VmHorseSur Instagram : https://www.instagram.com/vetmasterclass/Sur YouTube : https://www.youtube.com/channel/UC18ovcWk9e-mFiTL34OQ03gSur Linkedin : https://www.linkedin.com/company/vetmasterclass-horse/about/Belle journée à tous, Et continuez à vivre votre métier avec Passion ! Distribué par Audiomeans. Visitez audiomeans.fr/politique-de-confidentialite pour plus d'informations.

Medicus Pharma CEO Dr Raza Bokhari joined Steve Darling from Proactive to announce a major strategic move: the company has entered into a binding letter of agreement to acquire Antev Ltd., a clinical-stage biotech company. Antev is developing Teverelix, a next-generation GnRH antagonist aimed at treating cardiovascular high-risk prostate cancer patients and patients with acute urinary retention (AUR) due to enlarged prostate. Bokhari highlighted that the acquisition will significantly strengthen Medicus Pharma's drug development portfolio, positioning Teverelix as a first-in-class therapeutic to prevent AUR recurrence and address prostate cancer among patients with elevated cardiovascular risk—together representing a combined market opportunity of approximately $6 billion. Antev's program includes an FDA-approved Phase 2b study, which is designed to randomize 390 men after successfully weaning off catheterization. This is highly relevant given that 85% of the nearly one million AUR episodes annually in the U.S. occur in men over the age of 60. Roughly 30% of these patients experience a recurrent episode within six months, creating a standalone $2 billion annual market for preventive treatment. Teverelix, therefore, offers a critical and differentiated solution in a space underserved by existing therapies, with the potential to redefine standards of care for aging male populations. The acquisition also aligns with Medicus Pharma's mission to build a diversified pipeline targeting significant unmet medical needs with strong commercial potential. #proactiveinvestors #nasdaq #mdcx #tsxv #mdcx #pharma #Biotech #CancerTreatment #ClinicalTrials #FDAApproval #SkinCancer #HealthcareInnovation #Investing #MedicalResearch

Live from AUA2025: Advances in ADT Program CME Available: https://auau.auanet.org/content/LiveFromAUA2025#group-tabs-node-course-default1 At the conclusion of this CME activity, participants will be able to: 1. Employ the latest AUA and NCCN guidelines (Version 1.2025) related to Androgen Deprivation Therapy (ADT) into practice 2. Evaluate clinical outcomes, efficacy, and safety profiles of different types of ADT including oral and parenteral LHRH agonists and GnRH receptor antagonists in different treatment settings. 3. Compare testosterone recovery, treatment efficacy, safety profiles, and patient preferences between different modalities of ADT. 4. Recognize common side effects associated with different types of ADT and its combination therapies as well as strategies to mitigate these adverse effects to improve patient outcomes. 5. Implement a multi-disciplinary approach in managing advanced prostate cancer with ADT. 6. Evaluate the future directions and ongoing research that may impact the use of ADT in clinical practice.

This week on the Head Shepherd podcast, we're joined by Dr Pedro Fontes from the University of Georgia to talk about beef cattle reproduction. Pedro's research focuses on optimising fertility through artificial insemination (AI), synchronisation protocols, and embryo transfer strategies.Mark and Pedro discuss the latest findings on GnRH compounds, how pre-synchronisation boosts conception rates, why improved ultrasound technology is enhancing embryo recipient selection and how excess bull condition affects fertility. If you're looking for new ways to improve reproductive efficiency in your herd, this episode is a must-listen. Send us a message Head Shepherd is brought to you by neXtgen Agri International Limited. We help livestock farmers get the most out of the genetics they farm with. Get in touch with us if you would like to hear more about how we can help you do what you do best: info@nextgenagri.com.Thanks to our sponsors at MSD Animal Health and Allflex, and Heiniger Australia and New Zealand. Please consider them when making product choices, as they are instrumental in enabling us to bring you this podcast each week.Check out Heiniger's product range HERECheck out the MSD range HERECheck out Allflex products HERE

Dr. Irene Su and Dr. Alison Loren present the latest evidence-based recommendations on fertility preservation for people with cancer. They discuss established, emerging, and investigational methods of fertility preservation for adults and children, and the role of clinicians including discussing the risk of infertility with all patients. Dr. Su and Dr. Loren also touch on other important aspects of fertility preservation, including the logistics of referral to reproductive specialists, navigating health insurance, and costs. They also discuss ongoing research and future areas to explore, including risk stratification, implementing screening, referral, and navigation processes in lower resource settings, fertility measurements, and health care policy impacts. Read the full guideline update, “Fertility Preservation in People with Cancer: ASCO Guideline Update” at www.asco.org/survivorship-guidelines." TRANSCRIPT This guideline, clinical tools, and resources are available at http://www.asco.org/survivorship-guidelines. Read the full text of the guideline and review authors' disclosures of potential conflicts of interest in the Journal of Clinical Oncology,  https://ascopubs.org/doi/10.1200/JCO-24-02782   In this guideline, the terms "male" and "female" were defined based on biological sex, specifically focusing on reproductive anatomy at birth. "Male" refers to individuals born with testes, while "female" refers to those born with ovaries. The guideline, and this podcast episode, we will refer to individuals as "males" or "females" based on this definition. Brittany Harvey Hello and welcome to the ASCO Guidelines podcast, one of ASCO's podcasts delivering timely information to keep you up to date on the latest changes, challenges, and advances in oncology. You can find all the shows, including this one at asco.org/podcasts. My name is Brittany Harvey and today I'm interviewing Dr. Irene Su from the University of California, San Diego, and Dr. Alison Loren from the University of Pennsylvania, co-chairs on “Fertility Preservation in People With Cancer: ASCO Guideline Update.” Thank you for being here today, Dr. Su and Dr. Loren. Dr. Irene Su: Thanks for having us. Dr. Alison Loren: Thanks for having us. Brittany Harvey: Then before we discuss this guideline, I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO Conflict of Interest Policy is followed for each guideline. The disclosures of potential conflicts of interest for the guideline panel, including Dr. Su and Dr. Loren, who have joined us here today, are available online with the publication of the guideline in the Journal of Clinical Oncology, which is linked in the show notes. So then, to jump into the content here, Dr. Loren, this is an update of a previous ASCO guideline. So what prompted this update to the 2018 guideline on fertility preservation? And what is the scope of this particular update? Dr. Alison Loren: Yeah, thanks, Brittany. So, yeah, a couple of things, actually. I would say the biggest motivation was the recognition that the field was really moving forward in several different directions. And we felt that the previous guidelines really hadn't adequately covered the need for ongoing reproductive health care in survivorship, including the fact that fertility preservation methods can be engaged in even after treatment is finished. And then also recognizing that there is increasing data supporting various novel forms of fertility preservation in both male and female patients. And we wanted to be able to educate the community about the wide array of options that are available to people with cancer, because it really has changed quite a bit even in the last six years. And then lastly, as I'm sure this audience, and you definitely know, ASCO tries to update the guidelines periodically to make sure that they're current. So it sort of is due anyhow, but I would say motivated largely by those changes in the field. Brittany Harvey: Great. I appreciate that background information. So then I'd like to dive a little bit more into those updates that you discussed. So, Dr. Su, I'd like to review the key recommendations across the main topics of this guideline. So starting with what are the recommendations regarding discussing the risk of infertility with patients undergoing cancer treatment? Dr. Irene Su: Thanks, Brittany. So for every child, adolescent, and adult of reproductive age who's been diagnosed with cancer, the recommendation remains that healthcare clinicians should discuss this possibility of infertility as early as possible before treatment starts, because that allows us, as reproductive endocrinologists and fertility specialists, to preserve the full range of options for fertility preservation for these young people. Where it's possible, I think risk stratification should be a part of the clinical infertility risk counseling and then the decision making. And then for patients and families who have an expressed interest in fertility preservation, and for those who are uncertain, the recommendation is to refer these individuals to reproductive specialists. And it turns out this is because fertility preservation treatments are medically effective for improving post-treatment fertility and counseling can ultimately reduce stress and improve quality of life, even for those who don't undergo fertility preservation. And as Dr. Loren said, a change in the guideline is specifically about continuing these discussions post-treatment yearly or when cancer treatments change because that changes their infertility risk or when pregnancy is being considered. Brittany Harvey: Absolutely. Discussing that risk of infertility at the beginning, before any treatment is initiated, and when treatment changes, is key. So then talking about the options for patients, Dr. Loren, what are the recommended fertility preservation options for males? Dr. Alison Loren: There has been a little bit of an evolution in options for male patients. The standard of care option which is always recommended is cryopreservation of sperm, or otherwise known as sperm banking. And this is something that should be offered ideally prior to initiating cancer directed therapy. The guideline does reflect the fact that we're starting to understand in a little bit more depth the impact of cancer-directed treatments on the health and quantity of sperm. And so trying to understand when, if ever, it's appropriate to collect sperm after initiation of treatment, but before completion of treatment remains an area of active research. But the current understanding of the data and the evidence is that sperm banking should be offered prior to initiating cancer-directed therapy. And all healthcare clinicians should feel empowered to discuss this option with all pubertal and post-pubertal male patients prior to receiving their treatment. We do offer a little bit more information about the ideal circumstances around sperm banking, including a minimum of three ejaculates of sufficient quality, if possible, but that any collections are better than no collections. We also talk about the fact that there is a relatively new procedure known as testicular sperm extraction, which can be offered to pubertal and post-pubertal males who can't produce a semen sample before cancer treatment begins. There remains no evidence for hormonal protection of testicular function - that has been a long-standing statement of fact and that remains the case. And then we also begin to address some of the potential risk of genetic damage in sperm that are collected soon after initiation of cancer-directed therapy. We are starting to understand that there is a degradation in the number and DNA integrity of sperm that can occur even after a single treatment. And so, really highlighting the fact that collecting samples, again, to Dr. Su's point, as early as possible and as many as possible to try to optimize biological parenthood after treatment. Brittany Harvey: Yes. Thank you for reviewing those options and what is both recommended and not recommended in this scenario. So then, following those recommendations, Dr. Su, what are the recommended fertility preservation options for female patients? Dr. Irene Su: There are a number of established and effective methods for fertility preservation for people with ovaries, and this includes freezing embryos, freezing oocytes, freezing ovarian tissue. For some patients, it may be appropriate to do ovarian transposition, which is to surgically move ovaries out of the field of radiation in a conservative gynecologic surgery, for example, preserving ovaries or preserving the uterus in people with gynecologic cancers. We do recommend that the choice between embryo and oocyte cryopreservation should be guided by patient preference and clinical considerations, their individual circumstances, including future flexibility, the success rates of embryo versus egg freezing that we detail more in the guideline, and legal considerations. And what is new in this guideline, as Dr. Loren alluded to earlier, is consideration of post-treatment fertility preservation for oocyte and embryo freezing. And this is going to be because, for some females, there's going to be a shortened but residual window of ovarian function that may not match when they are in their life ready to complete their families. And so for those individuals, there may be an indication to consider post-treatment fertility preservation. We clarify that gonadotropin releasing hormone agonists, GNRH agonists, while they shouldn't be used in the place of established fertility preservation methods, e.g., oocyte and embryo freezing, they can definitely be offered as an adjunct to females with breast cancer. Beyond breast cancer, we don't really understand the benefits and risks of GNRH agonists and feel that clinical trials in this area are highly encouraged. And also, that for patients who have oncologic emergencies that require urgent chemotherapy, these agonists can be offered because they can provide additional benefits like menstrual suppression. What's emerging is in vitro maturation of oocytes. It's feasible in specialized labs. It may take a little bit shorter time to retrieve these oocytes. There are cases of live births following IVM, in vitro maturation, that have been reported. But these processes remain inefficient compared to standard controlled ovarian stimulation. And therefore, it's really being treated as an emerging method. Finally, uterine transposition. It's experimental, but it's a novel technique for us. It's really moving the uterus out of the field of radiation surgically. We recommend that this is done under research protocols. So taken together, there are improvements in fertility preservation technology, and consideration of which of any of these methods really depends on tailoring to what is that patient's risk, what is the time that they have, what is feasible for them, and what is the effectiveness comparatively among these methods for them. Brittany Harvey: I appreciate you reviewing those recommendations and considerations of patient preferences, the clarification on GNRH agonists, and then those emerging and experimental methods as well. So then the next category of recommendations, Dr. Loren, what are the recommended fertility preservation options for children? Dr. Alison Loren: Thanks, Brittany. This remains a very challenging area. Certainly for older children and adolescents who have begun to initiate puberty changes, we support proceeding with previously outlined standard methods of either sperm or oocyte collection and cryopreservation. For younger children who are felt to be at substantial risk for harm to fertility, the really only options available to them are gonadal tissue cryopreservation, so ovarian tissue or testicular tissue cryopreservation. As Dr. Su mentioned, the ovarian tissue cryopreservation methods are quite effective and well established. There's less data in children, but we know that in adults and older adolescents that this is an effective method. Testicular cryopreservation remains experimental, and we suggest that if it is performed, that strong consideration should be given to doing this as an investigational research protocol. However, because these are the only options available to children, we understand there may be reasons why there might need to be some flexibility around this in the proper setting of informed consent and ascent when appropriate for children. Brittany Harvey: Absolutely. And so we've discussed a lot of recommendations on fertility preservation options. So, Dr. Loren, what is recommended regarding the role of clinicians in advising people about these fertility preservation options? Dr. Alison Loren: Yeah, this is a really important question, Brittany, and I think that we really hope to empower the entire oncology clinical team to bring these issues to the forefront for patients. We know from qualitative studies that oncology providers sometimes feel uncomfortable bringing these issues up because they feel inexpert in dealing with them or because it's so overwhelming. Obviously, these are usually younger patients who are not expecting a cancer diagnosis, and there can be quite a lot of distress, understandably, around the diagnosis itself and the treatment plan, and it can be sometimes overwhelming to also bring up fertility as a potential risk of therapy. We are seeing that as patients are becoming more familiar and comfortable kind of speaking up, I think, social media and lots of sort of online communities have raised this issue, that we're seeing that young people with cancer do spontaneously bring this up in their visits, which we really appreciate and encourage. But I think sometimes clinicians feel it's sometimes described as a dual crisis of both the cancer diagnosis and a risk to future fertility and it can be a really challenging conversation to initiate. I feel, and we hope that the guidelines convey, that the whole point is just to bring it up. We do not expect an oncology clinician of any kind, including social workers, nurses, to be able to outline all of the very complex options that are articulated in this guideline. And in fact, the reason that the co-chairs include myself, a hematologist oncologist, and Dr. Su, who's a reproductive specialist, is because we understand that the complex reproductive options for our patients with cancer require expert conversations. So we do not expect the oncology team to go into all the guideline options with their patients. We really just want to empower everyone on the team to bring up the issue so that we can then get them the care that they need from our colleagues in reproductive endocrinology so that they can be fully apprised of all of their options with enough time before initiation of treatment to be able to embark on whichever therapies they feel are most suited to their family planning wishes. Brittany Harvey: Absolutely. And then jumping off of that, as a reproductive endocrinologist, Dr. Su, what do you think clinicians should know as they implement these updated recommendations? Dr. Irene Su: I wholly echo what Dr. Loren has said about- this is a team effort and it's been really fun to work as a team of various specialties on this guideline, so we hope that the guideline really reflects all of the partnerships that have occurred. I think that what clinicians should know is it may be well worth spending some time in identifying a pathway for our patients. So that starts off with the oncology team. How are we going to screen? How are we going to screen with fidelity? And then from the time of screening, really anybody who has an interest or potentially is unsure about their future fertility needs, who are the reproductive specialists, male and female, that you are in the community with to refer to? What is that referral process going to be like? Is it emails? Is it a phone? Is it a best practice advisory in your electronic health record system? From our standpoint as fertility specialists, we need to spend some time implementing in this system a way to receive these referrals urgently and also be able to support insurance navigation. Because actually, what is really exciting in this field is for the purpose of equitable access, there is increasing insurance coverage, whether it is because employers feel that this is the right thing to do to offer, or 17 states and the District of Columbia also have state mandates requiring fertility preservation coverage by many insurances, as well as, for example, federal employees and active military members. So more than ever, there is a decreased cost barrier for patients and still early days, so navigating health insurance is a little bit challenging. And that is the role, in part, of navigators and fertility clinic teams to help support these patients to do that. Dr. Alison Loren: Forming these relationships and reinforcing them so early and often is really key. Because although these patients come up with some infrequency, when they occur, they're really emergencies and we want to make sure that there's a well-established path for these patients to get from their oncology clinicians to the reproductive specialists. And as Dr. Su said, whatever works best for your system - there's a lot of different ways that people have tackled these challenging referrals - but it is really important to have an expedited path and for the receiving reproductive specialist office to understand that these are urgent patients that need to be expedited and that the oncology clinician's responsibility is to make sure that that's communicated appropriately. Brittany Harvey: Definitely. Thinking in advance about those logistics of referral and navigating health insurance and cost is key to making sure that patients receive the care that they want and that they'd like to discuss with clinicians. So then, Dr. Loren, you touched on this a little bit earlier in talking about the dual crisis, but how does this guideline impact people diagnosed with cancer? Dr. Alison Loren: Well, what we're hoping is that this is sort of a refresher. I think that many or hopefully most or all oncology clinicians are aware that this is a potential concern. And so part of our hope is that, as this guideline rolls out, it'll sort of bring to the top of people's memories and action items that this is an important part of oncology care is the reproductive health care of our patients. And it's a critical component of survivorship care as well. We want to remind people that the field continues to advance and progress. In oncology, we're very aware of oncologic progress, but we may not be so aware of reproductive healthcare progress. And so letting people know, “Hey, there's all these new cool things we can do for people that open up options, even in situations where we might have thought there were no options before.” It's a reminder to refer, because we're not going to be able to keep up with all the advances in the field. But Dr. Su and her colleagues will be able to know what might be an option for patients. I want to highlight that communication piece again because our reproductive colleagues need to know what treatments are going to be given, what the urgency is, what the risks are. And so part of our responsibility as part of the team is to make sure that it's clear to both our patients and our reproductive specialist colleagues what the risks are. And Dr. Su mentioned this earlier, but one really important open question is risk stratification. We know that not all cancer treatments are created equal. There are some treatments, such as high dose alkylating agents, such as cyclophosphamide or busulfan, or high doses of radiation directly to the gonadal tissue, that are extremely high risk for causing permanent gonadal harm very immediately after exposure. And there are other therapies, particularly emerging or novel therapies, that we really just have no idea what the reproductive impact will be. And in particular, as patients are living longer, which is wonderful for our patients, how do we integrate reproductive care and family building into the management of perhaps a younger person who's on some chronic maintenance therapies, some of which we know can harm either the developing fetus or reproductive health, and some of which we really don't know at all. And so there's a very large open question around emerging therapies and how to counsel our patients. And so we hope that this guideline will also raise to the forefront the importance of addressing these questions moving forward and helping our patients to understand that we don't necessarily have all the answers either, which we hope will enrich the discussion and really have it be a good example of shared decision making between the clinical teams and the patient, so that ultimately the patients are able to make decisions that make the most sense for them and reduce the potential for decision regret in the future. Dr. Su, I know you have spent a lot of time thinking about this. Dr. Irene Su: Yeah. I really echo this notion that not all cancer treatments are going to be toxic to future reproductive function. And as clinicians, I and colleagues know that patients want to know as much when there is no effect on their fertility, because that feels reassuring in that that prevents them from having to go through the many hoops that sometimes it can be to undergo fertility preservation, as it is to know high risk, as it is to know we don't know. This is key and central, and we need more data. So, for example, we often chat about, wouldn't it be great if from the time of preclinical drug development all the way to clinical trials, that reproductive health in terms of ovarian function, testicular function, fertility potential, is measured regularly so that we are not having to look back 30, 40, 50 years later to understand what happened. And so this is one of our key research questions that we hope the field takes note of going forward. Dr. Alison Loren: This is an important point. We focus greatly, as we should, on potential harms to fertility, making sure that there's access to all the reproductive options for young people with cancer. But to Dr. Su's point, not all therapies are created equal, and there are some therapies that are somewhat lower risk or even much lower risk, including, I'm a blood cancer specialist and so certainly in the patients that I take care of, the treatments related to AML, ALL, and some lymphomas are actually fairly low risk, which is why the post-treatment fertility preservation options are so important. And particularly for patients who potentially present acutely ill with acute leukemia do not have the time or the ability to engage in fertility preservation because of their medical circumstances, it's important to have that conversation. I want to emphasize to oncology clinicians that even if you know medically that this patient is unable to undergo fertility preservation techniques at the time of diagnosis of their cancer, that it's still appropriate to talk about it and to say, “We're going to keep talking about this, this is something that we're going to raise again once you're through this initial therapy. I'm not forgetting about this. It may not be something we can engage in now, but it's a future conversation that's important in your ongoing care.” And then to think about pursuing options when possible, particularly for patients who may require a bone marrow transplant in their future, either due to higher risk disease at presentation or in the event of a relapse, we know that generally bone marrow transplants, because of the high intensity conditioning that they require for most patients who are young, that permanent gonadal insufficiency will be a fixture. And so there can be a window of time in between initial therapy and transplant where a referral might be appropriate. So my public service announcement is that it's never the wrong time to refer to a reproductive specialist. And sometimes people make assumptions about chemotherapy that, “Oh, they've already been treated, so there's nothing we can do,” and I want to make sure that people know that that's not true and that it's always appropriate to explore options. Dr. Irene Su: I think we talk a lot about how important screening and referral is and I can imagine that it's hard to actually know how to implement that. One of our other research questions to look out for is that we see a lot of tertiary care centers that have put together big teams, big resources, and that's not always feasible to scale out to all kinds of settings. And so what's emerging is: What are the key processes that have to happen and how can we adapt this screening, referral, financial navigation process from larger centers to smaller centers to less resource settings. So I guess my public service announcement is there's research in this area, there's focus in this area, so keep an eye out because there will be hopefully better tools to be able to fit in different types of settings. And more research is actually needed to be able to trial these different screening, referral, navigation processes in lower resource settings as well. Brittany Harvey: Absolutely. It's important to think about the research questions on how to improve both the delivery of fertility preservation options and the discussion of it, and it's important to recognize, as you mentioned, the different fertility risks of different cancer directed treatment options and the importance to have the conversations around this. So then just to expand on this notion a little bit, Dr. Su, we've touched on the research needed here in terms of discussing fertility options with patients and referring and then also in some of the experimental and emerging treatment options. So, what are the other outstanding research questions regarding fertility preservation for people with cancer? Dr. Irene Su: A couple others I'd like to add and then have Dr. Loren chime in in case I missed anything in all of our discussions, there's so many wants. So head to head comparisons of which method is best for which patient and what the long term outcomes are: How many kiddos? Do we complete family building? That is still missing. Being able to invest in novel methods from - there's fertoprotective agents that are being tested, potentially spermatogonial stem cell transplant. These are closer to clinical trials to really early research on ovarian, testicular, uterine biology. This is needed in order to inform downstream interventions. One of the questions that is unanswered is: After treatment starts, when is it safe to retrieve oocytes? And so this is a question because, for example, for our leukemia patients who are in the middle of treatment, when is it safe to retrieve eggs? And we don't know. And then post-treatment, for people who have a reduced window, when do you optimally have the most number of eggs or embryos that you can cryopreserve? That's unknown. But I think the question around once treatment has started, is recent exposure of anti-cancer treatments somehow mutagenic or somehow toxic to the oocytes with regard to long term offspring health? That is unanswered. I'm going to scope out a little bit and maybe policy nerd this a little bit. It's been very exciting to see advocacy, advocacy from our patients, from our clinicians on trying to improve health care policy. Like how can we use mandates to improve this delivery? But we actually don't know because actually the mandates from states that require health insurance coverage for fertility preservation, they vary. And so actually what are the key ingredients and policies that will ultimately get the most patients to the care they need? That is in question and would be really interesting. And so what is a part of this guideline which is not often seen in clinical guidelines, is a call for what we think are best practices for health insurance plans to help patients be able to access. And so this means that we recommend being specific and comprehensive in the coverage of these established fertility preservation services that have been recommended. And this means, for example, an egg freezing covering the whole process from consultation to office visits, to ultrasounds and laboratories, to medicines, to the retrieval, and then to long term storage. Because particularly for the youngest of our patients, these gametes could be frozen for a number of years and may not always be so affordable without health insurance coverage. We think that fertility preservation benefits really should be at parity, that you should not be having more cost sharing on the patient compared to other medical services that are covered. This is an inequity and where possible we should eliminate prior authorization because that timing is so short between diagnosis and needing to start anti-cancer treatment. And so prior authorization having to go through multiple layers of health insurance is really a key barrier because we all know that health insurance literacy is limited for all of us. And so whatever we can do to support our patient for the intent of these benefits would be recommended. Dr. Alison Loren: That was so well said, Dr. Su. I'll take the oncology perspective and say that from our side, really being able to understand the risks of infertility and understanding better measurements of fertility capacity, understanding where our patients are - every patient is different. These conversations are very different for a 37-year-old than they are for a 17-year-old. And so what we haven't really talked about is the fact that certainly at least female patients, as they age, their reproductive potential declines naturally. And so their infertility trajectory may be accelerated, they may have a shorter timeline or have less reserve than younger patients. And so being able to tailor our risk discussions not just based on the specific treatments, but on the reproductive age of the patient sitting in front of us and really being able to tailor those to very personalized risks would be really helpful. Because, as Dr. Su mentioned, and I think, as many people know, undergoing fertility preservation techniques can be really arduous. Even if they're covered and paid for, and all of those logistics are easy, which they seldom are, the physical drain of having to do injections, go for labs, all of the parts of those therapies can be really difficult for patients. And so being able to really understand who needs to have these interventions and who could pass, and understanding what the risks are, as I mentioned earlier, for these novel and emerging therapies would be really helpful. Another really important aspect of future research questions is we would like to encourage all clinicians, both reproductive specialists and oncology clinicians, and also our young people with cancer, to participate in clinical studies pertaining to fertility measurements and preservation. We also exhort our industry colleagues to consider including important reproductive endpoints, including biomarkers of ovarian and testicular reserve, if possible, in clinical trials. It will enhance our ability to provide counseling and support for these therapies in the future to be able to understand what the true impact of infertility, family building and health of offspring to be able to include these data in prospective databases and trials. Brittany Harvey: Definitely. And I want to thank you both for raising those really important points. So we'll look forward to this ongoing research and optimizing policies for covering fertility preservation benefits for all patients with cancer. I want to thank you both so much for your work to update this critical guideline and talk about these important needs of people with cancer. And thank you for your time today, Dr. Su and Dr. Loren. Dr. Alison Loren: Thanks so much for having us. Dr. Irene Su: You're welcome. This was really fun. Dr. Alison Loren: It was fun. And I just will add that the team at ASCO is amazing and really made this a pleasure. Dr. Irene Su: I couldn't agree more. And from the point of being a fertility specialist, being invited to be a part of this with ASCO and with all of our colleagues, it's been really amazing. And so thanks for allowing us to contribute. Brittany Harvey: Definitely. And a big thanks to the entire panel as well. And thank you to all of our listeners for tuning in to the ASCO Guidelines podcast. To read the full guideline, go to www.asco.org/survivorship-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app available in the Apple App Store or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode.   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.    

