Quality of life in Klinefelter patients on testosterone replacement therapy compared to healthy controls: an observational study on the impact of psychological distress, personality traits, and coping strategies

PURPOSE

We aimed to verify if 1 year-testosterone-replacement therapy could produce a psychopathological recovery and a satisfactory quality of life in Klinefelter syndrome (KS) patients compared to matched healthy controls. Further, we analyzed personality traits and coping strategies, an issue not yet examined in androgen-treated KS patients. We also enquired whether any of the sociodemographic and psychological variables might predict a patient's general and sexual life satisfaction.

METHODS

The Quality of Life Enjoyment and Satisfaction Questionnaire and the Temperament and Character Inventory-Revised were administered to both 23 KS patients and matched healthy subjects. Psychopathology was investigated by the Symptom Checklist-90-Revised (SCL-90-R) and the Mini-mental State Examination. The COPE Inventory was used to identify cognitive and behavioral strategies to manage disease-related distress.

RESULTS

In testosterone-treated KS patients, when compared with controls, SCL-90-R subscales analysis evidenced high psychological distress, mainly presented as obsessive thoughts, hanger-hostility, phobias, and psychoticism. Self-directedness and self-transcendence, along with the prevalent use of emotion-focused coping strategies, outlined the personality of our KS patients. Depression and somatization proved to be predictors of general life dissatisfaction. Depression, anger-hostility, and paranoid ideation, instead, emerged as predictors of sexual life dissatisfaction.

CONCLUSION

Endocrinologists should cooperate with mental health providers to foster a better outcome of the disease in KS patients.

Menopausal Hormone Therapy and Suicide in a National Sample of Midlife and Older Women Veterans

BACKGROUND

Among midlife and older women, menopause symptoms and menopausal hormone therapy have been linked to mental health disorders and other comorbidities related to suicide. However, the role of hormone therapy as a prognostic factor of suicide risk is largely unknown.

OBJECTIVES

To examine associations between menopausal hormone therapy, suicide attempts, and suicide among midlife and older women Veterans.

RESEARCH DESIGN

In this longitudinal analysis of national Veterans Health Administration data from women Veterans aged 50 years and above, we used Fine-Gray proportional hazards models to examine associations between menopausal hormone therapy (prescribed in 2012-2013) and incident suicide attempts and suicide (index date-2016).

MEASURES

Menopausal hormone therapy and psychoactive medications from pharmacy records; suicide attempts and suicide from national suicide data repositories; demographic variables, medical and psychiatric diagnoses, and substance use disorders from electronic medical record data and International Classification Diagnoses-9-CM codes.

RESULTS

In this national sample of 291,709 women Veterans (mean age 60.47, SD 9.81), 6% were prescribed menopausal hormone therapy at baseline. Over an average of 4.5 years, 2673 had an incident suicide attempt (93%) or death by suicide (7%). Adjusting for age, race, and medical diagnoses, menopausal hormone therapy was associated with increased risk of suicide attempt (hazard ratio 1.41; 95% confidence interval, 1.22-1.64) and over 2-fold increased risk of death by suicide (hazard ratio 2.47; 95% confidence interval, 1.58-3.87). Associations with death by suicide remained significant after accounting for psychiatric comorbidity and psychoactive medications.

CONCLUSIONS

Menopausal hormone therapy may be an important indicator of suicide risk among midlife and older women.

Motivation for and adherence to growth hormone replacement therapy in adults with hypopituitarism: the patients' perspective

INTRODUCTION

While reasons for non-adherence in children requiring growth hormone (GH) replacement (GH-Rx) are well researched, few studies have investigated adherence in adult GH deficient patients. Against the background of the adverse medical sequelae of untreated severe GH deficiency (GHD) in adults, we explored adherence to GH-Rx and associated factors in this patient group.

METHOD

Cross-sectional analysis including 107 adult patients with severe GHD on GH-Rx, 15 untreated GDH patients and 19 who had discontinued therapy. Patients completed self-developed ad hoc surveys on adherence to medication and GH-Rx, specific beliefs about GH-Rx, side effects and burden of injection, reasons for never receiving or dropping out of therapy, respectively.

RESULTS

Adherence to GH-Rx was high (mean 15.8/18 points on the self-developed adherence score) and significantly correlated with general medication adherence. Higher age was significantly associated with better adherence to GH-Rx, while injection side effects, duration of treatment or device used were not. The most frequent reasons for not being on GH-Rx apart from medical reasons included fear of side effects, lack of belief in treatment effects and dislike of injections. In patients not on GH-Rx, the proportion of patients in employment was significantly smaller than in the treatment group, despite similar age and comorbidities.

CONCLUSIONS

Adherence to GH-Rx was high for those patients on therapy. Instead of focusing on improving adherence in those adults already on GH-Rx, efforts should be undertaken to ally fear of side effects and provide education on positive treatment effects for those eligible but not receiving therapy.

How sociophenomenology of the body problematises the 'problem-oriented approach' to growth hormone treatment

This article examines how people who are shorter than average make sense of their lived experience of embodiment. It offers a sociophenomenological analysis of 10 semistructured interviews conducted in the Netherlands, focusing on if, how, and why height matters to them. It draws theoretically on phenomenological discussions of lived and objective space, intercorporeality and norms about bodies. The analysis shows that height as a lived phenomenon (1) is active engagement in space, (2) coshapes habituated ways of behaving and (3) is shaped by gendered norms and beliefs about height. Based on this analysis, the article challenges what we label as the 'problem-oriented approach' to discussions about growth hormone treatment for children with idiopathic short stature. In this approach, possible psychosocial disadvantages or problems of short stature and quantifiable height become central to the ethical evaluation of growth hormone treatment at the expense of first-hand lived experiences of short stature and height as a lived phenomenon. Based on our sociophenomenological analysis, this paper argues that the rationale for giving growth hormone treatment should combine medical and psychological assessments with investigations of lived experiences of the child. Such an approach would allow considerations not only of possible risks or disadvantages of short stature but also of the actual ways in which the child makes sense of her or his height.

