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TS-Si News Service
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Wednesday, 10 October 2007 19:00 |
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Aloof Husbands: Lower "T" Than Unmarried Married Men
 Lewogoso, Lukumai, Kenya. Married men have lower testosterone levels, supporting a growing body of research. A new study confirms previous findings in North America that even married men who are considered aloof spouses — and provide minimal parenting — have much lower testosterone levels than single, unmarried men.
Researchers investigated the links between male testosterone levels and marital status among modern-day pastoralists in northern Kenya. Less than 1.5 percent of the men consider their wives a source of emotional support.
These findings add to the cross-cultural scope of published data on the topic of human pair bonding, parenting and testosterone,” explain the researchers.
The Ariaal males serve as herd boys until they reach puberty, at which point they are initiated, become warriors, and accumulate livestock. They do not marry and have children until around 30, and, the researchers suggest, value social bonds with male peers more than spousal bonds or familial bonds.“
“While a number of North American studies have shown lower testosterone levels among monogamously married men compared with their single counterparts, no study outside North America had observed this.”
 The research team included and Benjamin C. Campbell,
The researchers measured testosterone in morning and afternoon saliva samples of more than 200 Ariaal men over the age of twenty. They found that monogamously married men had lower testosterone levels than unmarried men in both the morning and afternoon. However, contrary to expectations, married men with more than one wife (polygynously married men) had even lower levels of testosterone that the monogamously married men.
“These results lend further support to arguments that male testosterone levels reflect, in part, variation in male mating effort,” the researchers write.
 “[However], contrary to earlier findings . . . polygynously married men did not show higher testosterone levels. In fact, follow-up analyses among Ariaal men aged 40 and older revealed lower testosterone levels among polygynously married men compared with monogamously married men.”
The researchers suggest that this may be due to the fact that it is older men – who typically have lower testosterone levels – who have the social status and wealth required to obtain more than one wife.
Testosterone and Marriage among Ariaal Men of Northern Kenya. Peter B. Gray, Peter T. Ellison, and Benjamin C. Campbell. Current Anthropology 48:5 (October 2007).
Abstract. Recent studies suggest that differential human male investment in mating (male-male competition and mate-seeking behavior) and parenting effort may be associated with variation in testosterone levels. The Ariaal present an interesting test case because marital relations tend to be aloof and direct paternal care minimal by cross-cultural standards. Polygyny is prevalent and increases with age, and the age-set system highly structures the transition to marriage. A test of the effect of marital status on testosterone levels among the Ariaal involved 205 men aged 20 and older from a settled agropastoral community and nomadic populations. Each participant provided morning and afternoon saliva samples in which testosterone levels were measured, provided demographic background during interviews, and had anthropometrics taken. As predicted, during the dynamic ages (20–39) of transition from life as a bachelor and warrior to monogamous marriage, men with one wife had significantly lower testosterone levels than unmarried men. Contrary to prediction, however, polygynously married men did not have higher testosterone levels than their monogamously married counterparts. While variation in testosterone may be associated with mating effort in young Ariaal men, political networks and wealth may be better predictors of marital status in older men.
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Last Updated on Thursday, 18 October 2007 07:38 |
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SciMed -
Healthcare
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TS-Si News Service
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Monday, 24 September 2007 19:00 |
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Leicester's surgical techniques capped patient satisfaction
 Leicester, UK. Complications from surgery are common enough, but surgeons and other medical personnel work on minimizing them to ensure patient satisfaction.
A new survey from a medical center in the United Kingdom (UK) claims that the majority of its patients who undergo male to female sex-change surgery are happy with the results.
Researchers published their results in the urology journal BJU International. They found that 88 per cent of patients were happy with their surgery at their first post-operative clinic visit, seven per cent were unhappy and five per cent made no comment.
Each of the patients under study had their penis surgically removed, their urethra repositioned and female labia majora constructed (no labia minora). A total of 93 per cent had a clitoris constructed using a section of the glans of their penis and 91 per cent had a skin-lined vagina.