La amenorrea es la ausencia de menstruación y se clasifica en dos tipos principales:1. Amenorrea primariaSe da cuando una persona no ha tenido nunca la menstruación a los 15-16 años.Causas: problemas genéticos (Síndrome de Turner, Síndrome de Rokitansky), alteraciones hormonales (déficit de GnRH, hiperplasia suprarrenal congénita), enfermedades crónicas o problemas estructurales en el aparato reproductor.Tratamiento dietético:Aporte adecuado de energía y macronutrientes, evitando déficits calóricos severos.Optimizar el consumo de grasas saludables para la producción de hormonas sexuales.Asegurar suficiente calcio, vitamina D y proteínas para el desarrollo óseo.Hierro y B12 si hay deficiencias nutricionales.2. Amenorrea secundariaSe da cuando alguien que tenía menstruaciones regulares deja de menstruar durante más de 3-6 meses.Causas:Hipotalámica funcional: déficit energético (restricción calórica, ejercicio excesivo, estrés).Síndrome de ovario poliquístico (SOP): resistencia a la insulina, hiperandrogenismo.Hipotiroidismo: niveles bajos de T3 y T4 afectan el ciclo menstrual.Hiperprolactinemia: tumores hipofisarios, estrés.Insuficiencia ovárica prematura: menopausia precoz.Desbalances nutricionales: déficits de grasas, proteínas, hierro, calcio, vitamina D y B12.Tratamiento dietético según la causa:1. Amenorrea hipotalámica funcional (por restricción calórica o ejercicio excesivo)Aumentar la ingesta calórica para salir del déficit energético.Incluir grasas saludables (aguacate, frutos secos, aceite de oliva, pescados grasos).No eliminar carbohidratos y asegurar suficiente glucosa para el hipotálamo.Reducir ejercicio excesivo y priorizar entrenamientos menos demandantes.Gestión del estrés (meditación, sueño adecuado).2. Amenorrea por SOPReducción del índice glucémico: dietas basadas en alimentos integrales, evitando azúcares refinados.Aporte suficiente de fibra para mejorar la sensibilidad a la insulina.Consumo adecuado de omega-3 para reducir inflamación (pescado azul, semillas de chía y lino).Evitar grasas trans y ultraprocesados para mejorar la respuesta hormonal.3. Amenorrea por hipotiroidismoAumentar el consumo de yodo, selenio y zinc (algas, mariscos, frutos secos, huevos).Evitar déficit de hierro y B12, ya que pueden empeorar la disfunción tiroidea.Evitar exceso de goitrógenos crudos (brócoli, col, coliflor en grandes cantidades).4. Amenorrea por hiperprolactinemiaAsegurar suficiente B6 y zinc (pavo, plátanos, frutos secos).Evitar estrés crónico, ya que eleva la prolactina.Reducir café y alcohol, ya que afectan la dopamina (regula la prolactina).5. Amenorrea por insuficiencia ovárica prematuraDieta rica en antioxidantes (frutas y verduras de colores intensos, té verde).Asegurar consumo de fitoestrógenos (soja, lino, sésamo).Aporte suficiente de calcio y vitamina D para la salud ósea.La estrategia clave en todos los casos es un enfoque personalizado según la causa subyacente, asegurando un equilibrio hormonal y nutricional adecuado.Conviértete en un seguidor de este podcast: https://www.spreaker.com/podcast/comiendo-con-maria-nutricion--2497272/support.

We are getting a little science-y today! In this episode, we talk all things amenorrhea with a large focus of the discussion on specifically functional hypothalamic amenorrhea. I am not a doctor and this is not intended to be medical advice or to diagnose you with HA. I just want to spread what I've learned, in hopes that it will help you too! TIMESTAMPS BELOW. EP on the things I did to get my cycle back my Instagram 1-1 coaching application 1:30 important disclaimers 3:16 what does HA/FHA stand for? 3:37 amenorrhea 101 5:55 HA is not the only cause for amenorrhea 7:00 hypothalamic causes for amenorrhea 7:36 functional hypothalamic amenorrhea 8:51 menstrual cycle hormone signaling 11:38 GnRH as the initiator of reproduction 12:36 characteristics of FHA 13:50 individual differences 14:27 leptin & its interplay with FHA 17:15 stress & its interplay with FHA 20:43 impact of strenuous exercise + low energy availability 21:19 low estradiol & bone mineral density risk 25:55 the thyroid & its interplay with FHA 27:25 what's really the root cause here (tying it together) 29:20 short terms effects of HA 30:04 long term effects of HA 31:24 it's not just a missing period 31:30 research on amenorrheic subjects 32:30 can you be overweight and have FHA? 33:50 can you have FHA even if you're not clinically underweight? 34:50 common approaches to reversing the condition 35:08 how is FHA diagnosed? labs, etc! 37:11 when to look to PCOS instead 38:40 is FHA reversible? much more to come on this topic - thanks for listening!!!

Send us a textOn this episode of the CMAJ Podcast, Dr. Mojola Omole and Dr. Blair Bigham explore Premenstrual Dysphoric Disorder (PMDD), a debilitating condition affecting 5% of people who menstruate, yet it is often misdiagnosed or misunderstood. The conversation builds on insights from the CMAJ article, “Five things to know about…: PMDD,” co-authored by Dr. Erin Brennand, an associate professor at the Cumming School of Medicine in Calgary.Abhi Bala shares her lived experience with PMDD, describing the profound impact of cyclical depressive symptoms, suicidal ideation, and emotional dysregulation on her life. Her journey from misdiagnosis to awareness highlights the importance of tracking symptoms and recognizing patterns linked to the menstrual cycle, which can lead to earlier diagnosis and treatment.Dr. Brennand explains how PMDD is frequently mistaken for depression or bipolar disorder, delaying accurate diagnosis and treatment. She highlights the importance of recognizing that PMDD's cyclical symptoms align specifically with the luteal phase—the final two weeks of the menstrual cycle. Dr. Brennand also discusses evidence-based treatments, including SSRIs, oral contraceptives, and, in severe cases, GnRH agonists.This episode provides valuable insights into diagnosing and managing PMDD, helping physicians better support their patients.For more information from our sponsor, visit rainbowhealthontario.caJoin us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.You can find Blair and Mojola on X @BlairBigham and @DrmojolaomoleX (in English): @CMAJ X (en français): @JAMC FacebookInstagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions

Reproductive physiologists are always trying to improve conception rates for the dairy herd. Double ovsync is one of the best tools in our toolbox to submit cows to first insemination. However, as estrus detection technology becomes more affordable and we learn more about physiology, perhaps combining the expression of estrus at insemination may improve fertility through optimizing ovulation timing. Dr. Julio Giordano and Ana Laplacette worked with their Cornell reproduction team to investigate this theory on over 4600 cows in 2 commercial herds. “We are trying to take advantage of the power of sync of ovulation and the power of estrus” Giordano explains. “To get the best of both, synergize the two.” The only change to the well-known Double ovsync protocol includes a delay in the final administration of GnRh before breeding. The goal, allowing the cows more time to show estrus. Take a moment to listen in to better understand the physiology of this synchronization program and how to improve your herd's reproductive management.   Topics of discussion 2:03       Introduction of Dr. Julio Giordano & Ana Laplacette 3:37       Why introduce Estrus detection to double ovsync? 6:25       Treatment description, Double ovsync 9:12       Did you cherry pick? 10:04     What metrics do you focus in on to determine the success of synchronization protocol 11:36     Considerations to grouping animals to best understand the data 13:57     How did you determine “heat” 15:23     Specific difference between G56 and G80 treatments 16:38   Increase in Estrus observed 2.2% vs 29.9% 17:09     Three types of cows –                (1) Show estrus without GnRh, 1/3                (2) Show estrus after GnRh, 1/3                (3) Never show estrus, 1/3   20:01     Anestrus cows – table 5 22:16     Follicle size differences between treatment 26:12     Did it work? Take home message for boots on the ground dairy producers 30:41     What is the difference between the estrus and non-estrus cows? 32:16     Follow up project: Give cows 1 week to show estrus after PGH of breeding OvSync Featured Article: Delaying induction of ovulation and timed AI in a Double-Ovsynch protocol increased expression of estrus and altered first service reproductive outcomes of lactating dairy cows   #2xAg2030; #journalofdairyscience; #openaccess; #MODAIRY; #DoubleOvSync; #G56; #G80; #cherrypick; #sync; #estrus; #dairy; #Lut; #GnRH; #conceptionrate; #dairysciencedigest; #ReaganBluel; 

This study compared efficacy of two r-FSH medications: follitropin alpha (Gonal-F) vs. follitropin beta (Puregon) on the number of live births cumulatively (CLBR). This was looking at patients 21-45yrs doing fresh embryo transfer after their first IVF or ICSI cycle.ResourcesCao JX, Song JY. Follitropin Alpha versus Follitropin Beta in IVF/ICSI Cycle: A Retrospective Cohort Study. Drug Des Devel Ther. 2024;18:4359-4369. Published 2024 Sep 26. doi:10.2147/DDDT.S479700Van den Haute L, Drakopoulos P, Verheyen G, De Vos M, Tournaye H, Blockeel C. Follitropin alpha versus beta in a first GnRH antagonist ICSI cycle: a retrospective cohort study. Reprod Biomed Online. 2021;43(4):655-662. doi:10.1016/j.rbmo.2021.06.014