Hormone use among Nepali transgender women: a qualitative study

OBJECTIVES

There is a dearth of information on transgender individuals in Nepal, particularly studies exploring their use of hormone therapies. The objectives of this study therefore were to explore (1) how hormones are used, (2) types of hormones used and (3) side effects experienced by transgender women after hormone use. This is the first study of its kind in Nepal addressing this important public health issue.

SETTING

The study was conducted in four districts of Nepal: Kathmandu, Sunsai, Banke and Kaski.

DESIGN AND PARTICIPANTS

This qualitative study comprises eight focus group discussions (FGDs) and nine interviews. FGDs and three face-to-face interviews were held with transgender women aged 18 years and older and six interviews with stakeholders working with and advocating on behalf of this population. The study was conducted between September 2016 and March 2017.

RESULTS

Our participants were young. The majority of FGD participants had completed school-level education and 40% had been using hormones for 1 to 3 years. Five overlapping themes were identified: (1) reasons and motivations for hormone use; (2) accessibility and use of hormones; (3) side effects; (4) utilisation of healthcare services and (5) discontinuation of hormone use.

CONCLUSION

Hormone use was common in our sample. Most received information on hormone therapy online and through their peer networks. A few study participants sought doctors' prescriptions for hormone therapy, but hormones were more likely to be bought from local private pharmacies or abroad through friends. This kind of self-medication is associated with a range of risks to the physical and mental health of transgender individuals. Incorporating information, education and communication about hormone therapy into existing health promotion interventions targeted to this population may help transgender people to make better informed choices.

Transition memories: experiences of trans adult women with hormone therapy and their beliefs on the usage of hormone blockers to suppress puberty

PURPOSE

In recent years, an increasing number of specialized gender clinics have been prescribing gonadotropin-releasing hormone (GnRH) analogs to adolescents diagnosed with gender dysphoria (GD) to suppress puberty. This paper presents qualitative research on the hormone therapy (HT) experiences of older trans-people and their views on puberty suppression. The main aim of this research was to explore the psychological aspects of hormonal treatments for gender non-conforming adults, including the controversial use of puberty suppression treatments.

METHODS

Using a semi-structured interview format, ten adult trans-women were interviewed (mean age: 37.4) to explore their personal histories regarding GD onset and development, their HT experiences, and their views on the use of GnRH analogs to suppress puberty in trans-children and adolescents.

RESULTS

the interview transcripts were analyzed using the consensual qualitative research method from which several themes emerged: the onset of GD, childhood experiences, experiences with puberty and HT, views on the puberty suspension procedure, and the effects of this suspension on gender identity and sexuality.

CONCLUSIONS

The interviews showed that overall, the participants valued the new treatment protocol due to the opportunity to prevent the severe body dysphoria and social phobia trans-people experience with puberty. It seems that the risk of social isolation and psychological suffering is increased by the general lack of acceptance and stigma toward trans-identities in the Italian society. However, during gender transitions, they highlight the need to focus more on internal and psychological aspects, rather than over-emphasize physical appearance. This study gives a voice to an under-represented group regarding the use of GnRH analogs to suppress puberty in trans-individuals, and collected firsthand insights on this controversial treatment and its recommendations in professional international guidelines.

Does having Turner syndrome affect quality of life in Brazilian women compared to common population?

OBJECTIVES

We aimed to measure the quality of life (QoL) of patients with Turner syndrome (PTS) and determine the extent to which their clinical or laboratory alterations influence QoL compared to reference women (RW) of the same age range.

SUBJECTS AND METHODS

From Dec-2013 to Dec-2014, 90 participants were recruited. They were 18 years and older: 48 with Turner syndrome (TS) (PTS) and 42 without (RW). Recruited subjects completed the Portuguese version of Short Form 36 (SF-36) questionnaire, and blood was drawn to measure LH, FSH, oestradiol (E2), progesterone (P4), SHBG, and SDHEA (by ECLIA) and testosterone (by LC MS/MS).

RESULTS

Age and schooling were similar between groups. The most common occupations for PTS were health worker, administration and education, and health worker or cashier for RW. Most participants were Catholic or Evangelical. Eighty-one percent (39/48) of cases used Hormonal Replacement Therapy (HRT), mostly transdermal (23/39). RW and PTS scored similarly on the SF-36 questionnaire. RW had higher oestradiol (p = 0,01), lower FSH (p = 0,01) and higher testosterone (p = 0,01) than PTS. Concentrations of P4, LH, SHBG or SDHEA were similar. Significant associations were found among QoL and hormones (E2 with Vitality and LH with Physical Role) only in the PTS group.

CONCLUSIONS

PTS do not consider that TS affects their QoL as measured by domains on the SF-36. Oestradiol was related with QoL, emphasising the importance of HRT.

[Menopausal therapy: Modern view of the problem.]

The steady tendency of modernity improve the average life expectancy of a man dictates the necessity of implementing the anti-aging stratege, one of the stratege for women is menopausal therapy. Currently, the protective effect of menopausal therapy for cardiovascular system has been proven up to 60 years after it's implication in treatment. MHT is rarely used in Russia, largely due to the hormonophobia of patients and doctors especially with oncological risk. In contrary, recent studies indicate prolonged use of MHT decrease the risk of breast, ovarian, cervical and endometrial cancer. Morden microdosed medications that include dydrogesteron and progesterone as a progestational agent, also minimize the risk. Currently, there are no restictions on the duration of appucation. Total mortality decrease by 30% based on the result of meta-analysis 23 studies, which involve 39 049 people age until 60 years old with menopausal therapy.