Computerized and manual databases were used for retrospective case-note reviews on all MtF sex-change surgery procedures since Leicester began Gender Identity services began in 1994.
“The outcome of this complex surgery depends on a number of factors” says lead author, urology registrar Jonathan C Goddard.
“These include the technical experience of the surgeon, the amount and quality of tissue that each patient has available for reconstruction and, most importantly, the realistic expectations of the patients themselves.
“One of the biggest problems with research of this nature is that many patients are difficult to contact. Having gone through a two-year real-life test before extensive surgery, which can include breast as well as genital construction, many want to start a new life and compartmentalise their past. This can include moving to a new area.”
Despite this, the research team managed to contact 70 of the patients who had undergone surgery at the hospital between 1994 and 2004.
They ranged from 19 to 76 years of age, with an average age of 43. Most had the surgery about three years before. 91 per cent had had a clitoris created and 89 per cent had a vagina created.
The researchers found that:
- 23 per cent of the patients had, or were having, regular intercourse and 61 per cent were happy with the depth of their vagina.
- 98 per cent had a sensitive clitoris and 48 per cent were able to achieve orgasm. 14 per cent were hypersensitive but none had elected to have their clitoris removed.
- 29 per cent were troubled by vaginal hair growth, six per cent had a vaginal prolapse (falling out of the normal position) and three per cent had an inadequate blood supply that resulted in tissue death (vaginal necrosis).
- 27 per cent reported urinary problems and the majority of these needed revision surgery.
Readers can evaluate these results in tandem with the comments on this page (Sidebar: SRS Vaginal Procedures).
“Despite these problems, which were mainly minor and easily corrected by secondary surgery, 76 per cent of the patients who provided detailed feedback were happy with the cosmetic result of their surgery and 80 per cent said the surgery had met their expectations” concludes Jonathan C Goddard.
Feminizing genitoplasty in adult transsexuals: early and long-term surgical results. Jonathan C. Goddard, Richard M. Vickery, Assad Qureshi, Duncan J. Summerton, Deenesh Khoosal, Tim R. Terry. BJU International 100 (3), 607–613. September 2007. doi:10.1111/j.1464-410X.2007.07017.x
Objective. To examine the early and late surgical outcomes of feminizing genitoplasty (FG) in adult transsexuals in a UK single surgeon practice over a 10-year period.
Patients and Methods. Computerized and manual databases were searched over the period 1994–2004 to identify patients who had undergone male to female FG. Case-notes were retrieved and analysed to identify epidemiological data, the number and type of perioperative problems, early results at outpatient review, late occurring problems and patient satisfaction.
A telephone questionnaire was then conducted targeting all FG patients in our series. The questions were directed at identifying surgical complications, outcome and patient satisfaction.
Results. In all, 233 case-notes were identified and 222 (95%) were retrieved. All patients had penectomy, urethroplasty and labiaplasty, 207 (93%) had formation of a neoclitoris, and 202 (91%) had a skin-lined neovagina. The median (range) age was 41 (19–76) years. The median hospital stay was 10 (6–21) days. A record of the first outpatient visit was available in 197 (84.5%) cases. The median time to follow up was 56 (8–351) days.
Over all, 82.2% had an adequate vaginal depth, with a median depth of 13 (5–15) cm and 6.1% had developed vaginal stenosis. Three (1.7%) patients had had a vaginal prolapse, two (1.1%) had a degree of vaginal skin flap necrosis and one (0.6%) was troubled with vaginal hair growth. In 86.3% of the patients the neoclitorizes were sensitive. There was urethral stenosis in 18.3% of the patients and 5.6% complained of spraying of urine. Minor corrective urethral surgery was undertaken in 36 patients including 42 urethral dilatations, and eight meatotomies were performed. At the first clinic visit 174 (88.3%) patients were ‘happy’, 13 (6.6%) were ‘unhappy’ and 10 (5.1%) made no comment. Of the 233 patients, we successfully contacted 70 (30%). All had had penectomy and labioplasty, 64 (91%) had a clitoroplasty and 62 (89%) a neovagina. The median age was 43 (19–76) years and the median follow up was 36 (9–96) months. Overall, 63 (98%) had a sensate neoclitoris, with 31 (48%) able to achieve orgasm; nine (14%) were hypersensitive. Vaginal depth was considered adequate by 38 (61%) and 14 (23%) had or were having regular intercourse. Vaginal hair growth troubled 18 (29%), four (6%) had a vaginal prolapse and two (3%) had vaginal necrosis. Urinary problems were reported by 19 (27%) patients, of these 18 (26%) required revision surgery, 14 (20%) complained of urinary spraying, 18 (26%) had an upward directed stream and 16 (23%) had urethral stenosis. The patients deemed the cosmetic result acceptable in 53 (76%) cases and 56 (80%) said the surgery met with their expectations.
