Treatment of pain in fibromyalgia patients with testosterone gel: Pharmacokinetics and clinical response.

To test our hypothesis that testosterone deficiency plays an important role in chronic pain, a Phase I/II pilot study was initiated with 12 fibromyalgia patients to verify that a daily dose for 28days with transdermal testosterone gel would 1) significantly and safely increase mean serum testosterone concentrations from low baseline levels to mid/high-normal levels, and 2) effectively treat the pain and fatigue symptoms of fibromyalgia. Pharmacokinetic data confirmed that serum free testosterone concentrations were raised significantly above baseline levels, by assessment of maximum hormone concentration (Cmax) and area under the curve (AUC) parameters: free testosterone Cmax was significantly raised from a mean of 2.64pg/mL to 3.91pg/mL (p<0.05), and 24hour free testosterone AUC was significantly raised from a mean of 35.0pg-hr/mL to 53.89pg-hr/mL. Assessment of the typical symptoms of fibromyalgia by patient questionnaire and tender point exam demonstrated significant change in: decreased muscle pain, stiffness, and fatigue, and increased libido during study treatment. These results are consistent with the hypothesized ability of testosterone to relieve the symptoms of fibromyalgia. Symptoms not tightly related to fibromyalgia were not improved.

New Hampshire House Bill 1719-FN. "An act defining human life as beginning at the moment of fertilization for the purposes of prenatal, pregnancy, and maternity services and programs".

Recently, the author was asked by the New Hampshire State Medical Society to testify before the State of New Hampshire's House Judiciary Committee, to address a bill that would establish the definition of when human life begins. Other states, such as South Dakota, recently passed a ban on abortion. Such legislation will severely limit a woman's ability to exercise her right to terminate her pregnancy. With the present composition of the US Supreme Court, it seems possible that in the not-too-distant future there will be a successful challenge to Roe v Wade. It is important that as health care providers we take the time to educate our public officials and general citizenry about the complexity of such issues. The subsequent editorial will paraphrase the statement that was delivered. Fortunately, the bill was defeated.

Hormone therapies in women aged 40 and older: prevalence and correlates of use.

CONTEXT: The objective of this paper is to report the prevalence and correlates of both prescription and non-prescription hormone use. DESIGN/SETTING/SAMPLE: Cross-sectional baseline study from a prospective cohort of 30,448 women receiving mammography in New Hampshire. MAIN OUTCOME MEASURES: Odds of prescription hormone and non-prescription hormone use. RESULTS: 29,851 women were included; 62% reported some use of prescription hormone therapy, with current long-term prescription hormone therapy users representing the largest group (25%). Among ever-users, estrogen only was the most commonly used preparation (71% versus 30% for estrogen and progestin combined). Both single agent estrogen and estrogen and progestin combined regimens were taken primarily for treatment of menopausal symptoms or disease prevention. Correlates for prescription hormone use included a family history of breast cancer (associated with decreased use-OR 0.88; 95% CI: 0.84, 0.93), and family history of heart disease (associated with increased use-OR 1.11; 95% CI: 1.06, 1.17). Ten percent of women reported ever use of phytoestrogens (over-the-counter hormones). Family history of breast cancer was a correlate of over-the-counter hormone use (OR 1.10; 95% CI: 1.01, 1.19). CONCLUSION: Management of menopausal symptoms and disease prevention were the main reasons for using prescription hormones, and health histories were important correlates of both prescription and over-the-counter hormone exposures. As evidence changes regarding risks and benefits of hormone exposure, primary care physicians should help women reassess their use of hormonal agents.

True hermaphroditism presenting as bilateral gynecomastia in an adolescent phenotypic male.

OBJECTIVE: To report a rare case of true hermaphroditism presenting in adolescence as bilateral gynecomastia in a phenotypic male. DESIGN: Case report. SETTING: Academic medical center. PATIENT(S): A 19-year-old phenotypic male who presented with pronounced bilateral gynecomastia and was ultimately diagnosed with true hermaphroditism. INTERVENTION(S): Endoscopic removal of the internal female genital tract (hemiuterus and ovary), reduction mammoplasty, repair of penile chordee, and left testicular prosthesis placement. MAIN OUTCOME MEASURE(S): Diagnosis and treatment of true hermaphroditism. RESULT(S): Bilateral mammoplasties, repair of a penile chordee, placement of a left testicular prosthesis, and excision of the left hemiuterus and ovary resulted in return to testicular function in this true hermaphrodite. CONCLUSION(S): Although rare, true hermaphroditism should be suspected in male patients presenting with bilateral breast enlargement in adolescence.