Quality of Life in Hypoparathyroidism

Patients with hypoparathyroidism have a multitude of physical, emotional, and cognitive complaints consistent with reduced quality of life (QOL). Impaired QOL in patients treated with conventional therapy with calcium and active vitamin D has been documented in epidemiologic (registry) studies, case-controlled studies, and surveys, and at baseline in clinical trials of parathyroid hormone (PTH). Treatment with PTH has been shown to improve QOL in some but not all studies.

Cognitive functioning and quality of life in patients with Hashimoto thyroiditis on long-term levothyroxine replacement

OBJECTIVE

Intrinsic imperfections of thyroid hormone replacement therapy may affect long-term general well-being. In patients with Hashimoto thyroiditis (HT), cognitive functioning may be affected via altered thyroid hormones action as well as by the autoimmune process. The aim of this study was to evaluate cognitive function and quality of life (QoL) in patients on long-term levothyroxine replacement for HT in relation to thyroid function tests and TPO (thyroid-peroxidase) antibody (TPOAb) status.

DESIGN

Retrospective cross-sectional study.

PATIENTS AND MEASUREMENTS

One-hundred-and thirty patients with HT on long-term levothyroxine replacement and 111 euthyroid control subjects. Both groups were divided into two age subgroups, 20-49 years (N = 59 vs N = 79) and > 50 years (N = 71 vs N = 32). Evaluation included biochemical and neuropsychological tests, evaluating attention, global cognitive status, verbal and working memory, executive function, depression and anxiety, and quality of life. We used ANOVA and partial correlations to test for significant associations.

RESULTS

FT4 (free-thyroxine), FT3 (free-triiodothyronine) levels and FT3/FT4 ratio were not different between patients and controls. Mean TSH (thyroid-stimulating hormone) was normal in all subjects but significantly higher in the patients (20-49 yrs:3.64 ± 2.74 vs 1.93 ± 1.10, >50 yrs:3.93 ± 2.84 vs 1.91 ± 0.90). Antibodies (TgAb,TPOAb) were higher in patients. Global cognitive function (MMSE-Mini mental state examination), conceptual tracking (TMT-Trail Making Test:A/B), verbal divergent thinking (like Phonemic fluency test), and anxiety and depression scores were significantly worse in patients vs controls. QoL was impaired in patients. there was a significant negative correlation between antibodies (TPOAb, TgAb) and quality in life (total SF36 score).

CONCLUSION

Patients on long-term levothyroxine replacement show persistent impairments in both cognitive functioning and general well-being.

Hysterectomy and incidence of depressive symptoms in midlife women: the Australian Longitudinal Study on Women's Health

AIMS

There is limited longitudinal research that has looked at the longer term incidence of depressive symptoms, comparing women with a hysterectomy to women without a hysterectomy. We aimed to investigate the association between hysterectomy status and the 12-year incidence of depressive symptoms in a mid-aged cohort of Australian women, and whether these relationships were modified by use of exogenous hormones.

METHODS

We used generalised estimating equation models for binary outcome data to assess the associations of the incidence of depressive symptoms (measured by the 10-item Centre for Epidemiologic Studies Depression Scale) across five surveys over a 12-year period, in women with a hysterectomy with ovarian conservation, or a hysterectomy with bilateral oophorectomy compared with women without a hysterectomy. We further stratified women with hysterectomy by their current use of menopausal hormone therapy (MHT). Women who reported prior treatment for depression were excluded from the analysis.

RESULTS

Compared with women without a hysterectomy (n = 4002), both women with a hysterectomy with ovarian conservation (n = 884) and women with a hysterectomy and bilateral oophorectomy (n = 450) had a higher risk of depressive symptoms (relative risk (RR) 1.20; 95% confidence interval (CI) 1.06-1.36 and RR 1.44; 95% CI 1.22-1.68, respectively). There were differences in the strength of the risk for women with a hysterectomy with ovarian conservation, compared with those without, when we stratified by current MHT use. Compared with women without a hysterectomy who did not use MHT, women with a hysterectomy with ovarian conservation who were also MHT users had a higher risk of depressive symptoms (RR 1.57; 95% CI 1.31-1.88) than women with a hysterectomy with ovarian conservation but did not use MHT (RR 1.17; 95% CI 1.02-1.35). For women with a hysterectomy and bilateral oophorectomy, MHT use did not attenuate the risk. We could not rule out, however, that the higher risk seen among MHT users may be due to confounding by indication, i.e. MHT was prescribed to treat depressive symptoms, but their depressive symptoms persisted.

CONCLUSIONS

Women with a hysterectomy (with and without bilateral oophorectomy) have a higher risk of new incidence of depressive symptoms in the longer term that was not explained by lifestyle or socio-economic factors.

Does PTH Replacement Therapy Improve Quality of Life in Patients With Chronic Hypoparathyroidism?

Studies have examined the impact of PTH on QoL but have not demonstrated improvements compared with controls. Vokes et al. and Palermo et al. have explored QoL in hypoparathyroidism in response to PTH.

Why women choose compounded bioidentical hormone therapy: lessons from a qualitative study of menopausal decision-making

BACKGROUND

In recent years, compounded bioidentical hormone therapy (CBHT) has emerged as a popular alternative to manufactured, FDA approved hormone therapy (HT)-despite concerns within the medical community and the availability of new FDA approved "bioidentical" products. This study aims to characterize the motivations for using CBHT in a U.S. sample of ordinary midlife women.