Conclusion. This is largest series of early results after male to female FG. Complications are common after this complex surgery and long-term follow-up is difficult, as patients tend to re-locate at the start of their ‘new life’ after FG. There were good overall cosmetic and functional results, with a sustained high patient satisfaction.
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Last Updated on Tuesday, 30 October 2007 02:25 |
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SciMed -
Healthcare
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TS-Si News Service
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Tuesday, 18 September 2007 19:00 |
Finasteride blocks production of male  hormone within prostate
 Chicago, IL, USA. The first long-term randomized trial of a chemopreventive agent for prostate cancer had shown an excess prevalence of high-grade prostate cancer in the drug-treated group.
However, Reanalysis of the data shows that the initial results may be attributable to shrinkage of the prostate at the time of biopsy.
The PCPT evaluated the drug finasteride, which blocks production of a male hormone within the prostate and is proven effective in treating benign prostatic hyperplasia, or enlargement of the prostate. The trial was stopped in 2003 when finasteride was found to reduce the risk of prostate cancer by nearly 25 percent. However, men assigned to the finasteride group had a greater prevalence of high-grade cancer.
 Gann said the results were confusing for clinicians and patients because the drug appeared to retard the development of prostate cancer and decrease its prevalence, but the increased risk of high-grade cancer was unexplained and worrisome.
Researchers reasoned one possible explanation was that because finasteride shrinks the prostate gland, it increases the likelihood that a biopsy will detect high-grade cancer.
"It's logical that if you shrink the size of the gland and then stick needles in it, you're more likely to find cancer if it exists," Gann said.
Finasteride (as Proscar) initially was approved in 1992 as a treatment for prostate enlargement, with approval in 1997 to treat male pattern hair loss. Finasteride is marketed as various brands, including Finalo, Finasterid IVAX, Fincar, Finpecia, Finast, Finara, Finax, Gefina, Proscar, Propecia, and Prosteride.
There is a second possible source of bias in the trial that may have contributed to overestimation of prostate cancer risk in the finasteride group. The drug lowers the blood level of prostate-specific antigen by approximately 50 percent.
The PSA level is a biological marker doctors use to detect disease, so PSA levels measured in men taking finasteride are routinely adjusted upward. This calculation may have led to overestimation of baseline PSA levels among men in the finasteride group who were already harboring high-grade tumors at the start of the study.
"This is a very unusual situation — though it will become more common in the future — where the drug affects the marker we use to find the cancer," said Gann.
Using data from the Prostate Cancer Prevention Trial study, Gann and colleagues developed statistical models that took into account the size of the prostate gland and the number of needle cores that were taken during biopsy. In essence, the researchers compared finasteride to placebo among men with an equivalent number of needle samples per unit of gland volume.
The analyses showed that adjusting for changes in gland size due to the drug could account for all of the excess high-grade tumors.
"Once we did this adjustment, all the excess high-grade went away, and the effect of the drug on low-grade cancer was even stronger, as we would expect," Gann said.
"This drug may have been much better than people thought," Gann said, "and the fears about its impact on high grade tumors may have been exaggerated based on this bias alone."
However, he said, the findings must be interpreted cautiously, and the new results alone do not justify definitive changes in clinical practice or widespread use of the drug.
"Our goal is to improve scientific understanding of what happened in this very important and expensive trial."
