Tag: hormones

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Morning Sickness Associated with Lower Miscarriage Risk

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During the first trimester of pregnancy, many women experience what’s commonly known as “morning sickness.” As distressing as this nausea and vomiting can be, a team of NIH researchers has gathered some of the most convincing evidence to date that such symptoms may actually be a sign of something very positive: a lower risk of miscarriage.

In fact, when the researchers studied a group of women who had suffered one or two previous miscarriages, they found that the women who felt nauseous during their subsequent pregnancies were 50 to 75 percent less likely to miscarry than those without nausea. While it’s not yet exactly clear what’s going on, the findings lend support to the notion that morning sickness may arise from key biological factors that reflect an increased likelihood of a successful pregnancy.

The study, reported recently in JAMA Internal Medicine [1], was led by Enrique Schisterman and Stefanie Hinkle of the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development. Their findings are based on a secondary analysis of existing data from the recently completed Effects of Aspirin in Gestation and Reproduction (EAGeR) trial. It found that aspirin might help in select cases but is not generally recommended to prevent pregnancy loss [2].

While other studies have looked at the effects of morning sickness on the risk of miscarriage, most have been limited to pregnancies lost late in the first trimester or thereafter. That’s one of the ways in which the EAGeR study is noteworthy. It enrolled 1,228 women who had one or two previous miscarriages and followed them for up to six menstrual cycles as they tried to become pregnant again.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Puberty Blockers May Improve the Mental Health of Transgender Adolescents

August 19, 2016

(Kaiser Health News) -Full-blown puberty is irreversible, but for transgender children, it’s no longer inevitable. By taking a gonadotropin-releasing hormone (GnRH) agonist, secretion of the sex hormones can be stopped and the onset of puberty suppressed, so that the body does not develop secondary sex characteristics. This has been done safely for decades to suppress sex hormones in children who develop too early, a condition known as precocious puberty. Suppressors have also been used to treat endometriosis, uterine fibroids and prostate cancer.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Sarah Richardson’s Sex Itself: The Search for Male and Female in the Human Genome by Paula Martin

Sex Itself: The Search for Male and Female in the Human Genome

Sarah Richardson

University of Chicago Press, 2013, 320 pages

 

In Sex Itself: The Search for Male and Female in the Human Genome (2013), Sarah Richardson takes gender criticism to a new level — the genomic one. Following the work of noted scholars such as Evelyn Fox Keller (1995), Anne Fausto-Sterling (2000) and Sarah Martin (1991), Richardson’s text explores the interplay between biological notions of sex and cultural conceptions of gender. With close historical attention, Sex Itself takes as its analytic object the sometimes bewildering practices making up the “search” for sex, from the discovery of distinct X and Y chromosomes to the attempt to enumerate the genetic differences between males and females. Richardson compellingly argues that gender is central to our understandings of chromosomal sex, and advocates for the acknowledgement of the interplay between sex and gender so that we may recognize how gender acts not only as a source of bias, but as a productive force driving genetic research.

Richardson troubles the etiological explanation of sex often assumed in both scientific and popular discourse; where genetic factors are taken as necessarily prior to other biological components and socio-cultural notions of gender are overlaid upon individual bodies and biologies (Chapter 1). Instead, she draws out themes of dynamism and exchange, noting how scientists have historically overlooked inherent ambiguities in the relationships between X and Y chromosomes in favor of promoting findings which support gendered ideas about biological sex differences. Though Richardson’s critical analysis centers on the ways in which socially contingent meanings of ‘male’ and ‘female’ have fundamentally shaped scientific practice, she does not shy away from technical and historical detail.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Joanna Kempner’s Not Tonight: Migraine and the Politics of Gender and Health by Christine Labuski

Not Tonight: Migraine and the Politics of Gender and Health

Joanna Kempner

University of Chicago Press, 2014, 232 pages

In her thoroughly engaging new book, Not Tonight: Migraine and the Politics of Gender and Health, Joanna Kempner argues that, despite a new clinical paradigm through which migraine has been transformed from a psychogenic to a neurobiological disorder, the condition remains “an opportunity to make jokes about moral character” (2). Grounding this assertion in the concept of a “legitimacy deficit,” (9) i.e., a gap between what sufferers experience and what biomedicine and broader society formally recognize as illness, Not Tonight demonstrates the synergistic roles that gender and perceptions of moral character can play in the lived experience of a disease condition, including its clinical management and representation. At its core, the book reveals how the virtual incompatibility between high moral character and a feminine gender impedes the social and clinical apprehension of migraine as a “real” disease condition.