METHODS

We analyze data collected from 21 current and former users of CBHT who participated in a larger qualitative study of menopausal decision-making among U.S. women. Interviews and focus groups were audio-recorded, transcribed verbatim, and analyzed thematically using an iterative inductive and deductive process.

RESULTS

Although women's individual motivations varied, two overarching themes emerged: "push motivations" that drove women away from conventional HT and from alternative therapies, and "pull motivations" that attracted women to CBHT. Push motivations focused on (1) fear and uncertainty about the safety of conventional HT, (2) an aversion to conjugated estrogens in particular, and (3) and overarching distrust of a medical system perceived as dismissive of their concerns and overly reliant on pharmaceuticals. Participants also voiced dissatisfaction with the effectiveness of herbal and soy supplements. Participants were attracted to CBHT because they perceive it to be (1) effective in managing menopausal symptoms, (2) safer than conventional HT, (3) tailored to their individual bodies and needs, and (4) accompanied by enhanced clinical care and attention.

CONCLUSIONS

This study finds that women draw upon a range of "push" and "pull" motivations in their decision to use CBHT. Importantly, we find that women are not only seeking alternatives to conventional pharmaceuticals, but alternatives to conventional care where their menopausal experience is solicited, their treatment goals are heard, and they are engaged as agents in managing their own menopause. The significance of this finding goes beyond understanding why women choose CBHT. Women making menopause treatment decisions of all kinds would benefit from greater shared decision-making in the clinical context in which they are explicitly invited to share their experiences, priorities, and preferences. This would also provide an opportunity for clinicians to discuss the pros and cons of conventional HT, CBHT, and other approaches to managing menopause.

Exploration of knowledge and understanding in patients with primary adrenal insufficiency: a mixed methods study

BACKGROUND

Primary adrenal insufficiency (PAI) is a rare and severe condition requiring lifelong steroid replacement. During acute illness or stressful events, it is important to appropriately adjust glucocorticoid dose; failure to do so may lead to an adrenal crisis. The aim of the study was to explore patients PAI knowledge and understanding of the condition, steroid replacement adjustment during acute illness or stress and provided education.

METHODS

Ten adult patients with PAI were purposefully recruited from two hospitals in a tertiary NHS Trust in England, UK. Data was collected using a mixed method approach utilising semi-structured audio-recorded interviews and hospital case note review. Interviews were transcribed verbatim and analysed using Burnard's content analysis framework. Information from the hospital case note review was captured using a matrix table based on pre-defined criteria.

RESULTS

Four key themes emerged: 'Addison's disease and hydrocortisone replacement'; 'stress and corticosteroids'; 'patient compliance/adherence' and 'transition'. Patients reported feelings of 'going through a transition from uncertainty to adaption' following diagnosis. All participants had a good level of knowledge and understanding of required medication however application in times of need was poor. Medication adherence and prevention of a crisis relied not only on patient knowledge and application but also the support of family and health professionals. Health care professional knowledge required improvement to aid diagnosis and management of PAI.

CONCLUSION

Patients with PAI did not apply existing knowledge to adjust steroid dose during acute illness or stress. Although a sample of limited size, our study identified there is a need to further explore why patients with Addison's disease do not apply existing knowledge during times of increased need. Future research should consider appropriate behaviour change interventions to promote medication adherence to reduce risk of an adrenal crisis.

The effect of hormone therapy on quality of life and breast cancer risk after risk-reducing salpingo-oophorectomy: a systematic review

BACKGROUND

It is unclear if the use of hormone therapy (HT) in carriers of BRCA mutations improves the quality of life (QOL) without increasing the risk of breast cancer following a risk-reducing salpingo-oophorectomy (RRSO). Our objective was to assess the effect of HT on QOL and breast cancer risk, after RRSO.

METHODS

We searched MEDLINE, EMBASE, CINHAL, and others, from inception to July 22, 2016, to identify relevant studies. Two reviewers independently screened identified records for controlled trials and observational studies that addressed the effect of HT on QOL and breast cancer risk in women with BRCA mutations, post RRSO. Two reviewers independently extracted data on populations, interventions, comparators, outcomes, and methodological quality. Studies addressing the same outcome were synthesized using written evidence summaries or tables.

RESULTS

Of the 1,059 records identified, 13 met our inclusion criteria. All studies were observational. Six studies assessed the effect on QOL. Of these, 3 showed improvement in QOL with HT use. The risk of breast cancer was evaluated in 4 studies. The mean duration of follow-up was 2.6 years (range 0.1-19.1). The risk of breast cancer did not change with HT use in all 4 studies.

CONCLUSIONS

Cumulative evidence from our review suggests that short-term HT use following RRSO improves QOL. The effect on breast cancer risk is still unclear. There are too few long-term studies to draw any strong conclusions. The need for future well-designed RCTs for more established evidence is imperative.

A 10-year follow-up of postmenopausal women on long-term continuous combined hormone replacement therapy: update of safety and quality-of-life findings

Objective: To assess the safety and health-related quality of life (HRQOL) of continuous combined hormone replacement therapy (ccHRT) with estradiol valerate/medroxyprogesterone acetate (E2V/MPA) over nine years and at follow-up one year after discontinuation.

Study design: A total of 419 women were randomized to one of four treatments: once-daily 1 mg E2V/2.5 mg MPA (1 + 2.5 group); 1 mg E2V/5 mg MPA daily (1 + 5 group); 2 mg E2V/2.5 mg MPA daily (2 + 2.5 group); 2 mg E2V/5 mg MPA daily (2 + 5 group) (Indivina, Orion Pharma). For the last six months, all received the 1 + 2.5 dosage. The 2 + 2.5 dosage was discontinued at the end of year 7. A total of 198 women continued after year 7.