In this episode of JCO Article Insights, Dr. Giselle de Souza Carvalho interviews Dr. Hatem Azim and Dr. Ann partridge on their JCO article “Fertility Preservation and Assisted Reproduction in Patients With Breast Cancer Interrupting Adjuvant Endocrine Therapy to Attempt Pregnancy,” TRANSCRIPT Giselle Carvalho: Welcome to the JCO Article Insights episode for the August issue of the Journal of Clinical Oncology. This is Giselle Carvalho, your host. I'm a Medical Oncologist in Brazil focusing on breast cancer and melanoma skin cancers, and one of the ASCO editorial fellows at JCO this year. Today, I will have the opportunity to interview Dr. Hatem Azim and Dr. Ann Partridge, two of the authors of the POSITIVE trial. We will be discussing their trial on “Fertility Preservation and Assisted Reproduction in Patients With Breast Cancer Interrupting Adjuvant Endocrine Therapy to Attempt Pregnancy,” which was published in May this year.  Hello, Dr. Azim and Dr. Partridge. Welcome to our podcast. Dr. Ann Partridge: Hi. Thanks. Dr. Hatem Azim: Hello. Giselle Carvalho: So, beginning with our interview for breast cancer survivors, in addition to the treatment itself, aging is one of the major contributors to infertility. The optimal duration of adjuvant endocrine therapy in patients with hormone positive early breast cancer ranges from five to ten years, depending on patient and tumor characteristics. This time interval can be critical for women who wish to attempt pregnancy. One of the main concerns in daily breast cancer oncology practice is whether breast cancer recurrence rates are increased either by temporary interruption of endocrine therapy for pregnancy or by the use of assisted reproductive technologies. Dr. Azim, what about assisted reproductive technology is worrisome regarding breast cancer outcomes? And how do the POSITIVE study results address the concern about worsening breast cancer outcomes either with assisted reproductive technology or endocrine therapy interruption? Dr. Hatem Azim: So, in the primary analysis of the POSITIVE trial, we tried to address one of these questions, whether temporary interruption with endocrine therapy affects breast cancer outcome. And what we found was that interruption did not appear to have a detrimental impact at the median follow up of 41 months. So in the current manuscript, we addressed the second question, whether assisted production of fertility preservation has an impact as well on breast cancer outcome. And we did not find any worsening of outcomes in patients who underwent these procedures compared to those who had a spontaneous pregnancy. Of course, we have relatively short follow up, but at least the outcomes at the median follow up of around 3 to 4 years appears to be reassuring. Giselle Carvalho: I see. Thank you. These are really important outcomes regarding premenopausal patients. So, moving on, results from your study show that after 24 months, 80% of women under 35 years old had at least one successful pregnancy, while the same was true for 50% of women aged 40 to 42. These results are particularly impressive considering that over 60% of women over 35 had undergone chemotherapy.  Dr. Partridge, other than age, what factors did you find were associated with a successful pregnancy?  Dr. Ann Partridge: Yeah. The biggest factor, other than age, that was associated with successful live birth pregnancy was use of assisted reproductive technologies. So either having gone through IVF prior to diagnosis and banking eggs or embryos prior to diagnosis and then using them during the study, for undergoing stimulation of the ovaries during the study and then using it during the study. And that's what we also looked at in this most recent analysis of the initial POSITIVE data.  Giselle Carvalho: I see. Thank you. The group of patients who underwent embryo oocyte cryopreservation at diagnosis were more likely to be nulliparous and treated with chemotherapy. Presumably these represent the patient group most afraid they will be infertile, as they would be receiving chemotherapy, and most desirous of pregnancy, as they had not yet had any children. Fertility preservation techniques are expensive and not easily available for all patients, particularly in less wealthy countries. Is there any group of your breast cancer patients with a high enough likelihood of pregnancy without assisted reproductive technology that you would not recommend this?  Dr. Ann Partridge: Sure. So we are so glad to have assisted reproductive technologies available in many places, but as you know, they're not available everywhere. And even where they're available for some people, it's either inaccessible for a number of reasons or it doesn't feel right emotionally or ethically. And then finally, sometimes people need fairly quick treatment and they just don't have the time, even though we don't think there are long delays. And so we do and are able to know who can get pregnant after standard chemotherapy. Not perfectly, but we can give estimates. And the gestalt is, the younger a woman is, the less likely she is to become amenorrheic and the associated infertile, although it's not a perfect match in terms of amenorrhea being a surrogate. And then there are particular chemotherapy regimens that are more gonadotoxic than others. The more cyclophosphamide, for example, or alkylating agent, the more anthracycline, the higher the likelihood generally of causing at least amenorrhea and likely infertility. The huge caveat there is that for some of our newer therapies, we have no good information about how they might impact on menstrual status, let alone the actual rates of fertility. So we need to collect those data. But certainly, if someone's very young, they're going to get four cycles of TC or they have inflammatory breast cancer, we often take kind of a let the chips fall where they may approach, because they just aren't able to access it and we'll often do something like ovarian suppression through the chemotherapy to help support them and hope that it improves their menstrual functioning in the long run and/or fertility. Giselle Carvalho: Thank you for your insight. So you found that pregnancy incidence over time differed by age group, although incidence of menstrual recovery over time was similar across all age groups, which I conclude that menstrual recovery does not translate into fertility. The addition of gonadotropin releasing hormone analogs to chemotherapy was not associated with time to pregnancy. However, of course, such use was not randomized.  Dr. Azim, if assisted reproductive technology is not available to patients for reasons such as socioeconomic factors, would you recommend using GnRH analogs with chemotherapy for the purpose of fertility preservation?  Dr. Hatem Azim: Yes. The short answer is yes. Of course, POSITIVE study was not designed to address the question around GnRH analogs, but we do have several randomized studies and meta analyses that have shown clearly that the use of GnRH analogs with chemotherapy reduce the risk of premature ovarian insufficiency. And subgroup analysis of some of these studies have shown a trend towards higher pregnancy rates as well. So, of course, if a patient does not have access to assist reproductive technology, GnRH analogs in combination with chemotherapy represent a very good alternative.  Giselle Carvalho: I see. Thank you. Thank you for your response. At enrollment, 93.2% of women on POSITIVE trial had stage 1 or 2 disease and 66% had no negative disease. Therefore, one possible bias is that investigators might have been more comfortable with temporarily interrupting endocrine therapy if the risk of relapse was low. Dr. Partridge, what recommendations would you have for women with stage three hormone receptor positive breast cancer who desire to attempt pregnancy? Dr. Ann Partridge: Yeah, thank you. That's a really good question. It comes up in our tumor boards and discussions about patient care all the time, and I think, as you know, only a small proportion, about 6%, had stage 3 disease. Those patients are at higher risk of recurrence by nature of their stage. Not that all stage 3 are created equal, because, of course, if someone had a complete pathologic response to preoperative therapy and their stage 3 disease at diagnosis went to a PCR, then that person may have even better outcomes in the long run than someone who had postoperative treatment, and we don't know their likelihood even with stage 1 or 2 disease. But someone that you're concerned about their risk of recurrence, they still remain at risk of recurrence. And while we do not think, based on the POSITIVE data and all the data that we've had from retrospective studies and other data sets collected for other reasons, that a pregnancy would worsen their outcome, we certainly don't believe that a pregnancy at this point in time will dramatically improve their outcome or as a treatment for breast cancer. That's when I have a heart to heart conversation with the patient, really acknowledging they still remain at high risk. And most of my colleagues tend to want the patient to get more endocrine therapy into their system before they take a break. We've kind of discussed this, and we want someone to get more like at least three to five years. That may be a little bit paternalistic, because, as we know, taking the break for people with a little lower risk didn't seem to worsen outcomes. Maybe it's fine. I don't know that a break at five years is any better than a break at two years. I don't know. Hatem, how do you handle this in your practice?   Dr. Hatem Azim: Well, I completely agree with you, Ann. I mean, it's very much decided on a patient by patient basis. The level of uncertainty that some patients accept to take is not necessarily like others. And sometimes we as physicians, we adopt this. I agree with this paternalistic approach. Nevertheless, it's very important for the patient who is 32, is not necessarily counseled like the patient who's 39, and her acceptance and the feasibility of waiting a bit longer as well in order to attempt pregnancy - the success of pregnancy afterwards is not necessarily the same. So I'm not sure we could adapt a one size fits all approach here. And I do not necessarily tend to factor much the elements around the stage. I think my point to patients is usually, well, you do have give and take this amount of risk of relapse, for example, and whether we accept to take such, what we could refer to as relatively unconventional approach of temporary interrupting endocrine therapy, and when we are comfortable to go ahead with this journey, depending on the feasibility of getting pregnant afterwards as well. So, yeah, I completely agree. It's very customized, based on and tailored according to the patients' situation. Giselle Carvalho: Thank you. I really appreciate your response to this. So, moving forward, tamoxifen alone was the most commonly prescribed endocrine therapy, followed by tamoxifen plus ovarian function suppression. The latter was preferred over aromatase inhibitors ovarian function suppression in the selected population. Endocrine therapy prescription changed in the second half of the recruitment period after July 2017 across all continents, likely due to the results of the SOFT and TEXT trials. It demonstrated absolute improvements in all disease outcomes by escalating endocrine therapy, which was more clinically meaningful in patients with high risk disease. Dr. Azim, how do you imagine this change could impact positive outcomes? Dr. Hatem Azim: Honestly, I'm not necessarily sure that it impacts significantly the way you interpret the data and the way we counsel our patients. So, in our study, some 50% of patients received GnRH analogs and around 15% received AI. And most of the patients, I would say, were recruited in the second half of the study after we had the results from, for example, SOFT and TEXT. Furthermore, as we alluded to earlier, we had 60% of patients who received chemo. So most of our patients had a stage 1 and 2 disease in which you would argue that the absolute difference between the different hormonal therapy options is not necessarily massive. Whether or not this would impact much, I'm not sure. I think the main counseling recommendations would apply, that patients who receive endocrine therapy would be asked to interrupt it for at least three months and then they attempt pregnancy afterwards. I don't know what you think, Anne, but I'm not sure that if we have more patients, and this is pretty much the case now, we have more patients treated with AI. I tend to do this a lot, especially if I'm thinking of interrupting, so I think I'm giving them maybe the best option first. I'm not sure this is necessarily, I mean, affecting me much, while interpreting that it does not appear that temporary interruption on the short term has an impact. Dr. Ann Partridge: I completely agree with your strategy. Depending on the patient and their tolerance, if they have enough risk to warrant ovarian suppression with AI or tamoxifen, of course I recommend that. And yet, at the same time, I agree with you in this group that was in POSITIVE, I think the groups are relatively low enough risk. Although 40% had no positive disease, the majority got chemo, so they weren't that low risk. And so I think over time, these kinds of patients are more and more going to get ovarian suppression. I'm doing that more in my practice as tolerated. And I hope that all that means is that their breast cancer outcomes will be better independent of a pregnancy. Giselle Carvalho: And on the topic of women with higher risk disease, CDK4/6 inhibitors are now used in the high risk adjuvant setting. How do you envision this impacting fertility? Dr. Hatem Azim: Well, this is a very good question. Of course, this is something, this is an area of research that we have to address. Some analysis from some of the adjuvant studies, for example, the PENELOPE-B, I think they reported on some of the results of their study in which they were evaluating palbociclib in the adjuvant setting and did not appear that there was significant differences in terms of the level of estradiol levels and FSH and anti-Müllerian hormone, for example. I think these were the parameters that were evaluated in this study. So, of course, more information. Of course, palb is not the CDK4/6 inhibitor approved in the adjuvant setting. So we need more information as well about the other CDK4/6 inhibitors and longer follow-up.  In my view from a counseling perspective, I think maybe you would have a certain level of uncertainty regarding whether or not this could have a mental impact on fertility. But the concept as well of possibly proposing a temporary interruption as we adopted in POSITIVE, would still apply. These patients would be treated as well, often, because if they are receiving CDK4/6 inhibitors in the adjuvant setting, it means that they have a high stage disease, so often they will be treated as well with GnRH analogs. I would counsel them pretty much the same, acknowledging a certain level of uncertainty regarding the data we have today on CDK4/6 inhibitors. Dr. Ann Partridge: Yeah, if they got a full course, they would generally be further out than many people on POSITIVE, because we treat with, for example, the abemaciclib for two years and then you want to wash out and things like that. In POSITIVE, the average was two years. And so you'd expect people of higher risk to be a little further out, which I think would make everybody a little more comfortable too, because someone who's very high risk, you'd worry about very early bad recurrence, too. Giselle Carvalho: Yeah. Thank you. So, Dr. Partridge, regarding adherence to endocrine therapy resumption after the two year break, what was the percentage of patients who resumed treatment and which strategies would you suggest to increase adherence in this case? Dr. Ann Partridge: That's a really great question. In the study, it was well over 70%, which is actually higher than you see in the general population of breast cancer survivors, especially young women. So in some cases, and I can tell you anecdotally, I experienced in my clinic that patients were more likely to start and take their endocrine therapy when they had the promise of the POSITIVE trial, to take a break to have a baby, because some of them don't want to start it, let alone stay on it, if they're told they have to take a full five to ten years. So it actually promoted adherence, ironically. And then for the people who got back on in the real world, the data suggests that by four years, somewhere close to half to 30% to half are no longer taking it. And so in POSITIVE it was, I think, 74% got back on, and that was only at the time point cut off when we did the initial primary data report. And of course more people will have gone back on because some people were still having babies and in the middle of things. And so I think that it's not as much of an issue with POSITIVE. In part, these are very compliant people, right? They're participating in a clinical trial to share the data with the rest of the world. They could have gotten pregnant on their own and they want to do it with their doctors. And so I think this is a little bit of a different group, but it was very reassuring to see that most people got on hormonal therapy after their interruption. Giselle Carvalho: And recurrence of hormone receptor positive breast cancer may occur late. How long do you plan to follow patients enrolled in the POSITIVE trial? Dr. Ann Partridge: So our plan is to follow them for at least 10 years. And it's interesting because we're starting to get close to that. We started enrollment in 2015, so I saw someone earlier this week who will have her 10 year mark next year because she got on in 2015. And that's very exciting. Obviously, it would be great to follow them even longer because ER positive breast cancer can recur many years later. But I do think that we feel as though at least 10 years will give us a good, very evidence-based feeling about the safety. Giselle Carvalho: Thank you. Thanks for sharing. With enrollment occurring at 116 institutions in 20 countries across four continents, this representation of different races and ethnicities provides strength to support this recommendation for this group of patients worldwide. Dr. Azim, what are your hopes for future analysis from this study and what future research in the area are you planning or would like to see performed?  Dr. Hatem Azim: So Ann mentioned, of course, it would be crucial to conduct the long term follow up of these patients, and provide more reassuring evidence on the safety of this approach of adjuvant endocrine therapy. So this is something we're really looking forward to. Other analysis that we are working on is the breastfeeding analysis. So looking at patients who underwent breastfeeding and how far the feasibility of this approach, obviously, but how far as well this had an impact on their breast cancer outcome. So this is something that hopefully we are going to report on soon, expected end of this year. As well, we are working on evaluating, we had a large translation research program within POSITIVE, addressing several questions, including the evolution of ovarian function parameters over time and the ovarian reserve. Also, we are working on reporting on this information. We hope that this could happen maybe in the coming year. Giselle Carvalho: Great. And finally, what advice do you give young women in your clinic who have been diagnosed with early stage hormone positive breast cancer and who are hoping to attempt pregnancy. Dr. Hatem Azim: We address these kinds of questions relatively early in their treatments and often they are very much concerned about their chance of future fertility. Usually early on, for example, before going for chemo and so on, I just share the information that this is something that we certainly could discuss and certainly there are the possibility that we could consider in the future that it's not a ‘no go' at least. And definitely it's something that we could work on once treatment is completed and recover from the adverse events of therapy. And because throughout the journey of treatments as well, women's wishes evolve over time and their perception of their pregnancy project as well evolve and change over time. So I think it's important to acknowledge, in my view, it's very important to acknowledge that this is feasible, this is possible, and because this as well provides an important psychological boost for them. And then as the patient comes over for their follow up after therapy and so on, start understanding, getting a little bit deeper into these kind of questions regarding feasibility, timing. If they are ER positive, then if it's okay to interrupt, not to interrupt, to explain a bit better and to consider a bit better regarding what kind of risk we're talking about. Articulating better, what do we mean by risk? So that sometimes you have a patient that is willing to accept a 10% risk, although others 1% risk for them represent a major threat. Also, it matters nulliparous versus a patient who already has two or three kids. So I think I tend to go a bit more granular in this kind of information as patients are out of chemo and on hormonal therapy and start addressing these matters. But I think it's important early on to share the information that nowadays we do have sufficient information not to discourage women who would like to have a pregnancy in the future. Giselle Carvalho: Thank you. Thank you. Dr. Partridge, would you like to add some final comments on this? Dr. Ann Partridge: Yeah, I think this is just such an important issue for our young breast cancer survivors and cancer survivors diagnosed at a young age, regardless of the type of cancer. So I think paying attention to this at diagnosis and through their survivorship is critical, both for their thriving in survivorship as well as for their long term health and cancer outcomes. Getting back to that adherence issue, people, if they're unhappy, won't do all the right things for themselves, sometimes medically and emotionally. And we know that infertility can be associated with long term distress for patients with and without cancer. So we need to pay attention to this and I'm really happy that ASCO is doing a podcast on this and I'm really happy that JCO is doing a podcast on this.  Giselle Carvalho: Thank you. I really would like to thank you both, Dr. Azim and Dr. Partridge for attending this interview. This is Giselle Carvalho. Thank you for listening to JCO Article Insights. Don't forget to give us a rating or review and be sure to subscribe so you never miss an episode. You can find all ASCO shows asco.org/podcast. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.  Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement.  Dr. Azim Employment Company name: Pierre Fabre, EMERGENCE THERAPEUTICS Stock and Other Ownership Interests Company name: Innate Pharma, Diaacurate Travel, Accommodations, Expenses Company name: Novartis Dr. Partridge Research Funding Company name: Novartis Patents, Royalties, Other Intellectual Property Company name: UpToDate    

A 9-year-old female presents for well child care with her parent. She is in the 4th grade, doing well academically, plays soccer on a local team, and reports, “I have 3 best friends”. Health history per parent and child reveals no concerns. On physical exam the clinician's notes the child is at about 40th percentile height and weight for age, and has breast budding and downy, straight, slightly pigmented pubic hair long the labia majora.These physical findings are consistent with:A. Precocious pubertyB. Early onset normative pubertyC. Age-appropriate pubertal findingsD. Concern for a GNrH producing lesionVisit fhea.com to learn more!

CME credits: 0.50 Valid until: 09-08-2025 Claim your CME credit at https://reachmd.com/programs/cme/case-in-point-the-use-of-gnrh-antagonists-pre-andor-post-surgery-and-the-potential-consequences-of-repeat-surgery/24400/ While both medical therapy and surgery often play a role in a woman's journey with endometriosis, it is less clear how to best sequence these approaches to optimize a patient's outcomes. Under what circumstances should you consider using a GnRH antagonist either before or after conservative surgery? Join Drs. Lee Shulman, Ayman Al-Hendy, and James Simon as they provide their collective thoughts on how best to sequence a GnRH antagonist with conservative surgery when managing endometriosis.=

CME credits: 0.50 Valid until: 09-08-2025 Claim your CME credit at https://reachmd.com/programs/cme/pain-points-weighing-the-benefits-and-drawbacks-of-the-gnrh-antagonists-throughout-the-endometriosis-treatment-journey/24399/ GnRH antagonists have emerged as a viable first-line (or subsequent-line) medical therapy for the management of endometriosis. They have proven to be effective and safe, and their use avoids the flare response observed with GnRH agonists. Join Drs. Lee Shulman, Ayman Al-Hendy, and Sawsan As-Sanie as they discuss the estrogen threshold hypothesis from the perspective of GnRH antagonists and delve into clinical data supporting the use of GnRH antagonists in the medical management of endometriosis.=

When it comes to IVF stimulation protocols, understanding the nuances is crucial. Join Dr. Carrie Bedient from The Fertility Center of Las Vegas, Dr. Abby Eblen from Nashville Fertility Center and Dr. Susan Hudson from Texas Fertility Center for an insightful episode that delves into this complex topic. The docs discuss the various approaches to ovarian stimulation, including the differences between protocols as well as the roles of medications such as gonadotropins, GnRH agonists and antagonist. They explore the reasons for customizing protocols for individual patients, taking into account factors like age, ovarian reserve, and previous response to stimulation. This episode offers a comprehensive look at the intricacies of IVF stimulation protocols and how they are tailored to maximize the chances of success for infertility patients. Have questions about infertility?  Visit FertilityDocsUncensored.com to ask our docs. Selected questions will be answered anonymously in future episodes.Today's episode is brought to you by Path Fertility 

In this month's Fertility & Sterility: Unplugged, we examine articles from F&S's sister journals! Topics this month include biomarkers for improving sperm parameters with varicocele repair (1:42), side effects with minimal controlled stimulation with in vitro maturation (14:48), and the use of a GnRH antagonist for heavy menstrual bleeding with fibroids (33:53). F&S Reviews: https://www.fertstertreviews.org/article/S2666-5719(24)00007-0/abstract F&S Science: https://www.fertstertscience.org/article/S2666-335X(24)00029-6/fulltext F&S Reports: https://www.fertstertreports.org/article/S2666-3341(24)00073-4/fulltext View the sister journals at: https://www.fertstertreviews.org https://www.fertstertreports.org https://www.fertstertscience.org  

Hoy hablo con Andrea Ruiz. Conversamos sobre:-Lupron, que es parte de una categoría de medicamentos llamados GnRh que baja tu estrógeno a niveles menopáusicos. -como varios estudios que comparan los medicamentos GnRh con otros medicamentos hormonales muestran que todos ellos proporcionan un alivio similar de los síntomas.-como el Lupron pueden tener efectos secundarios graves, e incluso incapacitantes, a largo plazo que continúan en algunos pacientes mucho después de dejar de tomar el medicamento.Quién es Andrea Ruiz?Andrea es Presidenta de la Asociación de Pacientes con Endometriosis y Adenomiosis del Perú. Hablamos en el episodio 3 sobre la nueva ley de endometriosis en Perú y su importancia para la comunidad de endometriosis en Perú.Para contactar con Andrea:INSTAGRAM @endometriosisperuFACEBOOK: Pacientes Endometriosis Perú. https://www.facebook.com/endometriosisperu¿Quieres más información en español sobre la endometriosis?LUPRON: https://insixteenyears.com/lupron-2/MI PÁGINA WEB: www.endoenloprofundo.comINSTAGRAM: @endo.en.lo.profundo

In the intricate dance of human reproduction, a peptide called Kisspeptin plays an important role in guiding the timing of ovulation in women and the production of sperm in men. Its discovery has sparked a wave of excitement in the field of reproductive medicine, offering new insights and potential treatments for those facing fertility challenges.  In this podcast, we'll talk about how kisspeptin works for fertility issues and much more. What is Kisspeptin? Kisspeptin is a neuropeptide that plays a vital role in reproduction, sexual behavior, and attraction. It enhances brain activity linked with sexual arousal and attraction while also prompting the release of gonadotropin-releasing hormone (GnRH) from the hypothalamus. This, in turn, triggers the pituitary gland to release luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which are crucial for testosterone and estradiol production. The controlled stimulation of LH and FSH by Kisspeptin offers a potential advantage over mainstay fertility treatments. This is because it may reduce the risk of ovarian overstimulation often associated with hormonal injections. Because of this, Kisspeptin is currently being studied as a promising alternative to current fertility treatment protocols. Moreover, Kisspeptin's ability to elevate LH and FSH levels may hold promise for men undergoing testosterone replacement therapy (TRT) programs. In cases where exogenous testosterone has led to decreased LH or FSH levels, Kisspeptin could offer a solution to restore hormonal balance. How Does Kisspeptin Work for Fertility Issues? Kisspeptin exerts its effects on fertility primarily through the hypothalamic-pituitary-gonadal (HPG) axis, a complex network of interactions between the brain and reproductive organs. In women, kisspeptin stimulates the release of gonadotropin-releasing hormone (GnRH) from the hypothalamus, which then triggers the secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) from the pituitary gland. These hormones, in turn, regulate the menstrual cycle and ovulation. In men, kisspeptin plays a similar role in stimulating GnRH release, which then prompts the production of LH and FSH, essential for spermatogenesis and testosterone production. Thus, kisspeptin is crucial for both female and male fertility. Utilizing Kisspeptin in Fertility Treatments: For individuals experiencing fertility issues, especially those related to irregular menstrual cycles or anovulation (lack of ovulation), kisspeptin has emerged as a promising therapeutic option. In clinical settings, synthetic forms of kisspeptin are administered via injection to stimulate the HPG axis and induce ovulation in women or improve sperm production in men. Common Kisspeptin Side Effects: While kisspeptin therapy is generally well-tolerated, like any medication, it can cause side effects. Common side effects may include: Injection site reactions: Pain, swelling, or redness at the injection site. Nausea or vomiting: Some individuals may experience gastrointestinal symptoms following kisspeptin administration. Headaches: Mild to moderate headaches have been reported in some cases. Hot flashes: Temporary episodes of feeling flushed or overheated may occur. It's important to note that the occurrence and severity of side effects can vary among individuals, and not everyone will experience them. Thanks again for listening to The Peptide Podcast. We love having you as part of our community. If you love this podcast, please share it with your friends and family on social media, and have a happy, healthy week! We're huge advocates of elevating your health game with nutrition, supplements, and vitamins. Whether it's a daily boost or targeted support, we trust and use Momentous products to supercharge our wellness journey.  Momentous only uses the highest-quality ingredients, and every single product is rigorously tested by independent third parties to ensure their products deliver on their promise to bring you the best supplements on the market. 

High Yield Endometriosis ReviewReview for your PANCE, PANRE, Eor's and other Physician Assistant exams.TrueLearn PANCE/PANRE SmartBank:https://truelearn.referralrock.com/l/CRAMTHEPANCE/Discount code for 15% off: CRAMTHEPANCE Merchandise Link: https://cram-the-pance.creator-spring.com/►Paypal Donation Link: https://bit.ly/3dxmTql (Thank you!)Included in review: Endometrioma, Contraceptives, GNRH Analogues, GNRH agonist, GNRH antagonist, Danazol, Chocolate cyst, Dysmenorrhea, Dyspareunia, Dyschezia, Infertility.

This episode is for you if you're new to learning about your cycle, your hormones, and how it all works. Bridget walks through the basics of:- Normal cycle lengths, bleed lengths, and cycle length variations- The four phases of the menstrual cycle- Estrogen and progesterone: what they do and how they shift- Why ovulation is the most important event in the cycleIf you've been here before and are more savvy on how your hormones fluctuate, this episode can still be a great refresher for you. Referenced episodes for a deeper dive:2. Getting Familiar with Cycle Syncing7. Estrogen & Why It's Critical for Your Cyclical Health8. Progesterone: the hormone you don't want to miss9. GnRH, FSH, LH - Hormones that Help Us Ovulate10. Testosterone: A hormone essential for your cycle too11. Part 1: Common Symptoms of Hormone Imbalance12. Part 2: Common Symptoms of Hormone Imbalance27. Cervical mucus: why, when, how much, and who caresReferenced freebie:Cycle Syncing Guidelines (Downloadable)Limited time offer: APPLY FOR MY COACHING BETA PACKAGE- Who's this beta group for? Menstruators with period pain, missing or irregular periods, bleeds that are less than two days or more than seven days, or another hormone/menstrual cycle related concern- What is it? A complementary three-month hormone coaching package where you and I work together 1:1.- When does it close out? As soon as all ten slots are filled. Connect with Bridget on Instagram Learn more at bridgetwalton.comIf you're interested in working with Bridget 1:1 to overcome your period pain and irregular cycles and take charge of your fertility, click this link to connect and set up a discovery call. If you want to support this podcast, follow this link to Buy Me a Coffee. Your support will help cover the cost of: podcast hosting platform fees, equipment, and transcription services.