Not Tonight is a fairly wide-ranging text. Across five chapters (each of which stand alone on their own merits), Kempner presents a set of interlocking variables through which the condition of migraine has thus far been understood: its social and clinical history; recent pharmaceutical advertising campaigns; online advocacy and activism; and the recent neurobiological turn in migraine care. In addition to online forums and blogs, much of Kempner’s fieldwork took place at clinical conferences where (mostly female) patients—as proxies for the specialty of headache medicine—were routinely maligned by clinicians, and where the neurobiological paradigm at the heart of her analysis has become institutionalized.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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When will transgender women deliver babies?

from Scientific American / Getty Images    

If we welcome transgender women, are transgender mothers a big deal? Although surgeons are still mastering the technique of transplanting wombs, patients are already asking when this will become possible.

At the moment, the only team which has succeeded in transplanting a uterus into a woman who later gave birth is in Sweden. Dr Mats Brännström developed the operation to help women who had been born without a uterus or who had to have hysterectomies. But elsewhere in Europe and in the US doctors are attempting the daunting surgery and it has been widely publicized. Scientific American spoke to several doctors who said that a handful of their transwomen patients were interested, even though it is still far from successful.

“A lot of this work [in women] is intended to go down that road but no one is talking about that,” Mark Sauer, a professor of obstetrics and gynecology at Columbia University, told the magazine. .

The operation is far more complex than most people imagine. First, the aspiring transwoman needs to create IVF embryos and store them. Then there is castration surgery and high doses of hormones. Surgery would be needed to create a “neo-vagina”. Anti-rejection drugs are needed.

There are other issues as well: the cost is very high and the operation could last for 10 or 11 hours. Would it be ethical for a doctor to allow a patient to risk his life in experimental surgery when there are safer alternatives for having children like adoption?

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Sex/Gender: Part III: What Counts as Adequate Function? by Constance Cummings

A Critical Moment: Sex/Gender Research at the Intersections of Culture, Brain, and Behavior

FPR-UCLA 2016 Conference Summary

The sex/gender conference succeeded in bringing together people “with different ideas and skills, different ways of thinking, that are actually transforming the field,” observed Carol Worthman, chair of Part 3 (“What’s at Stake?”). The earlier sessions (see Parts 1 and 2) provided us with a better sense of the complexities of sex/gender; we also learned some ways to usefully deconstruct – and form new ideas about – old questions. But there’s a lot at stake, Worthman continued. In the following session, speakers addressed the theme (“What counts as adequate function?”) from a variety of perspectives and from individual to macro levels of analysis. The question regarding adequate function is critical, Worthman reminded the audience, “because a lot of what is lurking in the background is frequently this question of ‘not good enough’ or ‘not a real person,’ both exogenously, in terms of how people are viewed, and endogenously, in terms of how they view themselves” by internalizing cultural norms. This suggests the importance of recognizing culture-mind-brain “intra-actions” (Barad, 1998, p. 96, noting “the inseparability of ‘objects’ and ‘agencies of observation’”) that can perpetuate shame, fear, and other forms of suffering.

This post reviews two films shown at the conference (Bitter Honey and Tales of the Waria) and three talks by neuroscientist Melissa Hines and anthropologists Hillard Kaplan and Marcia Inhorn.

Bitter Honey

On Day 1 and 2 of the conference, FPR founder and president, Robert Lemelson, a documentary filmmaker and psychological anthropologist on the UCLA faculty, screened Bitter Honey.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Love by design: when science meets sex, lust, attraction and attachment

A version of this post was originally published in the Conversation 

You are on holiday with your partner of several years. Your relationship is going pretty well, but you wonder if it could be better. It’s Valentine’s Day and you find a bottle on the beach. You rub it. A love genie appears. He (or she) will grant you three special Valentine wishes. Here are some of your choices:

  • to have more or less sexual desire (lust);
  • to remain always as “in love” as you were when you first fell in love (romantic attraction);
  • to be more or less bonded to your partner emotionally (attachment);
  • to be (happily) monogamous or polygamous.

What would you choose? What should you choose? What would your partner choose? Would you choose together, if you could? What would you choose for your partner?

In August 2015, the US Food and Drug Administration (FDA) approved the first drug to specifically increase sexual desire. While not yet available from doctors in Australia, it is available on the internet. Flibanserin or “Addyi” is used to “treat” hypoactive sexual desire disorder (HSDD), or low libido, in premenopausal women.

Addyi acts on neurotransmitter receptors in the brain (serotonin receptors – the same receptors targeted by some antidepressants like Prozac which themselves lower libido). The beneficial effects are modest. Prior to treatment, these women experienced about two or three satisfying sexual events over a month. After a course, they got around one extra sexually rewarding experience a month, though in some individual cases the effects would have been greater.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Bold attempt to reverse brain death gets US approval

Despite some sceptics, an Indian company working with a US biotech company has received a green light from the US clinical trials authority to test a protocol for reversing brain death.