Results: Annualized percentage rates for cardiovascular, stroke, breast and endometrial cancer events were below national rates for Finland and those reported for the Women's Health Initiative. There were no serious events with the 1 + 2.5 dosage or after ccHRT discontinuation. Climacteric symptoms remained significantly below baseline values after dosage reduction; some symptoms recurred after discontinuation of ccHRT. HRQOL ratings improved with ccHRT, irrespective of dosage, including depressed mood, anxiety, health perception and sexual interest. Scores on a scale assessing daily functioning and enjoyment (Q-LES-Q) improved from year 7 to year 9. They deteriorated during follow-up in women not continuing ccHRT.

Conclusions: Lower dosages of HRT were as effective as higher doses in improving climacteric symptoms and HRQOL ratings and had fewer safety concerns. Following discontinuation of ccHRT, patient satisfaction was variable, with 15% electing to continue or restart HRT and 7% resuming at follow-up. This supports the need for an individualized approach to therapy recommendations.

Suicidal ideation among postmenopausal women on hormone replacement therapy: The Korean National Health and Nutrition Examination Survey (KNHANES V) from 2010 to 2012

BACKGROUND

Suicide is a major public health problem around the world. Some studies have found that hormone replacement therapy (HRT) is associated with depression in postmenopausal women. Depression is a well-known risk factor for suicide; therefore, we investigated the relationship between HRT and suicidal ideation in postmenopausal Korean women.

METHODS

We included 2286 postmenopausal women with or without HRT from the Korean National Health and Nutrition Examination Survey 2010-2012. The use and duration of HRT and mental health status, including stress, depressive mood, and suicidal ideation and attempts, were assessed by self-report questionnaires.

RESULTS

The proportion of participants with depressive mood and suicidal ideation was higher in the HRT group than the non-HRT group (all p values<0.05). As the duration of HRT increased, the percentage of participants with suicidal ideation increased (p for trend=0.006). After adjusting for all covariates, the odds ratio (95% confidence intervals) for suicidal ideation was 1.742 (1.223-2.482) in the women with HRT, compared to women without HRT. HRT duration longer than 10 years was associated with suicidal ideation (odds ratio=2.089 and 95% confidence intervals=1.069-4.084).

LIMITATIONS

The cross-sectional design, a possibility of incorrect answer about menopausal status, and no assessment of the type of HRT are the main limitations of this study.

CONCLUSION

Postmenopausal women receiving HRT, especially for more than 10 years, showed increased suicidal ideation compared with postmenopausal women without HRT. Physicians should pay attention to mood symptoms and suicidal ideation in postmenopausal women with HRT.

Coming Up Short: Risks of Bias in Assessing Psychological Outcomes in Growth Hormone Therapy for Short Stature

CONTEXT

Two often cited assumptions for treating children with GH are that short stature (SS), as an isolated physical characteristic, is associated with psychosocial morbidity and that GH treatment may increase height and improve psychological adjustment. Findings across studies regarding the psychological consequences associated with GH management of children with SS are variable and frequently contradictory. The purpose of this systematic review is to evaluate the degree to which any conclusions about the relative risks or benefits of GH treatment on psychological outcomes can be made based on the published literature.

EVIDENCE ACQUISITION

Electronic databases were searched for randomized clinical trials and nonrandomized studies, published between 1958-2014, in which GH was administered for management of children with SS and psychosocial, cognitive, academic, or health-related quality of life outcomes were assessed. Methodological quality of each study was assessed using the Cochrane Collaboration's tool for assessing risk of bias.

EVIDENCE SYNTHESIS

Eighty studies were evaluated. No studies were rated as having a low risk of bias, the risk of bias was unclear in seven study outcome areas, and the remaining studies were judged as having a high risk of bias.

CONCLUSIONS

The high risk of bias present in the majority of the literature on GH treatment effects on psychological outcomes (in particular, lack of blinding) substantially weakens confidence in their results. This may serve to explain the variability of findings for these outcomes across studies.

Is it andropause?

In primary care practice, it is not unusual to encounter male patients in their 50s or older who report having loss of libido, erectile dysfunction, fatigue, and depression. Such signs and symptoms may signal an age-related decline in androgen levels, which commonly begins after age 40. However, psychologic problems and medical illness often confound the diagnosis. Drs Tan and Pu, who are currently conducting research on androgen deficiency, discuss the diagnostic difficulties of the physiologic phenomenon of andropause and offer a comprehensive approach to clinical assessment and laboratory evaluation.

Possible predictors for QOL improvement following GH replacement therapy in adult GHD

In addition to impaired physical activity, adult GH deficiency (GHD) can decrease quality of life (QOL). Hence, assessment of QOL is important to evaluate the efficacy of GH replacement therapy. This study aimed to identify factors that may be predictive of long-term improvement in QOL among clinical/laboratory variables during GH replacement therapy. The analysis included 83 Japanese adults with GHD who participated in the Hypopituitary Control and Complications Study (HypoCCS). Correlations between the change from baseline in clinical/laboratory variables at 6 months and the change from baseline in Quality of life (Short-Form 36 [SF-36] component scores) at 12 months were examined. Unexpectedly, all component scores were negatively correlated with the change in fasting plasma glucose concentration (FPG) (physical component summary [PCS], r = -0.456; mental component summary [MCS], r = -0.523; role/social component summary [RCS], r = -0.433). The change in MCS was positively correlated with the change in insulin-like growth factor-1 standard deviation score (IGF-1 SDS) (r = 0.417). The change in PCS was positively correlated with the change in body fat (r = 0.551). The change in RCS was positively correlated with the change in waist circumference (r = 0.528). Short-term changes in several clinical/laboratory variables, most notably FPG and IGF-1 SDS, were correlated with long-term changes in QOL. The clinical importance of these correlations for predicting GH replacement treatment efficacy warrants further investigation.