In this episode, I'm going to be talking about five things that could be sabotaging your fertility efforts to conceive. And a lot of these things may not be so obvious to a lot of people,    I will be covering:   Why too much of a good thing isn't so great for your fertility health (you'll find out what I mean!) The importance of sleep and how to regulate it if you're having trouble. Why many fertility disruptors can be hiding in your kitchen and ones that even fooled me! Important times to eat during the day and why!   For more information about Michelle, visit www.michelleoravitz.com   For more information on fertility diet, you can pick up my free fertility diet ebook in the notes. https://www.michelleoravitz.com/fertility-diet   The Wholesome FertilityFacebook group is where you can find free resources and support: https://www.facebook.com/groups/2149554308396504/   Instagram: @thewholesomelotusfertility   Facebook: https://www.facebook.com/thewholesomelotus/   Links mentioned in this episode:   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5457858/ https://www.ewg.org https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4350886/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7400274/   [00:00:00] Could these five things be sabotaging your ability to conceive? In this episode, I'm going to be talking about five things that could be sabotaging your fertility efforts to conceive. And a lot of these things may not be so obvious to a lot of people, So stick around.   So number one is over exercise. So while exercise is something that is really good for the body and it can actually improve fertility health. If a person is overweight or if they have not exercised before, it can improve your lymphatic movement, your blood circulation. And increase your overall energy. However, if you over exercise, too much of a good thing is not so good. So while exercise is amazing for the body, in some cases, over exercise has been shown to adversely impact reproductive health. So studies have confirmed that over exercising could [00:01:00] impact menstrual cycle irregularities and ovulation. or, amenorrhea, which is when your period completely stops.   There was one study done where women underwent a really intensive training for military camp. And what they found was that 68 to 98 percent of them who started out to have regular periods, ended up becoming irregular after the training. So what's been observed with over exercise is that it impacts the luteal phase. So it can cause luteal phase defect in the menstrual cycle, which means that the second part of the cycle, which is after ovulation is shorter than it should be. And the reason that is so important not to happen, is because it's a really important time for implantation to occur. And if it's too short, it doesn't allow for that pregnancy to take place. Over exercise can also increase cortisol and cortisol tends to compete with progesterone, [00:02:00] which is why it can impact the luteal phase since progesterone is the main hormone. that increases around the luteal phase. And it's a really important hormone, not only for pregnancy to occur, but also to support pregnancy, they also found that ovulation hormones such as GNRH, FSH and LH, as well as estradiol were suppressed, and that led to an ovulation, which means that they were not ovulating. And that is why over time it can either make the periods irregular or take away the periods altogether.   And as you know, you need to ovulate in order to get pregnant otherwise you're not going to have an egg to fertilize. So that is one of the reasons why overexercising can really impact the body is because it causes a lot of stress on the body. When the body experiences a lot of stress, it also increases cortisol, which is a stress hormone. Cortisol tends to compete with progesterone, which is a really important [00:03:00] hormone, but also the body overall is in a deficit of energy. So this could be also under eating. or over exercising, then it doesn't have enough reserves to ovulate and to have the menstrual cycle or to put it towards reproductive health. And I've talked about this before, is that reproductive health really, in essence, is a reflection of overall health. And in order to have a robust reproductive system, the body has to have enough energy and reserves in order to support it because pregnancy takes a lot of energy. And if it doesn't have enough energy and also enough blood to support it, then it is going to put that off to the side and worry more about survival because it's going to. focus whatever energy it has, if it's at a deficit, it's not going to spend too much. It's going to conserve its spending, which in essence, the spending is towards reproductive health.   It's going to conserve the spending so that it can focus more on overall health. So here's another thing [00:04:00] that I'm going to mention is that really this depends on the person and the body weight. So if somebody , is overweight and has a lot of reserves and energy that's really not being used and has been stored, then they benefit with a higher intensity workout. And even with that, not too much, but they can afford to do that because then their body will increase its energy and also decrease insulin resistance. So it actually can help in certain circumstances to increase it a little bit, nothing overdone, but like a little bit extra exercise in certain cases is important. But for women who have a normal body weight and they over exercise, then that can bring them at a deficit. So you look at it like an energetic bank account. We don't want to decrease that bank account, that reserve of energy, because we need that reserve in order to reproduce. So in order to create new life, you're kind of having an extra, an extra something, it's important that the body's able to support that.   So what is considered too much? So [00:05:00] anything more than seven hours, seven hours or more of aerobic exercise per week and moderate exercise is ideal, which is one to five. Hours per week and one to five hours per week has been shown to improve fertility. So it's important to keep it within a healthy range and not do too much. And nowadays, a lot of the gyms, they do very high intensity workouts and it's not the end of the world. If you like to do that once in a while, however, doing it every single day and sometimes even doing two. different times of exercising or just really overdoing it that can definitely tax the body and when the body feels taxed and There's too much of a deficit.   It starts to feel anxious So the body itself starts to feel like it needs to go into survival mode and what happens cortisol goes high Because it's a stress on the body So yes exercise can be a stress and a deficit of energy can feel like a stress Because then [00:06:00] the body's like, oh what's going on? I need to like, really. Hit the reserves or slow down my energy output and what that equates To is that we can't worry about reproducing right now so typically that is how over exercise can impact the reproductive health so Number two is plastics and i'm sure you've heard about this plastics. Yes. We know that it's not great for the body obviously but a lot of people don't realize that plastics can be hiding out in places that you least expect it. So the obvious ones are plastic bottles, you'll see that everywhere. A lot of people avoid them. You'll see people with glass bottles or stainless steel bottles. And listen, I know this, but sometimes I use plastic bottles when we're away. So all of what I'm saying doesn't have to be done to an extreme. And if it's too stressful, then that causes a whole other chain of events in the body as well. So it's not that you have to [00:07:00] completely avoid it, but for the most part, there are certain things that you really should watch out for. And first things first, did you realize that a lot of sanitary pads Have plastic and that is in the very precious area of your body and you're in there and your blood and you're open when you're having your period, your lining is more open and you're more susceptible to absorbing things when you have your period.   So it's important to find sanitary pads that are using organic cotton or a non toxic. And there are a lot of great. Brands out there. Same thing with tampons. You're sticking 'em up there. And you wanna make sure that it doesn't have any toxins or endocrine disruptors or chemicals that can impact your hormones. Here's another one. This is something that a lot of people don't pay attention to, and it was including me until I found out, and I was shocked when I found out, was tea sachets. And they're so pretty looking. I remember when regular normal [00:08:00] bags of tea it went from something really flat and boring to something that's three dimensional and really pretty and shiny. And guess what? The reason why it's shiny is because it has plastics and that plastic and that sachet can leak out a lot of nano particles of plastics in the hot water. Because as we know, many plastics are not supposed to be microwaved.   Well guess what? The heat itself leaches plastic. So when you put that in really, really hot boiling water, what do you think happens? It gets into your whole tea that you're about to drink. On a similar note, you'll find a lot of coffee makers have plastic. You'll find coffee pods that are plastic, and you're putting it in this hot coffee maker, and they're in a plastic container. And the coffee machine itself, or even like the machine that doesn't have the pods, goes through. Plastic. So it's hot water that goes through plastic. So those are things to pay attention to. Even an electric [00:09:00] tea kettle, a lot of them have plastic on the top. So there are ones that are just made with stainless steel. Those are things to pay attention to. Another thing that is very , commonly used, and I didn't pay attention to this right away.   And I knew this stuff are cutting boards and a lot of cutting boards are made with plastic. So that's a whole other thing. And you're cutting on those boards and you're cutting tiny pieces of plastics and putting them in your food and then taking that and heating it up.   So imagine infusing plastics into your food and why is plastic so bad? it's because plastic is an endocrine disruptor. It has chemicals that disrupt your hormones. And BPA was one of the chemicals and it was focused on a lot. And then they had other plastics, which is a marketing thing. Other plastics where they said BPA free. Why? Because they found out BPA was very much [00:10:00] impacting hormones, but not just hormones, but it also contributed to birth defects. So imagine this is just one that has been discovered, but there's probably a lot more when something leeches into your food, it's just not good.   You don't want anything leeching in your food. You want tools to stay tools and not to eat your tools. So it's important to have. Materials that are not going to leach and that can withstand the heat.   Here's another one. , it's a shocking one because again, this totally bypassed my mind. I never thought about this, but have you ever thought about those disposable coffee cups? Yes, they're made of paper, but what causes that paper not to crumble? And to get wet plastic, so there's a plastic lining that prevents the hot water from degrading the paper cup around it. So that is plastic that is getting exposed to very hot water so this is another thing that most people[00:11:00] don't realize, but it actually does leach out nanoparticles of plastic. And again, the endocrine system in the body is super sensitive and it works like a thermostat where it finds that something. It gets high, it's going to lower its own ability to produce it.   So a lot of times plastic can confuse the body and the body will think it is an estrogen. It's called xenoestrogens and it can cause the body to get confused and that can cause a cascade of events, not so good events that can impact your reproductive system. So what can you do? So I know this sounds overwhelming at first but all you have to do really is just take out some time at first and Eventually, it's gonna be a lot easier once you come up with a plan So take some time look through your kitchen and see what kind of products are possibly leaching or possibly not and to get help with that you can visit ewg. org and I'll have [00:12:00] that in the notes below. And that is a great resource. They look at different products. They look at different, chemicals and they rate products based on. How safe they are and how non toxic they are. So it's a great resource that is easy to get. And there are a lot of other apps out there that you can find as well. I remember think dirty was a great one. You can find, different products and look them up and see what is good and what is not so good.    But EWG is a great resource that you could pretty much look up anything. And they also have EWG certified products that you can find that they have looked into and saw that they were safe and they're safe enough where they are ready to put their stamp behind it. So once you do a little homework. On that, it's going to get a lot easier because then all you do is just reorder certain products and the prices are not that much of a difference and it's just so worth it because ultimately the price for your reproductive [00:13:00] health is higher than anything else.   So, number three, inadequate sleep. It sounds obvious, you know, sleep is important, but people don't realize just how important it is. Besides not being able to function with sleep, there's so many other things that sleep does for you that we don't even realize, especially for our reproductive health and our hormone balance. And it also goes back to that whole energy deficit. It's important to have enough energy for your body. And one of the ways that we restore our energy is through sleep. So the sleep wake cycle or circadian rhythm impacts the menstrual cycle and the ovulatory function. Think of this as a pulse. So it's kind of like a pulse from nature. We get the pulse of lights and then we have our own pulse where we have our own rhythm , of rest and awake.   In the morning, we'll have a rise in cortisol at night. We have a rise of melatonin. And so there's this pulse that happens within our body within our 24 hour clock. And that pulse ripples [00:14:00] into our menstrual cycle and our own internal rhythms.   So sleep is vital for hormone production, but it's also vital for lowering cortisol, because if you don't sleep enough, cortisol rises. And as we know, cortisol likes to compete with progesterone, so it can really impact your menstrual cycle function.  Keep in mind that you want to balance out sleep. So you don't want to sleep too much because sleeping too much isn't great either Sleeping too little isn't great. Anywhere from eight to nine hours of sleep per night is ideal so what can you do? In order to have good sleep hygiene, you want to get some sunlight early in the morning because one of the ways that our brains know night from day is by light. So when you perceive the light during the day, that anchors your circadian rhythm and helps you sleep at night and produce more melatonin at night.   Another thing that you can do is start to dim the lights as it gets closer to evening. So you want to dim the lights a couple of hours before [00:15:00] you go to sleep, or just make them a little lower, nothing too bright. And if you are in front of devices, you can get Something called blue light blockers, which are sunglasses. Well, they're not sunglasses, they're glasses that block out the blue light and they make everything look yellow. And that helps your brain because the blue light actually wakes up your mind and it makes you think that it's daytime. You might also want to have your sleep time routine. So things like diffusing lavender oil giving yourself a little self massage, reading a book, having some warm herbal tea are things you can do to ease yourself into better sleep.   So number four, and I see this a lot in my practice and I never hesitate to let my patients know. I just don't love it. And this is wearing your radiation. I see this with smartwatches or people putting their phones on their bodies so here's the thing when it doesn't have wires, it's got waves.   So the wires help the energy [00:16:00] to move, but then if it doesn't have that, it's got waves and those waves impacts your own energetic body. This isn't good for men or women. Cell phones have been shown to increase radiation and they emit invisible waves that your body does perceive on an energetic level. When they're close to our bodies, we are receiving that wave. We are absorbing those waves. These waves have been shown to influence your sleep, and they've been shown to influence your brain activity as well.   And I will link to that study in the notes. And TCM, traditional Chinese medicine, talks about our bodies and how they run on this vital life force energy So this energy that we have, it responds to our environment, and this is one of the reasons why nature is so beneficial. And when we have a disruption of that, of something that is not really natural and is foreign to the body and the body doesn't really know what to do with it, it disrupts your energetic patterns.  So yes, [00:17:00] technology can make things very convenient, but it comes with a cost, and it's important to protect your natural energetic frequency. So what can you do? So one of the things that I recommend is keep your phone outside of your room.   And if you have it in your room as an alarm clock, turn it on airplane mode. And if you absolutely can't do that for whatever reason, keep it away from your bed as far as you can. Also avoid putting things on your body that are cordless, that run on energetic frequencies, that are invisible.   Another thing that you can do is grounding. So putting your feet on the earth or on a grounding mat can help absorb those energetic frequencies in the body. So it's one way to clear out our body's frequency and also walking outside, being in nature, having that connection with nature and really connecting, even touching trees, because trees are, if you look at them with their roots in, they go into the earth too.   They use that energy that the earth provides. Something else that I [00:18:00] recommend is shungite, it's a type of stone that has a lot of carbon, it's carbon rich, and it's been shown in a study with rats to lower radiation in the body,  and because it's carbon rich, it absorbs and neutralizes the radiation. So lastly, number five, and this is a huge one, is skipping breakfast. So from an Ayurvedic perspective, when the sun comes up. Our bodies are primed to digest, so the sun reflects our internal state of Agni. Our fire increases as it's daytime, so our bodies are primed to eat.   And skipping meals, especially breakfast, which is a very important meal to prep your body so that it has energy for the day. It can increase cortisol as well. So again, this is a third thing that can increase cortisol and cortisol competes with progesterone, a very important hormone for conception.   Skipping breakfast can also lead to weight gain. And there was a study that was done observing college students that were skipping [00:19:00] breakfast and it's been shown that young women that were skipping breakfast had a correlation with menstrual cycle irregularities. I will put that study in the notes as well. So Ayurvedic practices encourage eating during the day and slowing that eating down as the sun goes down.   So during the day, and especially in the afternoon, that is when the body is primed to eat its largest meal. So our own internal acne, which is our digestive fire, is increased by responding to nature's fire, which from 12 to two is the highest when the sun is out.   So unlike what is frequently done with intermittent fasting, which tells you to skip breakfast. And by the way, was mostly studied on men and not women. And. Instead of skipping breakfast to do that, you can actually, if you'd like to fast fast when the sun goes down. So three or four hours before you go to sleep is ideal and it helps you to have better [00:20:00]sleep and it allows your body to rest fully. in that fasting state so that it's not focused so much on digestion, which takes a lot of energy. And then you can focus more on hormone balance and all the benefits that you can get from restorative sleep.   So what should you do? So I often suggest eating a balanced breakfast that includes proteins, healthy fats, healthy carbs, and fiber. So an example can be Eggs and spinach along with an avocado smash on buckwheat toast or full fat yogurt because full fat dairy is better. And has been shown to be healthier for fertility health with berries and granola and nuts and seeds. So there you have it. Those are five things that can possibly be sabotaging your fertility health. For more information that can help you improve and boost your fertility health, be sure to subscribe to this podcast.   Thank you so much for joining me today [00:21:00] and I'll see you next time.

Many aspects play a role in our body-mind health balance and may contribute to the trajectory of medical conditions. Women's health issues frequently, remain undetected or mistakenly diagnosed. One of these issues, which affects an estimated of 10% women globally, endometriosis. It has enormous implications on the quality of a woman's life. This severe inflammatory condition occurs  globally in 190 million women of reproductive age (1). Endometriosis can cause constant and intense pelvic pain, especially during periods, fatigue, depression, anxiety, and infertility. Endometriosis is the cause of 70% of all chronic pelvic pain cases in women in the United States (2). The cost of illness burden is significant in women with chronic pelvic pain, particularly the productivity costs (3). They are the greatest contributor to overall costs. Given pain is the most significant contributor, priority should be given to improving pain control in women with pelvic pain (4).   It is a chronic disease associated with severe, life-impacting pain during periods, sexual intercourse, bowel movements and/or urination, chronic pelvic pain, abdominal bloating, nausea, fatigue, and sometimes depression, anxiety, and infertility. There is currently no known cure for endometriosis and treatment is usually aimed at controlling symptoms. Access to early diagnosis and effective treatment of endometriosis is important, but is limited in many settings, including in low- and middle-income countries (5). Treatment Treatments to manage endometriosis can vary based on the severity of symptoms and whether pregnancy is desired. No treatments cure the disease. A range of medications can help manage endometriosis and its symptoms. Non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics (painkillers) like ibuprofen and naproxen are often used to treat pain. Hormonal medicines like GnRH-analogues and contraceptive (birth control) methods can also help control pain. These methods include: pills hormonal intrauterine devices (IUDs) vaginal rings implants injections patches References     References https://www.ox.ac.uk/news/2023-03-14-global-study-shows-experience-endometriosis-rooted-genetics#:~:text=Endometriosis%20has%20enormous%20implications%20on,depression%2C%20anxiety%2C%20and%20infertility. Payne JA. Acupuncture for Endometriosis: A Case Study. Med Acupunct. 2019 Dec 1;31(6):392-394. doi: 10.1089/acu.2019.1379. Epub 2019 Dec 13. PMID: 31871528; PMCID: PMC6918512. Armour M, Lawson K, Wood A, Smith CA, Abbott J. The cost of illness and economic burden of endometriosis and chronic pelvic pain in Australia: A national online survey. PLoS One. 2019 Oct 10;14(10):e0223316. doi: 10.1371/journal.pone.0223316. PMID: 31600241; PMCID: PMC6786587. https://www.who.int/news-room/fact-sheets/detail/endometriosis https://www.endometriosis-uk.org/endometriosis-facts-and-figures @drschwank @unesurcent @optimalperformancezurich

Why does it really matter which GnRH agonist or antagonist you choose for your patient, and how can you use the latest data to inform this decision? Credit available for this activity expires: 3/15/25 Earn Credit / Learning Objectives & Disclosures: https://www.medscape.org/viewarticle/1000411?ecd=bdc_podcast_libsyn_mscpedu

DSD 5.3 | Slight modifications of CIDR Sync - help or hinder? In this time of heifer inventory shortage – getting heifers pregnant (in a timely fashion) is even more important than ever. Contract heifer growers in California sought the help of Dr. Fabio Lima and his team at UC Davis to best understand the use of a 6-day CIDR sync with variable rates of GnRH could increase pregnancies when bred to sexed semen. The findings we discuss are published in the recently released Journal of Dairy Science article titled: Effect of 200 μg of gonadorelin hydrochloride at the first GnRH of a CIDR Synch program on  ovulation rate and pregnancies per AI in Holstein heifers. Listen in to hear the results and nuanced details of controlling reproductive structures using timed AI protocols. Topics of discussion 1:03       Production costs of heifer rearing - survey results 2:09       Introduction of Dr. Fabio Lima 3:46       Description of the project 4:20       TAI protocol description 5:31       Varying GnRH dose 6:34       What is the function of GnRH in the heifer? 7:51       Hallmark of a successful synchronization 8:24       Results of ultrasound (ovulation) and P4 blood sample analysis 10:04    Did increased ovulation translate into improved pregnancy outcome? 10:44    Pregnancy at d47, 100% sex semen discussion 13:41    Relationship of Luteinizing hormone and progesterone 15:16    What causes elevated circulating progesterone 16:30    How did we land on 2cc of GnRH to begin with? 18:34    Does increased GnRH cause increased twinning?              21:02    What do you want boots on the ground dairymen to know 23:01    What if you cherry picked? 23:32    Sometimes the plan doesn't work – but that's why we do research! Featured article: Effect of 200 μg of gonadorelin hydrochloride at the first GnRH of a CIDR Synch program on  ovulation rate and pregnancies per AI in Holstein heifers Articles also discussed in the podcast: Heifer study using 100 and 200 ug in 5-d CIDR Synch protocol. https://doi.org/10.1016/j.theriogenology.2023.04.026 Studies showing the implication of progesterone for double ovulation (a proxy for twining) and progesterone. https://doi.org/10.3168/jds.2018-14410       #2xAg2030; #journalofdairyscience; #openaccess; #MODAIRY; #gnrh; #CIDRsync; #twinning; #pregnancy; #heiferdevelopment; #TAI; #lutenizing; #dairysciencedigest; #ReaganBluel;

If there's an episode on endometriosis you don't want to miss, it's this one. Known for her honesty and rigorous research in the endometriosis space, Katie Boyce is the person people turn to when deciding fact from fiction. On this topic, Katie unpacks the latest medication on the scene in Australia - Ryeqo - and how it's not all its cracked up to be. Through this episode you'll learn: - What's the difference between GNRH-agonists vs GNRH-antagonists - How the pill compares to these medications - Why hormonal medications don't address endo - How testosterone could be the next thing in endo support - Why the "retrograde menstruation" idea won't go to bed (and the alarming reason some researchers still depend on it) - Exploring other hypotheses for what causes endo - And sooo much more SHOW NOTES: Katie's Instagram: instagram.com/endogirlsblog www.endogirlblog.com FB Group with Endo Specialists: https://www.facebook.com/groups/naturalmedicineforendo/ The Endo Care Collective: https://courses.jadewalker.com.au/endo-care-collective Hey Sister! https://heysister.com/collections/hey-sister (discount applied automatically) --- Send in a voice message: https://podcasters.spotify.com/pod/show/the-jade-walker-way/message

Hoy hablo con el Dr. José D. Eugenio-Colón. Nos explica:-el papel que juega el estrógeno y la progesterona durante el ciclo menstrual.-qué hace la supresión hormonal para endometriosis y qué no hace.-los diferentes tipos de supresión hormonal, como los anticonceptivos, las progestinas, los medicamentos GnRh, y el DUI.¿Quién es el Dr. José D. Eugenio-Colón? Es un cirujano que brinda atención quirúrgica mínimamente invasiva para el tratamiento del dolor pélvico y la endometriosis. Se especializa en cirugía de escisión con láser y utiliza esta como el principal tratamiento quirúrgico para la endometriosis. Sus intereses en investigación incluyen el dolor pélvico, el tratamiento de la endometriosis basado en evidencia científica y de múltiples especialidades, así como el desarrollo de algoritmos para el tratamiento y seguimiento de la endometriosis. En EEUU, Dr Eugenio-Colon trabaja en el Center for Endometriosis Care. En República Dominicana, Dr. Eugenio-Colon forma parte del equipo de Ginecología y Obstetricia EFS, ubicado en Medical Net, Santo Domingo. Es miembro de la Asociación de Laparoscopistas Ginecológicos (AAGL) y miembro del Colegio Estadounidense de Obstetricia y Ginecología (ACOG). Dr. Eugenio-Colon está interesado en mejorar el acceso médico en la comunidad latinoamericana, así como el turismo médico.Para contactar el Dr Eugenio-Colon:INSTAGRAM @drendometriosisCENTER FOR ENDOMETRIOSIS CARE en EEUU: 770-913-001MEDICAL NET A en Santo Domingo: 809-368-3111Para más información en español sobre la endometriosis, ve a mis recursos:MI PÁGINA WEB: www.endoenloprofundo.comINSTAGRAM: @endo.en.lo.profundo