Gann's co-authors include Yael Cohen of Gamida Cell Ltd. in Israel and Kenneth Liu, Norman Heyden, Alexandra Carides, Keaven Anderson, and Anastasia Daifotis of Merck & Co. Inc. Merck markets finasteride as Proscar.
Detection Bias Due to the Effect of Finasteride on Prostate Volume: A Modeling Approach for Analysis of the Prostate Cancer Prevention Trial. Yael C. Cohen, Kenneth S. Liu, Norman L. Heyden, Alexandra D. Carides, Keaven M. Anderson, Anastasia G. Daifotis, and Peter H. Gann. Journal of the National Cancer Institute (Advance Access: September 11, 2007). doi:10.1093/jnci/djm130.
To download an interview with Dr. Gann, right click on the ".mp3" link above, choose "save target as..." from the option menu, and save.
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Last Updated on Wednesday, 19 September 2007 01:06 |
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SciMed -
Healthcare
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TS-Si News Service
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Monday, 17 September 2007 19:30 |
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Surgery resulted in a more feminine nasal profile in all patients
 London, UK. Nasal surgery appears to effectively create feminine facial profiles in patients undergoing male-to-female gender [sex] reassignment.
“Transsexualism is a recognized medical condition, with an estimated incidence of one in 37,000, in which the affected individuals strongly believe themselves to have been born into the body of the wrong sex,” according to a report in Archives of Facial Plastic Surgery.
S. A. Reza Noureai, M.B.B.Chir., and colleagues at Charing Cross Hospital, London, studied 12 patients who underwent rhinoplasty (plastic surgery on the nose) as part of male-to-female gender reassignment between 1998 and 2004.
“Increasing acceptance of this condition as a medical disorder has led to the development of a number of medical and surgical approaches aimed at aligning the patient’s physical appearance with his or her perceived sex.”
The surgery involves reducing the overall size of the nose and also changing nasal angles to more closely match those of female noses. Two independent observers assessed the participants’ facial profile before and after surgery and also measured specific facial angles.
Patients’ nasal function was tested before and after surgery, and they were asked to rate their satisfaction on a five-point scale after the operation and again one year later.
“The surgical procedure resulted in a more feminine nasal profile in all patients,” the authors write. “One patient was subjectively unhappy with the results of surgery and underwent revision surgery, and the remaining patients were very satisfied with the results of surgical treatment, both in the early postoperative period and at the one-year follow-up visit. Five patients stated at the one-year visit that their nasal procedure had had one of the greatest impacts on their overall perception of themselves as female.”
No patients had difficulty with nasal valve functioning.
“Rhinoplasty is effective in achieving feminine facial profiles in patients undergoing male-to-female gender reassignment,” they conclude. “This requires reducing the overall nasal size and changing nasal angles to those more reminiscent of the female form. Because of the extensive resections often required to modify the nasal form, it is important to pay particular attention to preserving function, which may require concomitant nasal valve reconstruction.”
The Role of Nasal Feminization Rhinoplasty in Male-to-Female Gender Reassignment. S. A. Reza Noureai, MBBChir; Prem Randhawa, MRCS; Peter J. Andrews, FRCS; Hesham A. Saleh, FRCS. Arch Facial Plast Surg. 2007;9:318-320.
Abstract
Objective. To objectively assess the results of rhinoplasty in feminizing the facial profiles of male-to-female transsexual patients undergoing gender reassignment.
Methods. Twelve patients underwent nasal feminization as part of male-to-female gender reassignment. Global assessments of facial profile were performed, and nasofrontal, nasolabial, and supratip angles and the Goode ratio were objectively measured. Postoperative and long-term patient satisfaction was assessed.
Results. The surgical procedures created more feminine nasal profiles in all patients. The mean ± SD nasofrontal angle changed from 141.6° ± 6.0° to 150.5° ± 5.5° (P < .001). The nasolabial angle changed from 107.4° ± 14.3° to 115.2° ± 11.7° (P < .001), and the supratip angle from 1.7° ± 4.9° to 12.8° ± 5.8° (P < .001). The Goode ratio did not change significantly, remaining on average around 1.64 ± 0.15. In 4 cases, spreader grafts were used to reconstruct the nasal valve, and no cases of valve insufficiency occurred.