Ten-year change in quality of life in adults on growth hormone replacement for growth hormone deficiency: an analysis of the hypopituitary control and complications study

CONTEXT

Previous studies showed improvement in impaired quality of life (QoL) in adult patients with growth hormone (GH) deficiency (GHD) who were treated with GH; improvement was sustained over a few years after GH therapy.

OBJECTIVE

To evaluate the QoL over 10 years.

DESIGN

This was a prospective observational study.

SETTING

The study was conducted in clinical practice.

PATIENTS

1436 adult patients with adult-onset (AO) GHD (mean age [standard deviation (SD)]: 49.0 [12.2] years; 49% female) and 96 with childhood-onset (CO) GHD (31.3 [10.0] years; 60% female) (total N = 1532).

INTERVENTION

GH therapy.

MAIN OUTCOME MEASURES

QoL was measured by Questions on Life Satisfaction-Hypopituitarism (QLS-H) in countries where validated questionnaires and normative data for calculation of Z-scores were available. Change in QoL was tested by Student's t test and predicted by mixed-model repeated measures (MMRM) analysis.

RESULTS

At study entry, patients had diminished QoL Z-scores (mean [SD] AO, -1.55 [1.69]; CO -0.98 [1.32]). The largest QoL improvements were in the first year: mean (SD) increase 0.77 (1.37) for AO (P < .001) and 0.50 (1.37) for CO (P < .001). The initial improvement from study entry remained statistically significant throughout 10 years for AO and in years 1 to 4, 6, and 7 for CO (P < .05). MMRM analysis predicted a greater QoL improvement in those who were not depressed, lived in Europe, had poorer Z-scores at entry, had lower body mass index at entry, and had no impaired vision.

CONCLUSION

These data suggest that GH replacement provides sustained improvement in QLS-H scores toward normality for up to 10 years.

Experiences and treatment patterns of hypogonadal men in a U.S. health system

OBJECTIVE

To examine self-reported experiences with hypogonadism (HG) and patterns of testosterone replacement therapy (TRT) in men seeking care in a U.S. healthcare system.

METHODS

Men ≥ 18 years old with HG were identified from the 2008-2010 Reliant electronic medical records database. Surveys, including validated instruments for measuring symptoms of HG, were collected and evaluated for demographic and behavioural data.

RESULTS

Surveys were mailed to 133 men with HG in 2012. Of the 107 surveys returned, 95 were included in the final analysis. Most respondents were Caucasian (90.5%). Men reported developing symptoms of HG, as well as being diagnosed, at a median age of 50 years. The most common symptoms reported as reasons for seeking treatment were erectile dysfunction (66.3%), fatigue (59.0%) and decreased sex drive (57.9%). These continued to be the most bothersome symptoms at the time of the survey regardless of whether the patient received treatment, although men who were currently taking TRT reported less severe symptoms. Approximately 88% of men reported taking TRT at some point, with 61.9% on therapy at the time of the survey.

CONCLUSIONS

This study examined men's experiences with HG, including symptoms, quality of life, and treatments. Some symptoms continued despite treatment, and therapy was discontinued at a high rate, which men generally attributed to cost and perceptions of efficacy. In light of this lack of adherence, patients may benefit from appropriate expectation setting regarding reasonable timelines for symptom improvement, the strengths and challenges of various TRT formulations, the importance of adherence and the benefits and risks of TRT.

Effectiveness, tolerability and acceptance of an oral estradiol/levonorgestrel formulation for the treatment of menopausal complaints: a non-interventional observational study over six cycles of 28 days

BACKGROUND

Use of hormone therapy for menopausal complaints is a subject of controversy and increased uncertainty and concerns. This non-interventional study aimed to investigate a marketed oral formulation containing 1 mg estradiol and 0.04 mg levonorgestrel for continuous treatment of menopausal symptoms for approximately 6 months in women visiting gynecological practices in Germany.

METHODS

Changes in the menopause rating scale (MRS) total and sub-domain scores after three and six 28-d cycles served as primary endpoint. Skin- and hair-related complaints, quality of sexual life and subjective satisfaction with the treatment were assessed. Adverse drug reactions (ADRs), adverse events (AEs) and vaginal bleeding were evaluated.

RESULTS

MRS scores improved significantly above 5 points of clinical relevance as compared to baseline (n = 736, p < 0.0001). Skin- and hair-related symptoms abated; quality of sexual life improved. AEs were registered in 9.9% of the participants. No unexpected ADRs were reported. Bleeding episodes consistently decreased; >75% of the subjects were amenorrheic throughout the study. Medication's effectiveness and tolerability was rated very good/good by >80% of the participants, who also continued treatment.

CONCLUSION

This estradiol/low-dose levonorgestrel formulation safely alleviates menopausal symptoms in peri- and postmenopausal women with add-on benefits regarding dermatological and sexual life complaints.

Informing women on menopause and hormone therapy: Know The Menopause a multidisciplinary project involving local healthcare system

Background

Hormone therapy (HT) in the menopause is still a tricky question among healthcare providers, women and mass media. Informingwomenabouthormonereplacementtherapy was a Consensus Conference (CC) organized in 2008: the project KnowtheMenopause has been launched to shift out the results to women and healthcare providers and to assess the impact of the cc’s statement.