“Intersex” is often considered part of the “LGBTQIA+” community. But how do people with this condition feel about their inclusion that category?The more accurate and respectful term, “disorders of sexual development,” encompasses more than 40 different medical diagnoses. Today's guest, James Linehan, has one such DSD. Undiagnosed until age 16, hypogonadotropic hypogonadism prevented James from experiencing normal puberty. James had to undergo extensive treatment, and will forever remain a lifelong medical patient, causing a cascade of impacts on his mind, body, and relationships.James' lived experiences give him a unique perspective on today's fraught gender wars. After decades of living with his condition, James learned that his unique form of suffering is now being needlessly inflicted on vulnerable, otherwise physically healthy youth. Puberty blockers (GnRH agonists, such as Lupron), which are now commonly prescribed off-label to gender-questioning youth, induce conditions like James', raising major ethical concerns.Today we break down myths vs facts of DSDs and address what happens when identity politics and culture wars seek to appropriate real medical conditions faced by truly disadvantaged minorities. James expresses his frustration with the politicization of these conditions and the misrepresentation of the experiences of individuals with disorders of sexual development. We discuss the impact of his condition on fertility, relationships, and mental health.Throughout the episode, James challenges misconceptions and encourages listeners to approach these topics with empathy and a willingness to learn. James's story sheds light on the complexities of living with a disorder of sexual development and the resilience required to navigate the medical and emotional challenges associated with it.James Linehan is an IT and AI consulting professional with a background as an instructional resource specialist and an adjunct lecturer in sociology. He has a disorder of sexual development called hypogonadotropic hypogonadism, which he has been managing, medically, and learning about for over 40 years. James is passionate about raising awareness and understanding of diverse disorders of sexual development beyond the limited representation commonly discussed. He emphasizes the exploitation of individuals with DSDs and advocates for informed consent and ethical medical practices. He criticizes the politicization of intersex conditions and the distortion of narratives by trans activism. He wishes to share this long-term study about his condition, emphasizing that it is important to understand that Lupron causes iatrogenic hypogonadotropic hypogonadism. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4380912/Episode mentioned:30. Surviving Gender Malpractice: Brian's Detransition StoryArticle on Lisa Selin Davis' blog: My Body is a Puberty Blocker00:00 Start00:04 Medicalization and human rights04:28 Being politicized as a medical condition09:03 Learning disabilities and neurologic problems15:06 The good old days19:09 Medically induced puberty24:06 Infertility and treatment drawbacks26:09 Painful and messy pellet injections30:41 Puberty blockers and inadequate penile tissue38:05 Emotions during puberty41:15 Missed adolescent development43:39 Infertility and relationships49:57 Misinformation about transgender and hormones52:39 Developmental disorders in gender dysphoria56:43 Hormones and child development01:02:07 Replicating Mother Nature's cocktail01:07:23 XX males and biological sex01:10:27 Trauma of medicalization and fertility01:15:17 Ambitious doctors and unethical practices01:21:10 Endocrinologists and growth hormones01:24:38 Attempt to convert gay males To support this show, please leave a rating & review on Apple, Spotify, or wherever you get your podcasts. Subscribe, like, comment & share via my YouTube channel. Or recommend this to a friend!Learn more about Do No Harm.Take $200 off your EightSleep Pod Pro Cover with code SOMETHERAPIST at EightSleep.com.Take 20% off all superfood beverages with code SOMETHERAPIST at Organifi.Check out my shop for book recommendations + wellness products.Show notes & transcript provided with the help of SwellAI.Special thanks to Joey Pecoraro for our theme song, “Half Awake,” used with gratitude and permission.Watch NO WAY BACK: The Reality of Gender-Affirming Care (our medical ethics documentary, formerly known as Affirmation Generation). Stream the film or purchase a DVD. Use code SOMETHERAPIST to take 20% off your order. Follow us on X @2022affirmation or Instagram at @affirmationgeneration.Have a question for me? Looking to go deeper and discuss these ideas with other listeners? Join my Locals community! Members get to ask questions I will respond to in exclusive, members-only livestreams, post questions for upcoming guests to answer, plus other perks TBD. ★ Support this podcast on Patreon ★

Over the past 30 years the reproduction status of dairy has improved substantially, largely due to research around reproduction synchronization. This month we talk to Dr. Paul Fricke and Megan Lauber from the University of Wisconsin, about their recently released paper titled: Effect of postpartum body condition score change on the pregnancy outcomes of lactating Jersey cows inseminated at first service with sexed Jersey or conventional beef semen after a synchronized estrus versus a synchronized ovulation. We discuss the how to maximize the equation of fertility, through management. Once optimized, you'll find your herd entering the “high fertility cycle”. When all the stars align, production is high – disease is low and you are able to begin to stack reproductive technologies – such as genomically determined breedings using sexed and beef semen use following the ideal synchronization. Listen in to learn how to get your herd there and the physiology behind it.   Topics of discussion 1:54       Introduction of Dr. Paul Fricke & Megan Lauber 4:23       Objectives of the trial – stacking reproductive strategies 3:34       On farm monitoring – data collected 6:10       Getting all the cows on day 7 – the key to unlocking fertility 7:44       The history of Luteolysis – why is it so critical? 9:57       Rate limiting step of pregnancy 12:03     2019-2021 xx and beef semen usage 13:54     Research protocols and design 16:20     Equation of reproduction; comparing double ovsync vs estrus        17:50     Estrus or Double ovsync for Sexed semen 16:14     Day 19 – 40 pregnancy loss 17:30     What's happening when the GnRH shot is given? 22:13     The impact of Body Condition Score (BCS) change on fertility | >0.5          24:53     High fertility cycle 25:52     Not all cows loose condition through transition, those that did were impacted 26:38     Results: Double ovsync helps mitigate poor transition (Figure 4) 29:09     Why does it work? What physiology controls it? 30:15     Fat regulates GnRH?! 32:30     What do you want dairy producers to know from your research Featured article: Effect of postpartum body condition score c hange on the pregnancy outcomes of lactating Jersey cows inseminated at first service with sexed Jersey or conventional beef semen after a synchronized estrus versus a synchronized ovulation. Also mentioned in the discussion: Characterization of semen type prevalence and allocation in Holstein and Jersey females in the United States   #2xAg2030; #journalofdairyscience; #openaccess; #MODAIRY; #reproductionrevolution; #highfertilitycycle; #Ovsync; #DoubleOvSync; #transition; #transitiondairy; #dairysciencedigest; #ReaganBluel

"Hormones that help us ovulate" is the nicer way of saying "gonadotropin releasing hormone, luteinizing hormone, and follicle stimulating hormone" which are the three hormones that we'll focus on today. This is the third edition of this mini series where we dive into the main characters as far as sex hormones go. Because GnRH, LH, and FSH are a bit more straightforward than our friends progesterone and estrogen, this episode is a bit shorter and sweeter.In this episode, I announce that I'm looking for women who want to work with me one-on-one to improve their hormone balance. I'm really excited to get to know some of you! If you're experiencing irregular cycles or unruly periods, reach out to me through this link here. Fun fact: the coaching will be at no cost to you! All I'll ask for in return is your honest feedback as I validate the systems and processes that I've got in place so I can make sure that everything I've set up so far is smooth and works well for you (and the clients who come after you!).Listen in to hear about:- Bridget's recommendations for hormone balance while you're traveling- How GnRH, LH, and FSH support the menstrual cycle- What makes these alphabet soup hormones get out of balance- Practical tip: set aside time to identify the stressors in your life and make a plan to mitigate what can realistically be mitigated. Your nervous system will thank you.Connect with Bridget on Instagram Learn more at bridgetwalton.comIf you're interested in working with Bridget 1:1 to overcome your period pain and irregular cycles and take charge of your fertility, click this link to connect and set up a discovery call. If you want to support this podcast, follow this link to Buy Me a Coffee. Your support will help cover the cost of: podcast hosting platform fees, equipment, and (coming soon!) transcription services.

Fertility & Sterility on Air brings you some great interviews from ASRM 2023 in New Orleans, LA! In Part 1, we discuss science with leaders in the field and presenters from the conference. Topics include rates of vasectomy after the overturn of Roe v. Wade (Jessica Schardein) (1:11), ultrasound-guided ovarian ablation for PCOS (Karl Hansen) (6:32), intramyometrial carboprost for hysteroscopic myomectomy (Sarah Capelouto Cromack) (16:47), platelet-rich plasma and endometrial quality (Wael Elbanna) (25:09), oral GnRH antagonist for ovarian suppression in IVF (Marco Mouanness) (36:56), use of a microfluidic sperm selection device and blastocyst formation (Robert Rydze) (47:05), and risk of adverse maternal outcomes with fertility treatment across racial and ethnic populations (Sara Phillips) (55:59). View Fertility and Sterility at https://www.fertstert.org/  

Commentary by Dr. June Wha Rhee

Advances in ADT Part II: A Guide for Urologists CME Available: https://auau.auanet.org/node/39385 LEARNING OBJECTIVES After participating in this educational activity, participants will be able to: 1. Recognize and characterize different disease states for advance prostate cancer including M0 HSPC, M1 HSPC, M0 CRPC, and M1 CRPC. 2. Discuss the role of a multidisciplinary shared team approach for the diagnosis and management of advanced prostate cancer. 3. Facilitate discussions with patients and caregivers regarding treatment intensification for advanced prostate cancer. 4. Identify the role of combination therapy with ADT and additional systemic therapy to yield optimal survival outcomes for metastatic prostate cancer. 5. Differentiate mechanisms of action and side effects when ADT is delivered via GnRH agonists vs. antagonists. ACKNOWLEDGEMENTS Independent educational grant support provided by: Myovant Sciences LTD Pfizer, Inc.

Geoff Johnson, a qualified vet from Cambridge University, and subsequent Homeopath, guests on this episode, sharing his journey to Homeopathy, and holding the status of being the only person qualified in veterinary and human homeopathy circa 2001. Geoff has a wealth of knowledge and has completed the dynamis course with Jeremy Sherr and studied extensively with Dr. Bhawisha & Shachindra Joshi, Dr. Rajan Sankaran and Dr. Jan Scholten. Spurred on by his interest in the origins of chronic disease, based around the concept of the separation of yin and yang, Geoff conducted the provings of testosterone, progesterone, LH, GNRH and pineal gland.   SUPPORT ME IN PROMOTING HOMEOPATHY    FOLLOW ME ON INSTAGRAM @like_treatslike On my official Instagram, you'll find the latest guest podcast reels, show trailers, special messages, features on my upcoming guests and much much more.  Your follow will help 'promote and create more awareness' for Homeopathy around the world.   JOIN MY FACEBOOK PAGE @liketreatslike Your follow will help 'promote and create more awareness' for Homeopathy around the world.   SUBSCRIBE TO MY YOUTUBE CHANNEL @like_treatslike   THE HOMEOPATHY HEALTH SHOW ON UK HEALTH RADIO – The World's Number 1 ‘Talk Health' Radio   JOIN THE CONVERSATION - BE INSPIRED   LISTEN VIA PODCAST APPS Just search ‘Homeopathy Health' or 'Atiq Ahmad Bhatti' on all major podcast platforms including Apple Podcasts, Podbean, Spotify, Amazon Music, Podbean, Pocketcast, iHeart Radio, iTunes, Google Podcasts, Boomplay and YouTube.   LISTEN VIA ‘UK HEALTH RADIO' www.ukhealthradio.com/program/homeopathy-health   LISTEN VIA MY WEBSITE www.liketreatslike.co.uk/radio-and-podcast   LISTEN VIA MY YOUTUBE CHANNEL https://www.youtube.com/@like_treatslike Don't forget to hit subscribe!

Darryl Leong, MBBS, MPH M.Biostat, PhD, discusses cardiovascular risks in men with prostate cancer and reviews critical topics such as comparative risk of GnRH agonists versus antagonists. Moderated by JACC: CardioOncology Editor-in-Chief Bonnie Ky, MD, MSCE, FACC.

A recent study compared GnRH antagonists in egg donor ovarian stimulation cycles. The first drug is a newer agent, elagolix (Orilissa), that is taken as a tablet at night. The older drug is an injectable agent called ganirelix (Fyremadel). How did Orilissa stack up in terms of eggs retrieved and embryos formed vs. ganirelix? Were there adverse events, like ovarian hyperstimulation or early LH surge? Results explored in this episode and what they mean for upcoming egg donor cycles. ResourcesBoniface C, Schnorr JN, Gray J, et al. The role of elagolix in the suppression of ovulation in donor oocyte cycles. F S Rep. 2023;4(2):179-182. Published 2023 Mar 25. doi:10.1016/j.xfre.2023.03.006Check JH, Brasile D, Choe JK, Amui J, Wilson C. The effect of cetrorelix vs. ganirelix on pregnancy outcome using minimal gonadotropin stimulation in women with elevated day 3 serum follicle stimulating hormone levels. Clin Exp Obstet Gynecol. 2009;36(3):148-149.Fyremadel [package insert]. Parsippany, NJ: Ferring Pharmaceuticals, Inc.; 2022. manufactured by Sun Pharma (India)Kay, C. Contaminated Drugs, Shredded Papers: US FDA Uncovers Failures in India Pharma Factories. May 31, 2013. Accessed July 11, 2023. https://www.bloomberg.com/news/articles/2023-05-31/us-finds-contaminated-drugs-further-lapses-in-india-pharma-factories-post-covid#xj4y7vzkgKeenan, J. Sun Pharma pauses US drug exports from India plant after FDA scolding. April 27, 2023. Accessed July 10, 2023. https://www.fiercepharma.com/manufacturing/sun-pharma-hits-pause-mohali-plant-response-fda-letter/Orilissa [package insert]. North Chicago, IL: Abbvie; 2021.Zhang J, Zhou X, Chen Y, et al. Nan Fang Yi Ke Da Xue Xue Bao. 2019;39(10):1207-1212. doi:10.12122/j.issn.1673-4254.2019.10.12

Noradrenaline (norepinephrine) is a neurotransmitter and hormone that plays a role in the body's "fight or flight" response.  Acetylcholine is a neurotransmitter (“brain” +” across” + “to send”) that helps transmit signals in the brain and body. Its name comes from its chemical structure, an acetate group and a choline molecule.  Dopamine is a neurotransmitter that plays a role in motivation, reward, and movement. Its name comes from its chemical structure, a combination of two molecules called dihydroxyphenylalanine and dopamine. Adrenaline (epinephrine) is a hormone and neurotransmitter that helps the body respond to stress. Its name comes from its source, the adrenal glands.  Serotonin is a neurotransmitter that is involved in mood, appetite, and sleep. Its name comes from its chemical structure, a combination of sero- (meaning "serum") and -tonin (meaning "tonic" or "substance that modifies").  Corticotropin-releasing hormone (CRH) is a hormone that stimulates the release of cortisol, a stress hormone. The name comes from its function of stimulating the release of corticotropin, a hormone that stimulates the adrenal glands. Also, it gets its name from its role in stimulating the release of adrenocorticotropic hormone (ACTH) from the pituitary gland, which in turn stimulates the release of cortisol from the adrenal gland. Vasopressin is a hormone that regulates water balance in the body. Its name comes from its ability to constrict blood vessels (vasoconstriction) and increase blood pressure. Vasopressin, also known as antidiuretic hormone (ADH), is so named because it regulates water balance by causing the kidneys to reabsorb water. Thyrotropin-releasing hormone (TRH) is a hormone that stimulates the release of thyroid-stimulating hormone (TSH), which regulates the thyroid gland. Its name comes from its function of stimulating the release of thyrotropin.  Oxytocin is a hormone that is involved in social bonding, childbirth, and lactation. Its name comes from its ability to stimulate uterine contractions (oxytocic) and milk ejection (lactogenic).  Gonadotropin-releasing hormone (GnRH) is a hormone that stimulates the release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which regulate the reproductive system. Its name comes from its function of stimulating the release of gonadotropins.  Growth hormone–releasing hormone (GHRH) is a hormone that stimulates the release of growth hormone (GH), which regulates growth and metabolism. Its name comes from its function of stimulating the release of growth hormone.  Catecholamines are a group of hormones and neurotransmitters that includes adrenaline, noradrenaline, and dopamine. Their name comes from their chemical structure, which includes a catechol group and an amine group.  Histamine is a neurotransmitter and hormone that is involved in inflammation, allergies, and gastric acid secretion. ACTH (adrenocorticotropic hormone) is a hormone that stimulates the release of cortisol from the adrenal glands.  Orexin (hypocretin) is a neurotransmitter that is involved in wakefulness and appetite. Its name comes from its discovery in the hypothalamus and its ability to stimulate food intake (orexigenic).  Glutamic acid (glutamate) is a neurotransmitter that is involved in learning, memory, and neural plasticity. Its name comes from its chemical structure, a combination of glutamine and an acid group.  Galanin is a neuropeptide that is involved in pain perception, mood, and appetite. Its name comes from its discovery in the galanin-containing neurons of the hypothalamus.  Neurotensin comes from the words "neuro," meaning related to nerves, and "tensin," which refers to its ability to cause contraction in smooth muscle. Neurotensin is a neuropeptide that is found in the central nervous system and gastrointestinal tract. --- Support this podcast: https://podcasters.spotify.com/pod/show/liam-connerly/support

Episode 139: What is PCOS      Future Dr. Salimi explains the pathophysiology, signs, and symptoms of PCOS. Diagnostic criteria and the basics of treatment are also discussed. Dr. Arreaza adds some comments about the treatment of obesity.  Written by Elika Salimi, MS3, Western University of Health Sciences, College of Osteopathic Medicine of the Pacific. Comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Hello there! My name is Elika and I am a third-year medical student at Western University of Health Sciences. Today I will be talking to you about polycystic ovary syndrome AKA PCOS.Do you have a female patient in her reproductive years with irregular menstrual cycles, or no menstrual cycles at all? Is she unable to conceive a child? Did she have an unexpected diagnosis of diabetes? Does she have more acne than she would like, or has hair in unwanted or unexpected areas such as her chin?Does she have a hard time losing weight? If you answered YES to many of these questions, it is possible that your patient is suffering from polycystic ovary syndrome also known as PCOS, which is one of the most common endocrine disorders in women. Pathophysiology:The exact pathophysiology behind this syndrome is unknown; however, per the American College of Obstetricians and Gynecologists committee, some studies have shown a strong association between PCOS and obesity. In a woman with obesity disorder, the excess adipose tissue ends up increasing peripheral estrogen synthesis and as a result, there is a decrease in peripheral sensitivity to insulin which means many of these women tend to have hyperinsulinemia. To be more detailed, it is important to mention that during these anovulatory cycles, the increase in estrogen, which is also unopposed estrogen with a lack of progesterone, can lead to endometrial hyperplasia and consequently increase the risk of endometrial carcinoma.Clinical Features: Unless there is a clear history and physical or if perhaps there was an incidental ultrasound finding of polycystic ovaries, the diagnosis of PCOS is not exactly black-and-white. That is why it is important to increase awareness so that women can put the pieces of the puzzle together and come in to get evaluated. Multiple cysts in ovaries can present in patients without PCOS, and they are common in teenagers. To use the multiple cysts as part of the diagnosis, the patient has to be 2 years after menarche (AAFP). Some of these clinical symptoms typically start during adolescence displaying menstrual irregularities such as she could've had her period and then stopped getting it or she has a very delayed onset of her menstrual cycle. It is also possible to have spotty menstrual cycles also known as breakthrough bleeding or menorrhagia. And very important to many women, she could be infertile or have difficulties conceiving.She could also have diabetes because of insulin resistance that comes with the metabolic syndrome that develops with PCOS, which is also increased if she has obesity. This obesity disorder going hand in hand with the metabolic syndrome, can also increase the risk of having sleep apnea, which could affect the quality of her sleep, finding herself more fatigued than she should be after adequate hours of rest. Other symptoms include skin conditions such as hirsutism which is basically male pattern hair growth in women in areas such as the upper lip, chin, around the umbilicus, back, or even buttocks. She could also have male pattern hair loss on the head or too much acne or oily skin or acanthosis nigricans which are these brown/velvety hyperpigmented streaks on the neck or axilla, or groin. She could also find herself more depressed or anxious.Diagnosis:The diagnostic criteria and treatments are mainly addressed in the Journal of Clinical Endocrinology & Metabolism, an evidence-based guideline for the assessment and management of polycystic ovary syndrome, and the American Family Physician Journal:The diagnosis of PCOS requires the presence of at least two criteria that are not due to any other endocrine disorder such as thyroid disease or hyperprolactinemia, or other. 1) Periods of oligo-ovulation and or anovulation which means she's either having very low ovulatory cycles or she's not ovulating at all. 2) hyperandrogenism and this could be based on her clinical features or laboratory studies showing elevated testosterone levels or LH to FSH ratio and 3) Seeing enlarged and/or polycystic ovaries on a pelvic ultrasound. This means that the pelvic ultrasound shows an ovarian volume of equal to or greater than 10 mL and/or there's multiple cystic follicles that are about 2 to 9 mm in one or both of her ovaries which also usually tend to have a string of pearls appearance.So, if you have 2 out of the 3, you have PCOS. There are ways to confirm that there is in fact hyperandrogenism by doing lab studies and this could mean that her testosterone levels are elevated, or her androstenedione is elevated as well as elevated dehydro-epi-androsterone sulfate (DHEAS) and of course we need to rule out pregnancy and other endocrine disorders as I mentioned earlier. However, if the clinical picture of hyperandrogenism is there then that fulfills the diagnostic criteria for PCOS even if the serum antigen levels are normal. This also applies to an elevated LH:FSH ratio of typically greater than 2 to 1 which is also a characteristic finding of most patients with PCOS but this is not exactly necessary for diagnosis. We also don't need to find cystic follicles in order to diagnose PCOS. Treatment: In family medicine practices and even OB/GYN practice for PCOS the most common recommendation for all patients is to encourage them to increase their physical activity (exercise) and eat healthy and try to consider behavioral modifications to have a target BMI of ideally less than 25 kg/m² because this can reduce estrone production in adipose tissue.Then we are thinking about ways to treat patients who are not planning to conceive versus those that are. For those patients that are not planning to conceive the goal is to regulate their menstrual cycles and irregularities as well as their hyperandrogenism and to treat the comorbidities as well to overall improve their quality of life.The first line treatment for hyperandrogenism to try to regulate menstrual cycle abnormalities is combined oral contraceptives also known as birth control pills. This also reduces endometrial hyperplasia which in turn can decrease the risk of endometrial carcinoma as mentioned earlier and it can reduce menstrual bleeding and you can reduce acne and try to assist with the hirsutism as well. As mentioned earlier, PCOS can also go hand-in-hand with insulin resistance or hyperinsulinemia and therefore we can also use metformin that can improve menstrual irregularities but also address the metabolic side of this as well. Summary: Diet, exercise, combined oral contraceptives, and metformin.Some other more controversial medications to treat hyperandrogenism could be potassium-sparing diuretics such as spironolactone that also inhibits 17-a-hydroxylase or finasteride which is a 5-alpha-reductase inhibitor and flutamide which is an androgen receptor blocker. The mentioned examples are typically for those people that can't really tolerate combined oral contraceptives. Other things to consider for those that are suffering from obesity syndrome are to possibly consider bariatric surgery if of course the criteria are met, and this is on a case-by-case basis. Bariatric surgery may be an answer to many of our metabolic problems that's why it is now called metabolic surgery. For patients who are planning to conceive the goal is to manage their comorbidities such as weight loss but also to try to induce ovulation.Now the first-line therapy for inducing ovulation is a medication called letrozole which is an aromatase inhibitor that in turn reduces estrogen production stimulating FSH secretion and ultimately inducing ovulation, not to get too heavily into the weeds of how these medications work, but basically it improves pregnancy and live birth rate outcomes in patients who are infertile because of the fact that they have anovulatory cycles or a.k.a. they are not ovulating.Then we also have clomiphene which is just an alternative to letrozole and has a different mechanism of action but it also stimulates ovulation by more particularly causing a pulsatile secretion of GnRH and in turn increasing FSH and LH as well, and this medication might be actually preferred over metformin monotherapy in women that are suffering from obesity syndrome who also have anovulatory infertility. However, apparently, clomiphene can cause more chance of multiple gestations versus letrozole.Also, letrozole is preferred over clomiphene to induce ovulation because of a higher rate of live births, but we have the risk of multiple pregnancies with both these methods. Let's talk about the second-line therapies.As mentioned earlier we have this 2 to 1 ratio of FSH to LH in women with PCOS or at least a good amount of them. We said that that is not required to diagnose this disorder but we can also give women exogenous FSH plus human menopausal gonadotropin, but this is really a second-line treatment for ovulation induction and typically we go for second-line treatments if first-line therapies aren't successful. But I will mention that using this exogenous gonadotropin is very expensive and it requires you to have access to specialized healthcare facilities and constant ultrasound monitoring so this may just not be feasible for many people but if you have the resources and it's affordable for you then exogenous gonadotropins are actually preferred over clomiphene and metformin therapy.Metformin can also use as a second-line monotherapy for fertility treatments and this in combination with clomiphene can increase pregnancy rates, especially in women who are suffering from obesity disorder, and of course, this is first-line therapy for insulin resistance.Now if we're talking about an invasive type of procedure for infertility it would be laparoscopic ovarian drilling which basically, we use a laser beam or surgical needle to reduce ovarian tissue to decrease its volume and try to reduce androgen production. Doing this can cause a hormone shift that can induce FSH secretion and ultimately improve ovarian function as well. This is also a second-line treatment for ovulation induction, but it can be performed as a first line if other indications for laparoscopy are present. Third-line therapy would be in vitro fertilization which means that basically we take mature eggs from ovaries and then we fertilize them with sperm in a lab and then the fertilized egg or the embryo is transferred to a uterus to be implanted.For the management of hirsutism, the first-line therapy is usually non-pharmacological and that's electrolysis or light-based hair removal with laser or photo-epilation. For acne, we can consider benzoyl peroxide or topical antibiotics if necessary.Final thoughts: Now I know that was a ton of information but ultimately, we are trying to make women more aware of PCOS and let them know that they are not alone, also we are trying to reduce complications such as cardiovascular problems, diabetes, endometrial cancer, infertility or even pregnancy loss. The best we can do is try to educate more women because many are suffering from this condition and they have no idea. Again, my name is Elika Salimi, and I am a third-year medical student. If you have any questions, you can reach me at elika.salimi@westernu.edu.___________________________Conclusion: Now we conclude episode number 139, “What is PCOS.” Future Dr. Salimi explained that patients with Polycystic Ovary Syndrome present with: Hyperandrogenism, Oligo-ovulation or anovulation, and multiple cysts in ovaries. If your patient meets 2 out of the 3 criteria, then you can confidently give the diagnosis of PCOS. Dr. Arreaza reminded us that by treating obesity you are also treating PCOS. This week we thank Hector Arreaza and Elika Salimi. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Gynecology..ACOG Practice Bulletin No. 194: Polycystic Ovary Syndrome..Obstet Gynecol.2018; 131(6): p.e157-e171.doi:10.1097/AOG.0000000000002656Hoeger KM, Dokras A, Piltonen T.Update on PCOS: Consequences, Challenges, and Guiding Treatment.The Journal of Clinical Endocrinology & Metabolism.2020; 106(3): p.e1071-e1083.doi:10.1210/clinem/dgaa839Williams T, Mortada R, Porter S.Diagnosis and Treatment of Polycystic Ovary Syndrome..Am Fam Physician.2016; 94(2): p.106-13.pmid: 27419327.Legro RS, Arslanian SA, Ehrmann DA, et al.Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline.J Clin Endocrinol Metab.2013; 98(12): p.4565-4592.doi:10.1210/jc.2013-2350.International evidence-based guideline for the assessment and management of polycystic ovary syndrome 2018.https://www.monash.edu/__data/assets/pdf_file/0004/1412644/PCOS_Evidence-Based-Guidelines_20181009.pdf 