Conclusions. Rhinoplasty is effective in achieving feminine facial profiles in patients undergoing male-to-female gender reassignment. This requires reducing the overall nasal size and changing nasal angles to those more reminiscent of the female form. Because of the extensive resections often required to modify the nasal form, it is important to pay particular attention to preserving function, which may require concomitant nasal valve reconstruction.
Author Affiliations. Department of Otolaryngology, Charing Cross Hospital, London, England.
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Last Updated on Tuesday, 18 September 2007 01:41 |
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SciMed -
Healthcare
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TS-Si News Service
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Monday, 17 September 2007 19:00 |
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Study recommends insurance reimbursement to cover reduction
 New York, NY, USA. Smaller-framed patients reap significant health and quality-of-life benefits from breast reductions that involve the removal of under 500 grams of tissue per breast.
 The findings run counter to the policies of most U.S. health insurance companies, who typically do not reimburse women for smaller mammoplasties because they deem them to be only of cosmetic value.
"Of course, as plastic surgeons, we know that isn't true—you can't apply the same number, in terms of the benefits of excised breast tissue, to different-sized women," says co-author Dr. Jason Spector.
"Smaller women are going to have proportionally smaller breasts, but for their particular frame, their breasts may still be far too large and uncomfortable," Dr. Spector explains.
Investigators found that breast reductions of less than 500 grams per breast greatly eased back, neck and shoulder pain. The procedures also improved quality of life by allowing more exercise more, sports and a wider choice of clothing.
 All of the 59 patients in the study had come to the study's co-author, plastic surgeon Dr. Nolan S. Karp of NYU Medical Center, complaining of pain linked to uncomfortably large breasts. Dr. Karp is associate professor of plastic surgery at the NYU School of Medicine.
None of the women in the study had ever undergone any form of breast augmentation before.
On average, the mammoplasties involved the surgical removal of 415 grams of breast tissue per breast (830 grams total), for an average breast reduction of just over 2 cup sizes. Seventeen of the women had less than 750 grams total of breast tissue removed—an average decrease of 1.7 cup sizes.
Three months and then one year after their surgery, the women were asked about changes in pain and quality of life. They were asked to rate their pain from a score of 1 to 5 (5 being highest).
Scores fell dramatically after the reduction mammoplasties—in categories including lower-back pain, neck pain, headache and bra-strap "grooving."
"Women were also greatly relieved that they were more able to engage in healthful activities such as running or playing sports — demonstrating that breast reduction surgeries have even wider health implications," Dr. Spector says.
None of these findings come as a surprise to experienced plastic surgeons. "However, studies like this are needed if we are ever going to reverse the arbitrary ceiling the insurance industry has in place in terms of reimbursing breast reduction surgeries," Dr. Spector explains.
"The smaller-framed woman who comes to us complaining of chronic breast-linked pain is not having this procedure done for a 'lift' or any cosmetic purpose," he says. "Breast reduction surgeries involve some scarring, general anesthesia, and the usual level of surgical risk. Patients are not taking them lightly."
Dr. Spector is optimistic that reimbursement policies may change, based on the new findings.
"This is going to be useful data that patients and other plastic surgeons should be able to turn to as they go back and forth with insurance companies trying to get the procedure approved," Dr. Spector says.
"Women come in all shapes and sizes, and we're just pointing out that breast reduction — like many other surgeries — is definitely not a one-size-fits-all proposal."
Reduction Mammaplasty: A Significant Improvement at Any Size. Spector, Jason A. M.D.; Karp, Nolan S. M.D. Plastic & Reconstructive Surgery. 120(4):845-850, September 15, 2007.
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Last Updated on Saturday, 29 September 2007 06:22 |
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Geneva, Switzerland. A study suggests that men who have surgery for prostate cancer appear less likely to die of the disease within 10 years than men who choose other treatment options. 
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