Methods

And Findings: The project, aimed at women aged 45-60 years, was developed in four Italian Regions: Lombardy, Tuscany, Lazio, Sicily, each with one Local Health Unit (LHU) as “intervention” and one as “control”. Activities performed were: survey on the press; training courses for health professionals; educational materials for target populations; survey aimed at women, general practitioners (GPs), and gynaecologists; data analysis on HT drugs’ prescription. Local activities were: training courses; public meetings; dissemination on mass media. About 3,700 health professionals were contacted and 1,800 participated in the project. About 146,500 printed leaflets on menopause were distributed to facilitate the dialogue among women and health care professionals. Training courses and educational cascade-process activities: participation ranged 25- 72% of GPs, 17-71% of gynaecologists, 14-78% of pharmacists, 34-85% of midwives. Survey: 1,281 women interviewed. More than 90% believed menopause was a normal phase in life. More than half did not receive information about menopause and therapies. HT prescription analysis: prevalence fell from 6% to 4% in five years. No differences in time trends before-after the intervention. Major limitations are: organizational difficulties met by LHU, too short time for some local activities.

Conclusions

A huge amount of information was spread through health professionals and women. The issue of menopause was also used to discuss women’s wellbeing. This project offered an opportunity to launch a multidisciplinary, multimodal approach to menopause looking not only at pharmacological aspects, but also at quality of life and information.

A prospective study on sexual function and mood in female-to-male transsexuals during testosterone administration and after sex reassignment surgery

Testosterone administration in female-to-male transsexual subjects aims to develop and maintain the characteristics of the desired sex. Very little data exists on its effects on sexuality of female-to-male transsexuals. The aim of this study was to evaluate sexual function and mood of female-to-male transsexuals from their first visit, throughout testosterone administration and after sex reassignment surgery. Participants were 50 female-to-male transsexual subjects who completed questionnaires assessing sexual parameters and mood. The authors measured reproductive hormones and hematological parameters. The results suggest a positive effect of testosterone treatment on sexual function and mood in female-to-male transsexual subjects.

GH replacement improves quality of life and metabolic parameters in cured acromegalic patients with growth hormone deficiency

OBJECTIVE

Effects of GH replacement in patients with GH deficiency (GHD) after a cure for acromegaly so far have been poorly studied, although its prevalence among acromegalic patients may reach the 60%. The aim of the study was to evaluate whether metabolic parameters and quality of life are improved by GH replacement in patients with prior acromegaly and severe GHD.

DESIGN AND METHODS

This was a prospective study on 42 GHD subjects [22 men, mean age (sd): 48 ± 10]: 10 acromegalics treated with recombinant human GH (group A), 12 acromegalics who refused treatment (group B), and 20 subjects operated for nonfunctioning pituitary adenoma on recombinant human GH (group C). Serum IGF-I levels, lipid profile, glucose levels (fasting and after an oral glucose tolerance test), glycosylated hemoglobin, insulin resistance (homeostasis model assessment insulin resistance index), anthropometric parameters (body mass index, waist circumference, body composition), and quality of life (Questions on Life Satisfaction-Hypopituitarism Z-scores) were evaluated at baseline and after 12 and 36 months.

RESULTS

At baseline, group B showed higher IGF sd score than group A and C, as well as better quality of life and higher post-oral glucose tolerance test glucose levels than group A. After 12-months, similarly in group A and C, the IGF-I sd score significantly increased, and body composition and lipid profile improved, without deterioration of glucose tolerance. Quality of life significantly improved too, and the baseline difference between group A and B disappeared. Results were confirmed after 36 months.

CONCLUSIONS

In GHD acromegalic patients, GH therapy improved body composition, lipid profile, and quality of life as in patients with GHD due to nonfunctioning pituitary adenoma, without negative effects on glucose metabolism. GH replacement therapy should be considered in these patients, as in patients with GHD from other causes.

'Chaos, restitution and quest': one woman's journey through menopause

Menopause, a natural stage in a woman's reproductive life, is not an illness; yet some women experience severe enough symptoms to cause a breakdown in the body similar to illness or other major health disruptions. As part of a larger narrative analysis investigation of distress during menopause, this case study presents one woman's transformational journey through menopause, analysed through Frank's health and illness narratives - chaos, restitution and quest. The narratives were retranscribed using Labov's elements of a true story and Gee's poetic restructuring. This report of one woman's experience of distress during the menopause transition describes a poetic chaos narrative of incessant night sweats resulting in a loss of physicality and a deep-rooted belief in self-healing; a restitution narrative of restored health that mandated the surrender to a new healing discourse, experienced simultaneously as a victory and a defeat; and a quest narrative of seeking meaning, insight and new-found values and identities.

Testosterone therapy in women with androgen deficiency: Its time has come

The concept that women may have a testosterone deficiency is controversial, as is the possibility of testosterone replacement therapy for women. It has been stated that androgen deficiency is a new concept; however, women have been treated off-label for more than 50 years. A number of objections to such therapy in women have been reviewed and discussed, including the lack of a normal age-related concentration range for androgens, the lack of randomized, placebo-controlled clinical trials, and the possibility of chronic adverse effects, particularly the risk of cardiovascular disease and breast cancer. However, recent data have adequately addressed these concerns. Moreover, the 4-year safety data that are available for women is more than that available for testosterone replacement in men. Although more precise diagnostic techniques to measure total testosterone and free testosterone in women would be welcome, it is believed that physicians are able to identify women at risk of testosterone deficiency and safely replace these hormones in carefully selected patients.