Dr Ira Pastor, the CEO of the American biologics company Bioquark, believes that this could be a breakthrough technology, “another step towards the eventual reversal of death in our lifetime”.

The Reanima project has received approval to experiment on 20 subjects diagnosed with brain death at Anupam Hospital in Rudrapur, a small city about 250 km east of New Delhi.

While it may seem implausible, Dr Pastor points out that some brain dead patients “can still circulate blood, digest food, excrete waste, balance hormones, grow, sexually mature, heal wounds, spike a fever, and gestate and deliver a baby”. He has studied the regenerative properties of amphibians and other animals and believes that it is possible to regenerate brain tissue “with the convergence of the disciplines of regenerative biology, cognitive neuroscience, and clinical resuscitation”.

In the experiment, peptides will be administered into the spinal cord daily via a pump, with stem cells given bi-weekly, over six weeks. “It is a long term vision of ours that a full recovery in such patients is a possibility,” says Dr Pastor.

Is ReAnima being over-ambitious in this proof-of-concept study? Dr Dean Burnett, a neuroscientist at the Cardiff University’s Centre for Medical Education, believes that it might be. He told the London Telegraph:

“While there have been numerous demonstrations in recent years that the human brain and nervous system may not be as fixed and irreparable as is typically assumed, the idea that brain death could be easily reversed seems very far-fetched, given our current abilities and understanding of neuroscience.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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BioethicsTV: Mistaken diagnosis, patient battery, “work-arounds,” and trans-gender patient health

by Craig Klugman, Ph.D.

A look at the ethical and professionals issues raised in medical dramas this week: Chicago Med and Heartbeat.

Chicago Med

This new show is always good for presenting challenges in professionalism and bioethics. This week (season 1; episode 16) is no exception as the fictional hospital finds itself in the middle of a surprise Joint Commission visit (though they often refer to the organization as “jay-koh” it’s previous abbreviation). One of the storyline this week deals with a retired neurologist and her husband with Lewy Body syndrome. She diagnosed him originally and took him to see two specialists who confirmed her diagnosis. But the staff at the hospital is confused because he has moments of extreme lucidity and has not declined as much as he should have with this disease. Dr. Charles, the resident font of wisdom and psychiatrist, orders an MRI for the patient. The scan shows not Lewy body but rather a small tumor that is responsible for his observed behaviors.

This storyline demonstrates two professional issue and two ethical ones. The first professional concern is a boundary issue: Don’t treat your own family. As we learn, the neurologist made the diagnosis based on the symptoms she saw and her experience of seeing many patients with that disease. What she didn’t do was order brain scans to support her differential diagnosis. One also wonders if the two specialists actually bothered to examine the patient independently, or did they start the examination with the bias of what their esteemed colleague found?

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Critical interventions in birth in the first 1000 days by Jennifer Rogerson

Choice and the assigning of value in the practices and crafting of life-giving work

In healthy birthing initiatives described by, among others, the World Health Organization, emphasis has been placed on the importance of ‘the golden trio’: vaginal birth, breastfeeding and immediate skin to skin contact after birth. These three experiences are said to seed a baby’s immune system with good bacteria, preventing diseases from allergies through to diabetes and obesity, and facilitating neuroplasticity and brain development. In resource-poor countries, these are cheap and effective public health interventions. Despite these benefits, South Africa’s middle class caesarean section rate is extremely high.

My research is part of the University of Cape Town’s First 1000 days research cohort led by Fiona Ross and focuses on midwife assisted birth. While the WHO recommends that a country should not have a caesarean-section rate higher than 10-15% of all births, South Africa has extremely high rates of c-section birth, largely testament to the highly medicalized private health care system enjoyed by the rich. In some private sector hospitals, particularly in metro centers, the rates vary between 70% and 95%, despite a strong push by the state for so-called ‘natural delivery’ (vaginal birth). Given the prevalence of c-sections in the private sector, and that sector’s broad refusal of midwife attended (rather than obs/gynae attended) birth, middle class women who want a vaginal birth find it difficult to have the ‘natural birth of their dreams’. Private midwife consultation is one of the few options available to them. With a powerful rhetoric encouraging c-sections in the South African context (obstetricians have extremely high medical malpractice insurance fees with increasing legal suits, convenience for doctor and patient in choosing a birth date and the perception that c-sections are safer), women who chose vaginal birth with a midwife are making important medical choices that they understand in political terms.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.