In this episode of ASCO Educational podcasts, we'll explore how we interpret and integrate recently reported clinical research into practice. The first scenario involves a 72-year old man with high-risk, localized prostate cancer progressing to hormone-sensitive metastatic disease.  Our guests are Dr. Kriti Mittal (UMass Chan Medical School) and Dr. Jorge Garcia (Case Western Reserve University School of Medicine). Together they present the patient scenario (1:12), review research evidence regarding systemic and radiation therapy for high-risk localized disease (5:45), and reflect on the importance of genetic testing and (10:57) and considerations for treatment approaches at progression to metastatic disease (16:13).  Speaker Disclosures Dr. Kriti Mittal:  Honoraria – IntrinsiQ; Targeted Oncology; Medpage; Aptitude Health; Cardinal Health  Consulting or Advisory Role – Bayer; Aveo; Dendreon; Myovant; Fletcher; Curio Science; AVEO; Janssen; Dedham Group  Research Funding - Pfizer Dr. Jorge Garcia:  Honoraria - MJH Associates: Aptitude Health; Janssen Consulting or Advisor – Eisai; Targeted Oncology Research Funding – Merck; Pfizer; Orion Pharma GmbH; Janssen Oncology;  Genentech/Roche; Lilly  Other Relationship - FDA Resources  ASCO Article: Implementation of Germline Testing for Prostate Cancer: Philadelphia Prostate Cancer Consensus Conference 2019 ASCO Course: How Do I Integrate Metastasis-directed Therapy in Patients with Oligometastatic Prostate Cancer? (Free to Full and Allied ASCO Members) If you liked this episode, please follow the show. To explore other educational content, including courses, visit education.asco.org. Contact us at education@asco.org. TRANSCRIPT Dr. Kriti Mittal: Hello and welcome to this episode of the ASCO Education Podcast. Today we'll explore how we interpret and integrate recently reported clinical research into practice, focusing on two clinical scenarios: localized prostate cancer progressing to hormone-sensitive metastatic disease; and a case of de novo metastatic hormone-sensitive prostate cancer progressing to castration-resistant disease.   My name is Kriti Mittal and I am the Medical Director of GU Oncology at the University of Massachusetts. I am delighted to co-host today's discussion with my colleague, Dr. Jorge Garcia. Dr. Garcia is a Professor of Medicine and Urology at Case Western Reserve University School of Medicine. He is also the George and Edith Richmond Distinguished Scientist chair and the current chair of the Solid Tumor Oncology Division at University Hospital's Seidman Cancer Center. Let me begin by presenting the first patient scenario.  Case 1: A 72-year-old male was referred to urology for evaluation of hematuria. A rectal exam revealed an enlarged prostate without any nodules. A CT urogram was performed that revealed an enlarged prostate with bladder trabeculations. A cystoscopy revealed no stones or tumors in the bladder, but the prostatic urethra appeared to be abnormal looking. Transurethral resection of the prostate was performed. The pathology revealed Gleason score 4+5=9 prostate cancer, involving 90% of the submitted tissue. PSA was performed one week later and was elevated at 50. Patient declined the option of radical prostatectomy and was referred to radiation and medical oncology.   So I guess the question at this point is, Dr. Garcia, in 2023, how do you stage patients with high-risk localized prostate cancer and how would you approach this case? Dr. Jorge Garcia: That's a great question and a great case, by the way, sort of what you and I in our practice will call ‘bread and butter'. Patients like this type of case that you just presented come from different places to our practice.  So either they come through urology or oftentimes they may come through radiation oncology. And certainly, it depends where you practice in the United States, at ‘X', US, they may come through medical oncology.   So I think that the first question that I have is in whatever role I'm playing in this case, where the patient has seen a urologist or a rad onc or me first, I think it's important for us in medical oncology, at least in the prostate cancer space, to talk about how do we think of their case and put those comments into context for the patient. It's very simple for you to tell a patient you can probably have surgery, radiation therapy, but at the end of the day, how do you counsel that patient as to the implications of the features of his disease is going to be really important. I use very simple examples that I relate to my patients, but really this patient is a patient that has very high-risk prostate cancer based upon the NCCN guidelines and how we actually stratify patients into what we call low-risk, intermediate-, and high-risk, and between those very low and very high risk.  So his PSA is high, very high, I would argue. His Gleason score, now, what we call group grading is high. He has high-volume disease. So the first question that I would have is, what are the choices for treatment for a patient like this? But even before you and I may talk about treatment options, we really want to understand the volume of their disease and whether or not they have localized prostate cancer with high-risk features or whether or not they have locally advanced or hopefully not metastatic disease. So back in the days prior to the FDA approval for PSMA PET imaging, we probably will have a Technetium-99 whole-body bone scan, and/or we probably will actually use CT scanning. Most people in the past, we used to do just a CT of the abdomen and pelvic region. As you know, with the movement of oral agents in the advanced setting, I think most of us will do a chest CT, abdomen and pelvic region, and certainly we also probably will have a Technetium-99 bone scan.  Now, with the utility and the use of PET imaging, I think most people like him will probably undergo PET PSMA, where you use F-18 PSMA or Gallium-68 PSMA. I think the importance depends on how you look at the approval of these two technologies. I think that PET PSMA imaging is here to stay. It's probably what most of us will use. And based upon that, we will define yet the truest stage of this patient. So right now, what we know is he has high-risk features. Hopefully, their disease is localized. We'll probably put the patient through an imaging technology. If you don't have access to a PET, then obviously CT and a bone scan will do. But if you do, the PET will actually help us define if the patient has disease outside of the prostate region, in the pelvic area, or even if they have distant metastases. Dr. Kriti Mittal: I would agree with that approach, Dr. Garcia. I think in the United States, we've been late adopters of PSMA scans. I think this patient with high-risk localized disease, if insurance allows at our institution, would get a PSMA for staging. There are still some patients where insurance companies, despite peer-to-peer evaluations, are not approving PSMAs. And in those situations, the patient would benefit from conventional CTs and a bone scan. So let's say this patient had a PSMA and was found not to have any regional or distant metastases. He decided against surgery, and he is seeing you as his medical oncologist together with radiation. What would your recommendations be?  Dr. Jorge Garcia: I think the bigger question is, do we have any data to suggest or to demonstrate that if in the absence of metastatic disease with conventional imaging or with emerging technologies such as PSMA PET, there is no evidence of distant disease, which I think you probably agree with me, that would be sort of unlikely with a patient with these features not to have some form of PSMA uptake somewhere in their body. But let's assume that indeed then the PSMA PET was negative, so we're really talking about high-risk localized prostate cancer. So I don't think we can tell a patient that radical prostatectomy would not be a standard of care. We never had a randomized trial comparing surgery against radiation therapy. This patient has already made that decision and surgery is not an option for him. If he, indeed, had elected radiotherapy, the three bigger questions that I ask myself are where are you going to aim the beam of that radiation therapy? What technology, dose, and fractionation are you going to use? And lastly, what sort of systemic therapy do you need, if any, for that matter? Where we do have some data maybe less controversial today in 2023 compared to the past? But I think the question is, do we do radiation to the prostate only or do we expand the field of that radiation to include the pelvic nodes?  Secondly, do we use IMRT? Do you use proton beam or not? Again, that's a big question that I think that opens up significant discussions. But more important, in my opinion, is the term of hypofractionation. I think the field of radiation oncology has shifted away from the old standard, five, seven weeks of radiation therapy to more hypofractionation, which in simple terms means a higher dose over a short period of time. And there was a concern in the past that when you give more radiation on a short period of time, toxicities or side effects would increase. And I think that there is plenty of data right now, very elegant data, demonstrated that hypofractionation is not worse with regards to side effects. I think most of us will be doing or supporting hypofractionation. And perhaps even to stretch that, the question now is of SBRT. Can we offer SBRT to a selected group of patients with high-risk prostate cancer? And again, those are discussions that we will naturally, I assume, in your practice, in your group, you probably also have along with radiation oncology.  Now, the bigger question, which in my mind is really not debatable today in the United States, is the need for systemic therapy. And I think we all will go back to the old data from the European EORTC data looking at the duration of androgen deprivation therapy. And I think most of us would suggest that at the very least, 24 months of androgen deprivation therapy is the standard of care for men with high-risk prostate cancer who elect to have local definitive radiation therapy as their modality of treatment. I think that whether or not it's 24 or 36, I think that the Canadian data looking at 18 months didn't hit the mark. But I think the radiation oncology community in the prostate cancer space probably has agreed that 24 months clinically is the right sort of the sweetest spot.  What I think is a bit different right now is whether or not these patients need treatment intensification. And we have now very elegant data from the British group and also from the French group, suggesting, in fact, that patients with very high-risk prostate cancer who don't have evidence of objective metastasis may, in fact, benefit from ADT plus one of the novel hormonal agents, in this case, the use of an adrenal biosynthesis inhibitor such as abiraterone acetate. So I think in my practice, what I would counsel this patient is to probably embark on radiotherapy as local definitive therapy and also to consider 24 months of androgen deprivation therapy. But I would, based upon his Gleason score of group grading, his high-volume disease in the prostate gland, and his PSA, to probably consider the use of the addition of abiraterone in that context. Dr. Kriti Mittal: That is in fact how this patient was offered treatment. The patient decided to proceed with radiation therapy with two years of androgen deprivation. And based on data from the multi-arm STAMPEDE platform, the patient met two of the following three high-risk features Gleason score >8, PSA >40, and clinical >T3 disease. He was offered two years of abiraterone therapy. Unfortunately, the patient chose to decline upfront intensification of therapy. In addition, given the diagnosis of high-risk localized prostate cancer, the patient was also referred to genetic counseling based on the current Philadelphia Consensus Conference guidelines. Germline testing should be considered in patients with high-risk localized node-positive or metastatic prostate cancer, regardless of their family history. In addition, patients with intermediate-risk prostate cancer who have cribriform histology should also consider germline genetic testing.  Access to genetic counseling remains a challenge at several sites across the US, including ours. There is a growing need to educate urologists and medical oncologists to make them feel comfortable administering pretest counseling themselves and potentially ordering the test while waiting for the results and then referring patients who are found to have abnormalities for a formal genetics evaluation. In fact, the Philadelphia Consensus Conference Guideline offers a very elegant framework to help implement this workflow paradigm in clinical practice. And at our site, one of our fellows is actually using this as a research project so that patients don't have to wait months to be seen by genetics. This will have implications, as we will see later in this podcast, not only for this individual patient as we talk about the role of PARP inhibitors but also has implications for cascade testing and preventative cancer screening in the next of kin. Dr. Jorge Garcia: Dr. Mittal, I think that we cannot stress enough the importance of genetic testing for these patients. Oftentimes I think one of the challenges that our patients are facing is how they come into the system. If you come through urology, especially in the community side, what I have heard is that there are challenges trying to get to that genetic counsel. Not so much because you cannot do the test, but rather the interpretation of the testing and the downstream effect as you're describing the consequences of having a positive test and how you're going to counsel that patient. If you disregard the potential of you having an active agent based upon your genomic alteration, is the downstream of how your family may be impacted by a finding such as the DNA repair deficiency or something of that nature. So for us at major academic institutions because the flow how those patients come through us, and certainly the bigger utilization of multi-disciplinary clinics where we actually have more proximity with radiation oncology urology, and we actually maybe finesse those cases through the three teams more often than not, at least discuss them, then I think that's less likely to occur. But I think the bigger question is the timing of when we do testing and how we do it.  So there are two ways -- and I'd love to hear how you do it at your institution -- because there are two ways that I can think one can do that. The low-hanging fruit is you have tissue material from the biopsy specimen. So what you do, you actually use any of the commercial platforms to do genomic or next-generation sequencing or you can do in-house sequencing if your facility has an in-house lab that can do testing. And that only gets you to what we call ‘somatic testing', which is really epigenetic changes over time that are only found in abnormal cells. It may not tell you the entire story of that patient because you may be missing the potential of identifying a germline finding. So when you do that, did you do germline testing at the same time that you do somatic testing or did you start with one and then you send to genetic counseling and then they define who gets germline testing? Dr. Kriti Mittal: So at our site, we start with germline genetic testing. We use either blood testing or a cheek swab assay and we send the full 84-gene multigene panel. Dr. Jorge Garcia: Yeah, and I think for our audience, Dr. Mittal, that's great. I don't think you and I will be too draconian deciding which platform one uses. It's just that we want to make sure that at least you test those patients. And I think the importance of this is if you look at the New England Journal paper from many years ago, from the Pritchard data looking at the incidence of DNA repair deficiency in men with prostate cancer in North America, that was about what,  around 10% or so, take it or leave it. So if you were to look only for germline testing, you only will, in theory, capture around 10% of patients. But if you add somatic changes that are also impacting the DNA pathway, then you may add around 23%, 25% of patients. So we really are talking that if we only do one type of testing, we may be missing a significant proportion of patients who still may be candidates, maybe not for family counseling if you had a somatic change, rather than germline testing, the positivity, but if you do have somatic, then you can add into that equation the potential for that patient to embark on PARP inhibitors down the road as you stated earlier. It may not change how we think of the patient today, or the treatment for that matter. But you may allow to counsel that patient differently and may allow to sequence your treatments in a different way based upon the findings that you have. So I could not stress the importance of the NCCN guidelines and the importance of doing genetic testing for pretty much the vast majority of our patients with prostate cancer. Dr. Kriti Mittal: Going back to our patient, three years after completion of his therapy, the patient was noted to have a rising PSA. On surveillance testing, his PSA rose from 0.05 a few months prior to 12.2 at the time of his medical oncology appointment. He was also noted to have worsening low back pain. A PSMA scan was performed that was noteworthy for innumerable intensely PSMA avid osseous lesions throughout his axial and appendicular skeleton. The largest lesion involved the right acetabulum and the right ischium. Multiple additional sizable lesions were seen throughout the pelvis and spine without any evidence of pathologic fractures. So the question is, what do we do next? Dr. Jorge Garcia: The first question that I would have is, the patient completed ADT, right? So the patient did not have treatment intensification, but at the very least he got at least systemic therapy based upon the EORTC data. And therefore, one would predict that his outcome will have been improved compared to those patients who receive either no ADT or less time on ADT. But what I'm interested in understanding is his nadir PSA matters to me while he was on radiation and ADT. I would like to know if his nadir PSA was undetectable, that's one thing. If he was unable to achieve an undetectable PSA nadir, that would be a different thought process for me.   And secondly, before I can comment, I would like to know if you have access to his testosterone level. Because notably, what happens to patients like this maybe is that you will drive down testosterone while you get ADT, PSAs become undetectable. Any of us could assume that the undetectability is the result of the radiation therapy. But the true benefit of the combination of radiation and ADT in that context really comes to be seen when the patient has got off the ADT, has recovered testosterone, and only when your testosterone has normalized or is not castrated, then we'll know what happens with your serologic changes. If you rise your PSA while you recover testosterone, that is one makeup of patient. But if you rise your PSA while you have a testosterone at the castrated level, that would be a different makeup of a patient. So do we have a sense as to when the patient recovered testosterone and whether or not if his PSA rose after recovery?  Dr. Kriti Mittal: At the time his PSA rose to 12, his testosterone was 275. Dr. Jorge Garcia: Okay, perfect. You and I would call this patient castration-naive or castration-sensitive. I know that it's semantics. A lot of people struggle with the castration-naive and castration-sensitive state. What that means really to me, castration-naive is not necessarily that you have not seen ADT before. It's just that your cancer progression is dependent on the primary fuel that is feeding prostate cancer, in this case, testosterone or dihydrotestosterone, which is the active metabolite of testosterone. So in this case, recognizing the patient had a testosterone recovery and his biochemical recurrence, which is the rising of his PSA occur when you have recovery of testosterone, makes this patient castration-sensitive. Now the PET scan demonstrates now progression of his disease. So clearly he has a serologic progression, he has radiographic progression. I assume that the patient may have no symptoms, right, from his disease?  Dr. Kriti Mittal: This patient had some low back pain at the time of this visit. So I think we can conclude he has clinical progression as well. Dr. Jorge Garcia: Okay, so he had the triple progression, serologic, clinical, and radiographic progression. The first order of business for me would be to understand the volume of his disease and whether we use the US CHAARTED definition of high volume or low volume, or whether we use the French definition for high volume from Latitude, or whether we use STAMPEDE variation for definition, it does appear to me that this patient does have high-volume disease. Why? If you follow the French, it's a Gleason score of >8, more than three bone metastases, and the presence of visceral disease, and you need to have two out of the three. If you follow CHAARTED definition, we did not use Gleason scoring, the US definition. We only use either the presence of visceral metastases or the presence of more than four bone lesions, two of which had to be outside the appendicular skeleton. So if we were to follow either/or, this patient would be high-volume in nature.  So the standard of care for someone with metastatic disease, regardless of volume, is treatment intensification, is you suppress testosterone with androgen deprivation therapy. And in this case, I'd love to hear how you do it in Massachusetts, but here, for the most part, I would actually use a GnRH agonist-based approach, any of the agents that we have. Having said that, I think there is a role to do GnRH antagonist-based therapy. In this case, degarelix, or the oral GnRH antagonist, relugolix, is easier to get patients on a three-month injection or six-month injection with GnRH agonist than what it is on a monthly basis. But I think it's also fair for our audience to realize that there is data suggesting that perhaps degarelix can render testosterone at a lower level, meaning that you can castrate even further or have very low levels of testosterone contrary to GnRH agonist-based approaches.  And also for patients maybe like this patient that you're describing, you can minimize the flare that possibly you could get with a GnRH agonist by transiently raising the DHT before the hypothalamic-pituitary axis would shut it down. So either/or would be fine with me. Relugolix, as you know, the attraction of relugolix for us right now, based upon the HERO data, is that you may have possibly less cardiovascular side effects. My rationale not to use a lot of relugolix when I need treatment intensification is quite simple. I'm not aware, I don't know if you can mitigate or minimize that potential cardiovascular benefit by adding abiraterone or adding one of the ARIs, because ARIs and abiraterone by themselves also have cardiovascular side effects. But either/or would be fine with me. The goal of the game is to suppress your male hormone.  But very important is that regardless of volume, high or low, every patient with metastatic disease requires treatment intensification. You can do an adrenal biosynthesis inhibitor such as abiraterone acetate. You can pick an androgen receptor inhibitor such as apalutamide or enzalutamide if that's the case. The subtleties in how people feel comfortable using these agents, I think, none of us – as you know, Dr. Mittal - can comment that one oral agent is better than the other one. Independently, each of these three oral agents have randomized level 1, phase III data demonstrating survival improvement when you do treatment intensification with each respective agent. But we don't have, obviously, head-to-head data looking at this.  What I think is different right now, as you know, is the data with the ARASENS data, which was a randomized phase III trial, an international effort looking at triple therapy, and that is male hormone suppression plus docetaxel-based chemotherapy against testosterone suppression plus docetaxel-based chemotherapy plus the novel androgen receptor inhibitor known as darolutamide. This trial demonstrated an outcome survival improvement when you do triple therapy for those high-volume patients. And therefore, what I can tell you in my personal opinion and when I define a patient of mine who is in need of chemotherapy, then the standard of care in my practice will be triple therapy. So if I know you are a candidate for chemotherapy, however, I make that decision that I want you to get on docetaxel upfront. If you have high-volume features, then the standard of care would not be ADT and chemo alone, it would be ADT, chemo, and darolutamide.  What I don't know, and what we don't know, as you know, is whether or not triple therapy for a high-volume patient is better, the same, equivalent, or less than giving someone ADT plus a novel hormonal agent. That is the data that we don't have. There are some meta-analyses looking at the data, but I can tell you that at the very least, if you prefer chemo, it should be triple therapy. If you prefer an oral agent, it certainly should be either apalutamide, abiraterone acetate, and/or enzalutamide. But either/or, patients do need treatment intensification, and what is perplexing to me, and I know for you as well, is that a significant proportion of our patients in North America are still not getting treatment intensification, which is really sub-optimal and sub-standard for our practice.  Dr. Kriti Mittal: Thank you, Dr. Garcia, for a terrific discussion on the application of recent advances in prostate cancer to clinical practice. In an upcoming podcast, we will continue that discussion exploring management of de novo metastatic prostate cancer.   The ASCO Education Podcast is where we explore topics ranging from implementing new cancer treatments and improving patient care to oncologists' well-being and professional development. If you have an idea for a topic or a guest you'd like to see on the ASCO Education Podcast, please email us at education@asco.org. To stay up to date with the latest episodes and explore other educational content, please visit education.asco.org. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.   Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.    

In this episode of the School of Doza podcast, Nurse Doza discusses thyroid health, including hypothyroidism and Hashimoto's disease. He emphasizes the commonality of these conditions and provides advice for navigating them. Nurse Doza also explains the thyroid's role in the body and offers tips for improving thyroid function. The episode aims to provide listeners with knowledge and tools to optimize their health and transform their lives   Get 10% OFF MSW NUTRITION Supplements by use code NURSE DOZA https://www.mswnutrition.com/products/liver-love?ref=NURSEDOZA SIgn Up for The Nurse Doza Newsletter https://www.mswnutrition.com/blogs/msw TIMESTAMPS: 00:00 CLASS IS IN SESSION 00:59 Thyroid Dysfunction & Hashimoto's [00:03:41] Hashimoto's autoimmune disorder [00:07:22] Hashimoto's and inflammation [00:11:22] Hashimoto's and inflammation [00:15:11] Hashimoto's and thyroid disorders [00:17:40] Hashimoto's and TSH [00:21:07] Thyroid Antibodies and Medication [00:24:22] Hashimoto's and thyroid medication [00:27:56] Stress and its effects [00:31:31] Hashimoto's and the liver [00:35:13] Liver health and inflammation [00:38:26] Liver Love Supplement. NOTES: What: “Hashimoto's thyroiditis is a type of autoimmune disease — your immune system doesn't recognize your thyroid as your own and attacks it. Hashimoto's disease is common and affects about five people in 100 in the United States.”(1)   Who will develop ? “autoimmune diseases, like certain liver conditions, B12 deficiency, gluten sensitivity” (1) Symptoms of Hashimoto disease include: (2) Weight gain Fatigue Hair loss   Low tolerance for cold temperatures Irregular menstrual periods Constipation Depression Joint pain the patient may develop a non-tender, symmetrical, and painless goiter. As inflammation continues, thyroid follicles are damaged and can rupture. (3) Heart disease: “Hypothyroidism lowers heart rate and cardiac output leading to increased risk of cardiovascular disease (Biondi et al. 2002; Biondi 2012), hypercholesterolemia, and hypertension (Klein and Ojamaa 2001; Toft and Boon 2000). Even subclinical hypothyroidism already presents a doubling of myocardial infarction and an elevated rate of atherosclerosis”(4) Studies:https://my.clevelandclinic.org/health/diseases/17665-hashimotos-disease (1)   https://www.niddk.nih.gov/health-information/endocrine-diseases/hashimotos-disease(1) https://medlineplus.gov/lab-tests/thyroid-antibodies/(2) https://www.ncbi.nlm.nih.gov/books/NBK500006/ (3)  Hs-crp hypothyroidism: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4244578/ (4) The second thing you need to know about hashimotos/hypothyroidism TREATING TSH WONT MATTER________   “Hyperprolactinemia can be caused by hypothyroidism. Thyrotropin-releasing hormone (TRH) from the hypothalamus stimulates prolactin and TSH release. Prolactin release can suppress testosterone, LH, FSH, and GnRH release.” (1) dx with the blood test TPO (thyroid perioxidase)______(2) RT3: “T4 conversion to T3 and rT3: After its release from the thyroid gland, T4 is converted to T3, which is an active thyroid hormone, or to rT3, which is considered an inactive form. The rate and ratio of T4 conversion to either T3 or rT3 depend on the body's metabolic needs.”(3) Studies: https://www.ncbi.nlm.nih.gov/books/NBK500006/ (1) https://medlineplus.gov/lab-tests/thyroid-antibodies/(2)  https://www.verywellhealth.com/reverse-t3-thyroid-hormone-overview-3233184(3) The third thing you need to know about hashimotos/hypothyroidism is medication might not fix it ______   Armour, NP (bioidentical)    “How is Hashimoto's disease treated? If Hashimoto's disease does progress to hypothyroidism, usual treatment is a synthetic (man-made) form of thyroid hormone called levothyroxine (Synthroid®, Tirosint®, Levoxyl®, Levothroid®, Unithroid®).” “There is no special diet for Hashimoto's disease”(1) Studies: https://my.clevelandclinic.org/health/diseases/17665-hashimotos-disease(1) The fourth thing you need to know about hashimotos/hypothyroidism is _your thyroid problem didnt start with the thyroid ______   HIGH DHEA-S: Infertility / acne / PCOS (1) LOW DHEA-S: erectile dysfunction (1)    Dopamine inhibits TSH synthesis and release (2), but raises TRH    Epinephrine then cortisol in adrenals (3)   “After an external stimulus triggers the body's stress response, the pituitary-adrenal axis and sympathetic division of the autonomic nervous system are activated.” (4)   “Functional deficiency due to impaired mechanisms of catecholamine release, reuptake, or receptor sensitivity has neurophysiologic effects involving dysregulation of mood and attention” (4)  “cocaine or amphetamines”    “these findings indicate that the prolonged administration of pharmcological doses of DA significantly reduced serum TSH levels and thyroid hormone secretion in normal and criticall   ill patients, most likely by a direct inhibition of pituitary TSH with a secondary effect on thyroid gland secretion” (5)  Studies: https://my.clevelandclinic.org/health/diagnostics/22148-dheas-test-dhea-sulfate-test (1)   HPA and thyroid https://www.ncbi.nlm.nih.gov/books/NBK278958/(2)    Cortisol: https://www.ncbi.nlm.nih.gov/books/NBK538239/ (3)    Catecholamines https://www.ncbi.nlm.nih.gov/books/NBK507716/ (4)    Dopamine admi and thyroid suppression: https://pubmed.ncbi.nlm.nih.gov/7400302/ (5)   The fifth thing you need to know about hashimotos/hypothyroidism is _liver needs to be activated _______ Liver lowers TPO “there might exist common pathways in the pathogenesis of NAFLD and thyroid autoimmunity.” (1) IL-6 inhibits TSH release (2) IL-6 effects liver (3) Studies: https://pubmed.ncbi.nlm.nih.gov/30016121/(1)  https://www.ncbi.nlm.nih.gov/books/NBK278958/(2) https://www.journal-of-hepatology.eu/article/S0168-8278(16)00083-0/fulltext(3)   Get 10% OFF MSW NUTRITION Supplements by use code NURSE DOZA https://www.mswnutrition.com/products/liver-love?ref=NURSEDOZA   SIgn Up for my Newsletter https://www.mswnutrition.com/blogs/msw

On this episode of BackTable Urology, Dr. Aditya Bagrodia and Dr. Rana McKay, a medical oncologist at UC San Diego, discuss guidelines and advances in prostate cancer treatment. --- CHECK OUT OUR SPONSOR Veracyte https://www.veracyte.com/decipher --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/B9kR7B --- SHOW NOTES First, they define three types of prostate cancer. Metastatic castration-sensitive disease refers to patients with metastatic cancer who have low testosterone levels because of androgen deprivation therapy (ADT). Nonmetastatic castration-resistant disease is nonmetastatic cancer with testosterone levels unresponsive to ADT. This category is harder to define as the classification varies based on imaging modality. Finally, metastatic castration-resistant disease is the most lethal type of prostate cancer, as there is an unmet need in developing therapeutics for these patients. Traditionally, the castrate level is defined as a testosterone level

In this episode of BackTable Urology, Dr. Aditya Bagrodia interviews Dr. David Penson, professor and chair of urologic oncology at Vanderbilt University, about the indications and benefits of surgery for high risk prostate cancer. --- SHOW NOTES First, Dr. David Penson gives the traditional definition of high-risk prostate cancer, which is a PSA level over 20 ng/mL, a Gleason grade greater than 10, and a cancer staged at T2 or higher. However, he notes that in recent years, a more heterogeneous criteria has developed, so some patients with a Gleason grade greater than 8 and a T3 stage can also be considered high risk. Dr. Penson believes that pathological analysis is the best criteria to use when assessing risk and also uses MRI to distinguish between T2 and T3 patients and look for the median lobe before surgery. In his personal experience, he has noted that some patients will find online information about prostate cancer as a relatively benign chronic disease. For patients with high risk cancer, it is important to emphasize that the conventional active surveillance approach for low risk prostate cancer will not be beneficial. Both doctors agree that sending their patients curated, quality information is important and recommend using the WellPrept app. The doctors also discuss different imaging modalities involved in staging, such as PSMA PET scan, a bone scan, and prostate MRI. Before surgery, patients may receive neoadjuvant treatment. In the past, GnRH agonists were used, but long term data showed that patients receiving this type of therapy in addition to surgery had the same recurrence rate as patients who underwent surgery alone. Recently, newer neoadjuvant treatments, like PARP inhibitors, have been developed. Next, Dr. Penson speaks about choosing surgery versus radiation therapy (RT) as a primary treatment. The main risk of prostatectomy is its impact on continence and sexual dysfunction. The downside of radiation therapy is that the possibility of surgery as a therapeutic option is eliminated and its side effects, such as irritating urinary symptoms. Dr. Penson also notes that nerve sparing prostatectomies may be cancer sparing. In his opinion, if patients have impotence at baseline, nerve sparing surgery is not beneficial because of the risk of leaving positive margins. Contraindications to surgery include rectal involvement, a history of multiple abdominal surgeries, severe heart disease, bladder neck involvement, and a high volume nodal disease. Ideal prostatectomy patients are ones who have high grade disease contained in the prostate (T2) and patients with preexisting lower urinary tract symptoms (LUTS). Finally, the doctors discuss the use of nomograms to determine the extent of cancer control and the need for additional therapy. Dr. Penson has limited use for nomograms. He believes that they can generally be used to predict mortality, but not cure rates. He prefers to base prognosis on postoperative results. If the postoperative pathology report comes back with widely positive margins or bladder neck involvement, he discusses RT as an adjuvant treatment with his patients. For this reason, he emphasizes the need for collaboration with radiation oncologists and multidisciplinary tumor boards. --- RESOURCES WellPrept App: https://wellprept.com/

Huberman Lab Podcast Notes Key Takeaways The same key hormones are involved in male and female puberty and reproduction: GnRH, LH, and FSHOvulation & menstruation is about creating the opportunity for fertilization to occur if sperm is within close enough proximityMen: if you want to conceive in the next 90 days, avoid elevating body temperature (e.g., hot tubs, hot baths, sauna, etc.) to optimize testes temperature and sperm healthMany miscarriages, trisomy abnormalities, failures at fertilization, and birth defects occur because egg and sperm chromosomes are not properly pulled apart into haploidsThere is evidence that heat from laptops and electronics on the lap are negatively impacting sperm countFrequency of intercourse for conception: abstain from intercourse 2-3 days before ovulation; then on the day prior to ovulation or the day of ovulation, have as much intercourse as you can/want Successful fertilization largely depends on the quality of the egg Err on the side of conservative when trying to conceive and talk to OB/GYN at the onset of your desire to have children; the probability of conceiving naturally decreases throughout 30s due to the diminishing quality of eggsRead the full notes @ podcastnotes.orgIn this episode, I discuss the mechanisms by which human eggs and sperm are generated, the ovulatory/menstrual cycle, the conception process and overall fertility in males and females. I also explain how, regardless of whether you seek to conceive children, optimizing egg and sperm health is directly related to vitality and longevity. I cover the nutrition-based, behavioral, supplement-based and prescription approaches to optimizing egg and sperm health, the ovulatory/menstrual cycle and fertility. In addition, I explain lifestyle choices that greatly assist or harm fertility—several of which are very surprising. I provide science-based protocols for those trying to conceive children. The tools and principles I discuss can also improve overall vitality and longevity in all people, regardless of age.  For the full show notes, visit hubermanlab.com. Thank you to our sponsors AG1 (Athletic Greens): https://athleticgreens.com/huberman Maui Nui: https://mauinuivenison.com/huberman Eight Sleep: https://eightsleep.com/huberman InsideTracker: https://www.insidetracker.com/huberman Supplements from Momentous https://www.livemomentous.com/huberman Timestamps (00:00:00) Fertility, Vitality & Longevity (00:04:24) Maui Nui Venison, Eight Sleep, Momentous (00:08:20) Eggs & Sperm, Genes, Fertilization (00:18:28) Puberty: Gonadotropin Releasing Hormone (GnRH), Melatonin & Leptin (00:23:38) Onset Trends of Puberty, Odors Effects (00:31:24) Female Puberty, Luteinizing Hormone (LH), Follicle Stimulating Hormone (FSH) (00:35:25) AG1 (Athletic Greens) (00:36:34) Ovulatory & Menstrual Cycle (00:40:36) Follicular Phase: Egg Maturation & Ovulation, FSH & Estrogen (00:51:09) Luteal Phase: Progesterone & Estrogen, Menstruation (00:58:14) Ovulation & Libido; Luteal Phase & Malaise; Individual Variability (01:03:14) InsideTracker (01:04:18) Sex Chromosomes, Sperm (01:11:40) Tool: Testicular Temperature & Fertility (01:17:22) Sperm Production, Seminal Fluid, Vasectomy (01:24:07) Sperm Cells, Mitochondria & Motility, Intercourse Frequency & Fertilization (01:28:31) Sperm Production, GnRH, FSH, LH & Testosterone (01:36:21) Ejaculate Quality, Sperm Counts, Fertilization, Ectopic Pregnancy (01:44:14) Tool: Sexual Intercourse Frequency & Fertilization (01:53:24) Tools: Tracking Ovulation, Libido, Lubricants (01:56:42) Fecundability: Egg Quality & Woman's Age, Cumulative Pregnancy Rate (02:08:17) Miscarriages, Chromosomal Abnormalities (02:11:23) Female Fertility: Age, Follicle Testing & Anti-Mullerian Hormone (AMH) Testing (02:18:51) Male Fertility: Sperm Analysis, Age (02:24:52) Fertility & Hormone Analysis, Age (02:29:07) Fertility Effects of Sleep, Cortisol/Stress, Cannabis/Nicotine & Alcohol (02:42:40) Fertility, Sexually Transmitted Infections (STIs), Viral Infection & Cystic Fibrosis (02:47:42) Tool: Testicular Temperature & Fertility (02:51:26) Tool: Phones & Sperm Quality (02:58:06) Deliberate Cold Exposure & Fertility, Testicular Temperature, Cortisol/Stress (03:05:43) Fertility, Exercise & Mitochondrial Health; Intermittent Fasting (03:14:46) Testosterone Replacement Therapy & Sperm Production; Supplements (03:20:36) Sex Determination in Offspring, In Vitro Fertilization (IVF), Sperm Fractions (03:32:23) Postcoital Female Position & Fertilization, Sperm Quality (03:36:57) Cannabis & Sperm Motility, Libido, Pregnancy (03:42:33) Acupuncture, Fertility & Pregnancy (03:49:25) Fertility Supplements: L-Carnitine & Allicin, Coenzyme Q10 (03:56:18) Fertility Supplements: Inositol, Omega 3 Fatty Acids (04:02:50) Supplements for Hormones: Tongkat Ali, Shilajit, Zinc (04:13:02) Fertility & Prescription Medications (04:16:44) Human Reproduction & Fertility (04:20:12) Zero-Cost Support, YouTube Feedback, Spotify & Apple Reviews, Sponsors, Momentous, Social Media, Neural Network Newsletter Disclaimer Title Card Photo Credit: Mike Blabac

In this episode, I discuss the mechanisms by which human eggs and sperm are generated, the ovulatory/menstrual cycle, the conception process and overall fertility in males and females. I also explain how, regardless of whether you seek to conceive children, optimizing egg and sperm health is directly related to vitality and longevity. I cover the nutrition-based, behavioral, supplement-based and prescription approaches to optimizing egg and sperm health, the ovulatory/menstrual cycle and fertility. In addition, I explain lifestyle choices that greatly assist or harm fertility—several of which are very surprising. I provide science-based protocols for those trying to conceive children. The tools and principles I discuss can also improve overall vitality and longevity in all people, regardless of age.  For the full show notes, visit hubermanlab.com. Thank you to our sponsors AG1 (Athletic Greens): https://athleticgreens.com/huberman Maui Nui: https://mauinuivenison.com/huberman Eight Sleep: https://eightsleep.com/huberman InsideTracker: https://www.insidetracker.com/huberman Supplements from Momentous https://www.livemomentous.com/huberman Timestamps (00:00:00) Fertility, Vitality & Longevity (00:04:24) Maui Nui Venison, Eight Sleep, Momentous (00:08:20) Eggs & Sperm, Genes, Fertilization (00:18:28) Puberty: Gonadotropin Releasing Hormone (GnRH), Melatonin & Leptin (00:23:38) Onset Trends of Puberty, Odors Effects (00:31:24) Female Puberty, Luteinizing Hormone (LH), Follicle Stimulating Hormone (FSH) (00:35:25) AG1 (Athletic Greens) (00:36:34) Ovulatory & Menstrual Cycle (00:40:36) Follicular Phase: Egg Maturation & Ovulation, FSH & Estrogen (00:51:09) Luteal Phase: Progesterone & Estrogen, Menstruation (00:58:14) Ovulation & Libido; Luteal Phase & Malaise; Individual Variability (01:03:14) InsideTracker (01:04:18) Sex Chromosomes, Sperm (01:11:40) Tool: Testicular Temperature & Fertility (01:17:22) Sperm Production, Seminal Fluid, Vasectomy (01:24:07) Sperm Cells, Mitochondria & Motility, Intercourse Frequency & Fertilization (01:28:31) Sperm Production, GnRH, FSH, LH & Testosterone (01:36:21) Ejaculate Quality, Sperm Counts, Fertilization, Ectopic Pregnancy (01:44:14) Tool: Sexual Intercourse Frequency & Fertilization (01:53:24) Tools: Tracking Ovulation, Libido, Lubricants (01:56:42) Fecundability: Egg Quality & Woman's Age, Cumulative Pregnancy Rate (02:08:17) Miscarriages, Chromosomal Abnormalities (02:11:23) Female Fertility: Age, Follicle Testing & Anti-Mullerian Hormone (AMH) Testing (02:18:51) Male Fertility: Sperm Analysis, Age (02:24:52) Fertility & Hormone Analysis, Age (02:29:07) Fertility Effects of Sleep, Cortisol/Stress, Cannabis/Nicotine & Alcohol (02:42:40) Fertility, Sexually Transmitted Infections (STIs), Viral Infection & Cystic Fibrosis (02:47:42) Tool: Testicular Temperature & Fertility (02:51:26) Tool: Phones & Sperm Quality (02:58:06) Deliberate Cold Exposure & Fertility, Testicular Temperature, Cortisol/Stress (03:05:43) Fertility, Exercise & Mitochondrial Health; Intermittent Fasting (03:14:46) Testosterone Replacement Therapy & Sperm Production; Supplements (03:20:36) Sex Determination in Offspring, In Vitro Fertilization (IVF), Sperm Fractions (03:32:23) Postcoital Female Position & Fertilization, Sperm Quality (03:36:57) Cannabis & Sperm Motility, Libido, Pregnancy (03:42:33) Acupuncture, Fertility & Pregnancy (03:49:25) Fertility Supplements: L-Carnitine & Allicin, Coenzyme Q10 (03:56:18) Fertility Supplements: Inositol, Omega 3 Fatty Acids (04:02:50) Supplements for Hormones: Tongkat Ali, Shilajit, Zinc (04:13:02) Fertility & Prescription Medications (04:16:44) Human Reproduction & Fertility (04:20:12) Zero-Cost Support, YouTube Feedback, Spotify & Apple Reviews, Sponsors, Momentous, Social Media, Neural Network Newsletter Disclaimer Title Card Photo Credit: Mike Blabac

Let's talk about a potential new high-tech mine in Minnesota, how scientists have created a synthetic mouse embryo using stem cells, and a major breakthrough in the cause of and treatment for Down Syndrome.  Remote Mines“This Remote Mine Could Foretell the Future of America's Electric Car Industry” by Ana Swansonhttps://www.nytimes.com/2022/08/30/business/economy/electric-cars-us-nickel-mine.html“Fight over Minnesota nickel mine plan by Talon Metals is local — and global, too” by Mark Reillyhttps://www.bizjournals.com/twincities/news/2022/08/31/talon-metals-nickel-mine-minnesota.htmlMouse Embryos “Scientists Use Stem Cells To Create Synthetic Mouse Embryos” by Associated Presshttps://www.nbcnews.com/science/science-news/scientists-use-stem-cells-create-synthetic-mouse-embryos-rcna44881“Post-gastrulation synthetic embryos generated ex utero from mouse naive ESCs” by Shadi Tarazi, Alejandro Aguilera-Castrejon, Carine Joubran, Nadir Ghanem, Shahd Ashouokhi, Francesco Roncato, Emilie Wildschutz, Montaser Haddad, Bernardo Oldak, Elidet Gomez-Cesar, Nir Livnat, Sergey Viukov, Dmitry Lokshtanov, Segev Naveh-Tassa, Max Rose, Suhair Hanna, Calanit Raanan, Ori Brenner, Merav Kedmi, Hadas Keren-Shaul, Tsvee Lapidot, Itay Maza, Noa Novershtern, and Jacob H. Hannahttps://www.cell.com/cell/fulltext/S0092-8674%2822%2900981-3Down Syndrome Treatment“Hormone that could improve cognitive function in Down syndrome identified” By Helen Floershhttps://www.fiercebiotech.com/research/scientists-have-identified-hormone-could-restore-cognitive-function-down-syndrome#:~:text=Now%2C%20a%20team%20of%20researchers,it%20could%20improve%20cognitive%20performance.“GnRH replacement rescues cognition in Down syndrome” by MARIA MANFREDI-LOZANO et al.https://www.science.org/doi/10.1126/science.abq4515Follow Curiosity Daily on your favorite podcast app to get smarter with Calli and Nate — for free! Still curious? Get exclusive science shows, nature documentaries, and more real-life entertainment on discovery+! Go to https://discoveryplus.com/curiosity to start your 7-day free trial. discovery+ is currently only available for US subscribers.Find episode transcripts here: https://curiosity-daily-4e53644e.simplecast.com/episodes/remote-mines-mouse-embryos-down-syndrome-treatment

You know those IDIOT REPUBLICANS who think that SCIENCE hasn't TOTALLY PROVEN that puberty blockers and hormones are AWESOME????? And TOTALLY REVERSIBLE????? Well two MOUTH-BREATHING IDIOTS who probably also HATE CRT and PUPPIES are so BIGOTED they don't even ACCEPT the MEDICAL CONSENSUS.(Show notes a bit longer and more in-depth than usual this week to help everyone follow along, double-check stuff, etc.)Show notes/Links:Carole hooven DESTROYS jon stewartThe state lawshttps://www.kff.org/other/issue-brief/youth-access-to-gender-affirming-care-the-federal-and-state-policy-landscape/Jesse on the state laws in 2020The vote went down after the episode was recorded, but Florida has now banned yuth gender medicine, with exceptions for those already receiving it and future research projectshttps://www.nytimes.com/2022/11/04/health/florida-gender-care-minors-medical-board.htmlThe full episode of Stewart's show: https://tv.apple.com/us/episode/the-war-over-gender/umc.cmc.1jj39s607lehulo4k0iscsarp“I don't send someone to a therapist when I'm going to start them on insulin.”https://www.theatlantic.com/magazine/archive/2018/07/when-a-child-says-shes-trans/561749/“Historically, mental health professionals have been charged with ensuring ‘readiness' [she puts that in scare quotes] for phenotypic transition, along with establishing a therapeutic relationship that will help young people navigate this very same transition. These 2 tasks are at odds with each other because establishing a therapeutic relationship entails honesty and a sense of safety that can be compromised if young people believe that what they need and deserve (potentially blockers, hormones, or surgery) can be denied them according to the information they provide to the therapist.” This excerpt strongly suggests she doesn't believe in the traditional gatekeeping role a mental-health clinician might play in a situation like this, helping to determine if a young person will benefit from transitioning.https://jamanetwork.com/journals/jamapediatrics/article-abstract/2504256Kids — sorry, sorry — “adolescents” — getting double mastectomies at 13 or 14https://pubmed.ncbi.nlm.nih.gov/29507933/“Suicide Attempts among Transgender and Gender Non-Conforming Adults: Findings of the Naitonal Transgender Discrimination Survey.”https://williamsinstitute.law.ucla.edu/wp-content/uploads/Trans-GNC-Suicide-Attempts-Jan-2014.pdfn.b.: “Without such probes, we were unable to determine the extent to which the 41 percent of NTDS participants who reported ever attempting suicide may overestimate the actual prevalence of attempts in the sample.” And:Finally, it should be emphasized that the NTDS, like all similar surveys, captured information about suicide attempts, not completed suicide. Lacking any information about completed suicide among transgender people (due primarily to decedents not being identified by gender identity or transgender status), it may be tempting to consider suicide attempt data to be the best available proxy measure of suicide death. Data from the U.S. population at large, however, show clear demographic differences between suicide attempters and those who die by suicide. While almost 80 percent of all suicide deaths occur among males, about 75 percent of suicide attempts are made by females. Adolescents, who overall have a relatively low suicide rate of about 7 per 100,000 people, account for a substantial proportion of suicide attempts, making perhaps 100 or more attempts for every suicide death. 13 suicides per 100,000 in a GIDS samplehttps://link.springer.com/article/10.1007/s10508-022-02287-7Insanely high rate of 2.8% in a Belgian clinical samplehttps://biblio.ugent.be/publication/8706800/file/8707586.pdfT H E G U I D E L I N E SStewart: So these, the guidelines that you wrote, because you were responsible with the endocrine board for writing guidelines of care for endocrinology.Safer: The Endocrine Society, yesStewart: The endocrine society.Yes.Stewart: And that was based on, uh, research papers, data, the things that you saw. Intervening with gender affirming care which may be just being respectful or, as they get older some of these other things. You've seen that have a reduction in depression, a reduction in suicide — that's what you've studied.Safer: Absolutely.Nothing about mental health improvement, lotta assessment-talk, “low evidence” at best https://academic.oup.com/jcem/article/102/11/3869/4157558?login=false#99603239The Ibuprofen System For Evidence Assessmenthttps://www.ncbi.nlm.nih.gov/books/NBK470778/table/app2.t2/Erica Anderson and Laura Edwards-Leeper take their concerns to the Washington Posthttps://www.washingtonpost.com/outlook/2021/11/24/trans-kids-therapy-psychologist/Jesse's interview with Anderson on BARPodRutledge: We don't have enough data, we don't have enough to show that these drugs are effective and that these children are better off. And that we should encourage…Stewart: You don't have enough, or it's not enough for you? I've got some bad news for ya. Parents with children who have gender dysphoria, have lost children, to suicide, and depression. Rutledge : They absolutely have.Stewart: —because it's acute. And so these mainstream medical organizations have developed guidelines through peer reviewed data, and studies. And through those guidelines, they've improved mental health outcomes.Rutledge's read on the evidence is perfectly reasonableHere's Sweden's National Board of Health and Welfare:For adolescents with gender incongruence, the [National Board of Health and Welfare] deems that the risks of puberty suppressing treatment with GnRH-analogues and gender-affirming hormonal treatment currently outweigh the possible benefits, and that the treatments should be offered only in exceptional cases. … To minimize the risk that a young person with gender incongruence later will regret a gender-affirming treatment, the NBHW deems that the criteria for offering GnRH-analogue and gender-affirming hormones should link more closely to those used in the Dutch protocol, where the duration of gender incongruence over time is emphasized.https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/kunskapsstod/2022-3-7799.pdfAnd here's Finlands' Council for Choices in Health Care, via an unofficial translationIn light of available evidence, gender reassignment of minors is an experimental practice. Based on studies examining gender identity in minors, hormonal interventions may be considered before reaching adulthood in those with firmly established transgender identities, but it must be done with a great deal of caution, and no irreversible treatment should be initiated. Information about the potential harms of hormone therapies is accumulating slowly and is not systematically reported. It is critical to obtain information on the benefits and risks of these treatments in rigorous research settings.https://segm.org/sites/default/files/Finnish_Guidelines_2020_Minors_Unofficial%20Translation.pdfNHS headed same wayhttps://www.engage.england.nhs.uk/specialised-commissioning/gender-dysphoria-services/user_uploads/b1937-ii-specialist-service-for-children-and-young-people-with-gender-dysphoria-1.pdfDutch stuffhttps://www.tandfonline.com/doi/full/10.1080/0092623X.2022.2121238https://www.tandfonline.com/doi/full/10.1080/0092623X.2022.2046221Depression and suicidality linked to blockers, perhaps rarelyhttps://www.accessdata.fda.gov/drugsatfda_docs/label/2016/019732s042,020517s038lbl.pdfThttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3693622/“Testosterone Therapy is Associated With Depression, Suicidality, and Intentional Self-Harm: Analysis of a National Federated Database”https://www.sciencedirect.com/science/article/abs/pii/S1743609522012449#:~:text=Testosterone%20use%20was%20independently%20associated,testosterone%20deficient%20sub%2Dgroup%20analysisThe book to read on Thttps://www.amazon.com/Story-Testosterone-Hormone-Dominates-Divides/dp/1250236061The desistane literature is by no means “debunked,” and if you actually read the studies, no, the clinicians who wrote them did not confuse a bunch of merely gender nonconforming kids for genuinely gender dysphoric onesThese studies aren't perfect and come from different contexts, but they consistently tell the same storyhttp://www.sexologytoday.org/2016/01/do-trans-kids-stay-trans-when-they-grow_99.htmlThat story probably doesn't apply to kids who socially transition at a young age https://www.nytimes.com/2022/05/04/health/transgender-children-identity.htmlhttps://publications.aap.org/pediatrics/article/150/2/e2021056082/186992/Gender-Identity-5-Years-After-Social-Transition?autologincheck=redirected%3fnfToken%3d00000000-0000-0000-0000-000000000000Even at the bigger clinics that do take a multidisciplinary approach, and where kids could theoretically get comprehensive, holistic care, that isn't always happeninghttps://www.reuters.com/investigates/special-report/usa-transyouth-care/In interviews with Reuters, doctors and other staff at 18 gender clinics across the country described their processes for evaluating patients. None described anything like the months-long assessments de Vries and her colleagues adopted in their research. At most of the clinics, a team of professionals – typically a social worker, a psychologist and a doctor specializing in adolescent medicine or endocrinology – initially meets with the parents and child for two hours or more to get to know the family, their medical history and their goals for treatment. They also discuss the benefits and risks of treatment options. Seven of the clinics said that if they don't see any red flags and the child and parents are in agreement, they are comfortable prescribing puberty blockers or hormones based on the first visit, depending on the age of the child. “For those kids, there's not a value of stretching it out for six months to do assessments,” said Dr Eric Meininger, senior physician for the gender health program at Riley Hospital for Children in Indianapolis. “They've done their research, and they truly understand the risk.”2020 Finnish studyhttps://pubmed.ncbi.nlm.nih.gov/31762394/Those who did well in terms of psychiatric symptoms and functioning before cross-sex hormones mainly did well during real-life. Those who had psychiatric treatment needs or problems in school, peer relationships and managing everyday matters outside of home continued to have problems during real-life. … Medical gender reassignment is not enough to improve functioning and relieve psychiatric comorbidities among adolescents with gender dysphoria. Appropriate interventions are warranted for psychiatric comorbidities and problems in adolescent development.Jack Turban misinterpreting it:https://archive.ph/wip/x6LGWGIDS study comparing a group of kids with serious mental health problems who were delayed access to youth gender medicine to a group of kids who were able to start sooner because their mental health was solid enoughhttps://pubmed.ncbi.nlm.nih.gov/26556015/Severely distorted UW study also found no improvement among kids who went on youth gender medicineYet another study out of GIDS, on kids from 12 to 15 years old who went on blockers, found no mental-health improvements, full-stophttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0243894Littman defends Littman's research methodshttps://link.springer.com/article/10.1007/s10508-020-01631-zThat dumb chartWe also have chartshttps://www.newscientist.com/article/mg21929361-000-multiple-personalities-takedown-of-a-diagnosis/http://www.fmsfonline.org/?ginterest=RecoveredMemoriesInTheCourts“Another significant issue raised with us is one of diagnostic overshadowing – many of the children and young people presenting have complex needs, but once they are identified as having gender-related distress, other important healthcare issues that would normally be managed by local services can sometimes be overlooked.”https://cass.independent-review.uk/wp-content/uploads/2022/03/Cass-Review-Interim-Report-Final-Web-Accessible.pdfNHS changes course on the safety/reversibility of blockers in 2020https://www.transgendertrend.com/nhs-no-longer-puberty-blockers-reversible/[Michael Hobbes got mad at me for posting this because he doesn't like Transgender Trend, but holy hell is that stupid: They are simply summing up and putting into writing a change to the NHS website, and they're citing a BBC report on the same subject. -Jesse]OLD LANGUAGE: The effects of treatment with GnRH analogues are considered to be fully reversible, so treatment can usually be stopped at any time after a discussion between you, your child and your [multidisciplinary team]NEW LANGUAGE: Little is known about the long-term side effects of hormone or puberty blockers in children with gender dysphoria. Although the Gender Identity Development Service (GIDS) advises this is a physically reversible treatment if stopped, it is not known what the psychological effects may be. It's also not known whether hormone blockers affect the development of the teenage brain or children's bones. Side effects may also include hot flushes, fatigue and mood alterations.Serious Lupron side effectshttps://www.statnews.com/2017/02/02/lupron-puberty-children-health-problems/For years, Sharissa Derricott, 30, had no idea why her body seemed to be failing. At 21, a surgeon replaced her deteriorated jaw joint. She's been diagnosed with degenerative disc disease and fibromyalgia, a chronic pain condition. Her teeth are shedding enamel and cracking. None of it made sense to her until she discovered a community of women online who describe similar symptoms and have one thing in common: All had taken a drug called Lupron. Thousands of parents chose to inject their daughters with the drug, which was approved to shut down puberty in young girls but also is commonly used off-label to help short kids grow taller. The drug's pediatric version comes with few warnings about long-term side effects. It is also used in adults to fight prostate cancer or relieve uterine pain and the Food and Drug Administration has warnings on the drug's adult labels about a variety of side effects. More than 10,000 adverse event reports filed with the FDA reflect the experiences of women who've taken Lupron. The reports describe everything from brittle bones to faulty joints. In interviews and in online forums, women who took the drug as young girls or initiated a daughter's treatment described harsh side effects that have been well-documented in adults.Caroline Jemsbyhttps://www.journalismfund.eu/journalists/carolina-jemsbyGULDSPADENhttps://archive.ph/wip/GFuryClip in questionhttps://drive.google.com/file/d/1bL4WWMCs46dCKweZzz0gBj1AqE62k3oj/view?usp=sharingFull unlocked interview with JesseGLAAD is glad journalists are falling in linehttps://www.glaad.org/blog/jon-stewart-sets-record-straight-gender-affirming-carehttps://www.glaad.org/blog/john-oliver-explains-why-gender-affirming-care-is-so-importantBut sometimes nothttps://www.glaad.org/gap/jesse-singalJesse's response to the original version of his page (he hasn't yet responded to the new one, which went up after this, because life is short): The TikTok Doc yeets some teetshttps://www.nytimes.com/2022/09/26/health/top-surgery-transgender-teenagers.htmlWhoops:Dr. Gallagher of Miami said that she follows up with patients for up to a year. “I can say this honestly: I don't know of a single case of regret,” Dr. Gallagher said in May, adding that regret was much more common with cosmetic procedures. But one of her former top surgery patients, Grace Lidinsky-Smith, has been vocal about her detransition on social media and in news reports. “I slowly came to terms with the fact that it had been a mistake born out of a mental health crisis,” Ms. Lidinsky-Smith, 28, said in an interview.So basically, these clinicians are claiming top surgery has incredibly low regret rates, but they're simply not bothering to keep in touch with their patients. And one year is not very long for followup on this — if you give a kid top surgery at 15 or 16, one of the questions is whether, as their peers sexually develop and start families, they'll at some point wish they had breasts. It's a totally natural, important question, and you can't answer it if your patients are disappearing into the void just one year after you perform surgery on them.Age guidelineshttps://www.cdc.gov/hiv/policies/law/states/minors.htmlOliver: So the benefits of providing care are immense and the risks of withholding it are dire. A survey of around 28,000 trans people found that of those who wanted hormone therapy and didn't receive it 58% reported suicidal thoughts in a given year, which is why the three major professional associations of Child and Adolescent doctors, psychologists and psychiatrists have endorsed gender affirming care and condemned efforts to deny it. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0261039This study is ridiculous and doesn't even show any correlation between access to hormones and improvement on the more serious suicide measures anywayOliver: You may have seen or heard from a small subset of people who D transitioned but it is worth noting such cases are rare and highly individualized. Studies show an average of just 2% of people who transition expressed regret. And the vast majority of those who have opted to detransition did so not because of changes in their gender identity but due to external factors such as stigma and lack of social support. Supposedly 1% - 2% regret ratehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8099405/Lost to follow datahttps://docs.google.com/spreadsheets/d/1Yog0cUgVufxoTY64q-ll1wr7XcBhuqKD/edit?usp=sharing&ouid=102378063559486309340&rtpof=true&sd=trueOliver is relying not on a study of detransitioners, but on individuals who currently identify as transhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8213007/Littman study of detransitionershttps://pubmed.ncbi.nlm.nih.gov/34665380/Reasons for detransitioning were varied and included: experiencing discrimination (23.0%); becoming more comfortable identifying as their natal sex (60.0%); having concerns about potential medical complications from transitioning (49.0%); and coming to the view that their gender dysphoria was caused by something specific such as trauma, abuse, or a mental health condition (38.0%). Homophobia or difficulty accepting themselves as lesbian, gay, or bisexual was expressed by 23.0% as a reason for transition and subsequent detransition. The majority (55.0%) felt that they did not receive an adequate evaluation from a doctor or mental health professional before starting transition and only 24.0% of respondents informed their clinicians that they had detransitioned.  This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.blockedandreported.org/subscribe

Part 2 of how NUTRITION has a HUGE impact on your BRAIN! Everything in your brain is something you ate, something you made from something you ate, or, in a few cases, something your mother ate. Nutrition impacts your mental and emotional health, the function of your five senses, and your conscious and unconscious control over your body movements. Join me as I lead you in a safari through the textbook, “Neuroscience,” pointing out along the way all the interesting connections to nutrition. Listen in for part 2 on the NEUROTRANSMITTERS! 0:00:37     Cliff Notes 0:04:15     Overview of neurotransmitters 0:06:55     Glutamate is the primary excitatory neurotransmitter. 0:14:08      De novo glutamate in the central nervous system is overwhelmingly made from glucose. 0:16:55     Ketogenic diet for epilepsy 0:20:12    Glutamate metabolism 0:23:42    There are two classes of glutamate receptors: ionotropic and metabotropic. 0:24:45     There are three classes of metabotropic glutamate receptors, their actions are complex and variable, and they can be excitatory or inhibitory. 0:25:05     The ionotropic glutamate receptors include AMPA receptors, NMDA receptors, and kainite receptors, all of which have a depolarizing effect by allowing sodium and potassium to flow freely through them. 0:27:47     Four unique things about the NMDA receptor: magnesium is required to block its ion channel, it's important for coincidence detection, it allows calcium to come into the cell, and it has a glycine-binding site. 0:33:16     Long-term potentiation (LTP) and long-term depression (LTD) are important for forming memories, and glutamate receptors play an important role. 0:40:48     GABA and glycine are the two primary inhibitory neurotransmitters of the central nervous system. 0:44:04     GABA and presumably glycine can be stimulatory if there is more chloride on the inside of the neuron than the outside. 0:48:53     Evidence that GABA might cross the blood-brain barrier 0:51:44     GABA in foods 0:54:14     GABA metabolism in the nervous system 0:56:08     Glycine 1:02:02     Acetylcholine 1:07:50     The biogenic amines include histamine, serotonin, and the catecholamines (dopamine, norepinephrine, and epinephrine). 1:08:30     Synthesis of the catecholamines 1:10:46     Dopamine 1:14:08     Norepinephrine 1:16:32     Histamine 1:20:15     Serotonin 1:23:10     ATP and adenosine 1:26:38     Peptide neurotransmitters 1:27:00     Hypothalamic releasing hormones include thyrotropin-releasing hormone (TRH), corticotropin-releasing hormone (CRH), and gonadotropin-releasing hormone (GnRH). 1:29:15     Melanocyte-stimulating hormone (MSH) 1:29:32     Oxytocin 1:30:18     Vasopressin 1:30:57     Synthesis of the neuropeptides Substance P, MSH, oxytocin, and vasopressin requires glycine, zinc, copper, and vitamin C. 1:34:24     Endocannabinoids and the importance of arachidonic acid, EPA, and DHA Nutrition in Neuroscience Related Content Chris Masterjohn Lite: Could Oxaloacetate Supplements Help With Glutamate Sensitivity? Chris Masterjohn Lite: 5 Ways to Help With Glutamate Sensitivity and Glutamate Dominance Chris Masterjohn Lite: Does Glycine or GABA Wake You Up? Chris Masterjohn Lite: Carbs or Keto for Sleep? Chris Masterjohn Lite: How to Manage Your Magnesium Status Mastering Nutrition: Why You Need Glycine -- A Panel Discussion Balancing Methionine and Glycine in Foods: The Database  Chris Masterjohn Lite: Get Better Sleep With Glycine Start Here for Methylation has glycine and choline resources, and covers the methylation process used in the synthesis and degradation of biogenic amines. Mastering Nutrition: Methylate Your Way to Mental Health With Dopamine The Pursuit of Happiness: How Nutrient-Dense Animal Fats Promote Mental and Emotional Health, covers the endocannibinoids. Testing Nutritional Status: The Ultimate Cheat Sheet is a comprehensive guide for testing nutritional status for all the nutrients discussed in this episode, and more. Use the code MASTERINGNUTRITION for $5 OFF. Nutrition in Neuroscience Research The textbook, Neuroscience. Relaxation and immunity enhancement effects of gamma-aminobutyric acid (GABA) administration in humans. on the use of GABA for fear of heights and to alter anxiety- and focus-related brain waves. γ-Aminobutyric acid (GABA) administration improves action selection processes: a randomised controlled trial on use of GABA to improve decision-making under pressure. Desarrollo de un pan de masa madre rico en GABA y péptidos IECA contains a table on the GABA content of foods on page 84 of the PDF. Acetylcholinesterase inhibitor from plants on the different plants containing natural acetylcholinesterase inhibitors. A Mass Spectrometry-Based Method to Screen for α-Amidated Peptides on the neuropeptides that require glycine, vitamin C, copper, and zinc for their biological activity. Effects of copper occupancy on the conformational landscape of peptidylglycine α-hydroxylating monooxygenase also on the neuropeptides that require glycine, vitamin C, copper, and zinc for their biological activity.