Perinatal exposure to progesterone, estradiol, or mifepristone affects sexual differentiation of behavior in opossums (Monodelphis domestica)

The effects of perinatal exposure to progesterone (P) and estradiol (E) on sexual differentiation of behavior and morphology were examined by treating male and female gray short-tailed opossums on postnatal day 8 with progesterone alone (P), P plus estradiol (E) (PE), the P receptor antagonist mifepristone/RU486 (MIF), or corn oil control (C) and gonadectomizing them before puberty. When given female hormone replacement therapy in adulthood and tested with intact stimulus males, MIF animals showed less female-typical aggressive threat behavior than animals in other treatment groups. Stimulus males scent marked in more tests involving females than males and in more tests involving MIF animals than animals in other treatment groups. Body weight was lower in females than in males and was lower in MIF animals than in animals in other treatment groups, and P females failed to show female-typical genital locks after copulation. Sexual receptivity was similar in males and females and, while not decreased by any perinatal hormone treatment, was higher in PE males than in animals of either sex in any treatment group. These findings suggest that perinatal exposure to P is associated with the organization of feminine threat behavior and the defeminization of attractivity, body weight and genital anatomy in this marsupial. Reasons for these findings and for why female sexual receptivity is enhanced by perinatal exposure to exogenous E only in an endogenous masculine environment are discussed.

Depressed mood through women's reproductive cycle: correlation to mood at menopause

OBJECTIVES

Depressive symptoms are frequent through the different stages of a woman's reproductive cycle. The aim of this study was to evaluate a possible correlation of depressive mood before menstruation, during pregnancy, after delivery and around the menopause.

METHODS

The sample consisted of 110 women (mean age 52 years, standard deviation 4 years) who rated their mood at present and retrospectively at different stages of the reproductive cycle. Mood was rated using a visual analogue scale.

RESULTS

A significant statistical association was found between the present mood and mood at the premenstrual period, but not with mood at pregnancy or after delivery. These findings were independent of age, menopausal status or use of hormone replacement therapy.

CONCLUSIONS

The statistical association between depressed mood around menopause and before menstruation supports the assumption that there is a common etiology, which could be attributed to hormonal or psychological factors, or both.

Women's perceptions of hormone replacement therapy: risks and benefits (1980–2002). A literature review

OBJECTIVES

Many postmenopausal women are reluctant to take hormone replacement therapy (HRT) and those who do are likely to discontinue within 1 year. Setting aside the beliefs and prejudices of the prescriber, women's own perceptions of risks and benefits may influence their willingness to accept and then persevere with HRT. We conducted a systematic literature review relating women's beliefs about HRT to acceptance and adherence.

METHODS

Using standard guidelines for systematic search procedures, we identified 112 papers (published during 1980-2002) from databases such as Medline, PsycINFO and the NHS and Cochrane libraries.

RESULTS

Women hold both positive and negative beliefs about HRT. Their perceptions of benefits are often countered by concerns over potential adverse effects, beliefs that are sometimes at odds with the clinical evidence. The use and discontinuation of HRT are influenced more by short-term symptom relief than by considerations of long-term benefits. Many women who refuse HRT believe that the menopause is a natural event that does not warrant 'chemical' intervention. Doctors and nurses are not used to their full capacity as an education and information resource to counter the possibility of unbalanced stories in the media.

CONCLUSIONS

Addressing women's preconceptions about HRT should be an important part of the process of prescribing and review. Such an approach will help ensure that a woman's decision to start or continue HRT is informed by an understanding of the known risks and benefits, rather than by myths or mistaken beliefs about the menopause or HRT.

Knowledge and attitude towards menopause and hormone replacement therapy (HRT) among postmenopausal women

INTRODUCTION

To determine the knowledge and attitude towards menopause and Hormone Replacement Therapy (HRT) among postmenopausal women.

METHOD

A descriptive cross sectional study based on sample of convenience was conducted at outpatient services of Jinnah Medical College Hospital Karachi from 1st January 2005 to 30th April 2005. One hundred and two postmenopausal women who came to outpatient department of Jinnah Medical College Hospital Karachi as a patient or as an attendant were interviewed after taking verbal consent. Sociodemographic characteristics, knowledge and attitude towards menopause and HRT were collected through a structured pretested questionnaire.

RESULTS

The mean age of respondents was 55.1 +/- 10 years (range 40 - 75 years). The mean age at menopause was 47.4 +/- 3.3 years. Majority of respondents belonged to poor socioeconomic class (75.5%) and 62 (60.8%) had received no formal education. Ninety seven percent of women had heard about menopause and 29.4% were aware of the symptoms. Four (3.92%) knew the long term implications of menopause. Out of 102, only 02 (1.96%) respondents were aware of HRT. Most of respondents (94%) did not consider menopause to be a medical condition but a normal transition. Majority of respondents had positive (47%) or Neutral (39.2%) attitude towards menopause. Thirty six (35.29%) respondents were not sexually active. Decrease libido and frequency was reported by 33 (32.3%) respondents while 25(24.5%) reported no change.

CONCLUSION

Majority of women lacked sufficient knowledge on menopause and HRT. Women's attitude towards menopause showed that majority considered it a natural event and not a medical condition.

Quality of life (QOL) in menopause

Quality of life (QOL) is generally not precisely defined or measured. This has resulted in confusing and often misleading conclusions in multiple publications, including those coming from both the HERS and the WHI writing groups. Health-related QOL and global QOL are accurately defined, and current instruments for measuring them are available. In the continuing effort to determine the true risks and benefits of postmenopausal hormone usage, it is critical that the full spectrum of effects be measured. There is no excuse for future studies on hormone use not to include well-validated instruments for measuring QOL and for not reporting those effects as part of the rest of the study. Questionnaire instruments can often provide more information than many of the invasive tests that are part of contemporary trials. They also add little cost, yet can be invaluable in the analysis of real cost-effectiveness of interventions in contemporary women's health care. Beyond safety and efficacy evaluation of drug therapies, there is an absolute need to know about the real impact of these therapies on overall quality of life.

Attitudes towards the menopause and hormone therapy over the turn of the century

OBJECTIVE

To assess attitudes and beliefs about the menopausal transition in a population of peri- and postmenopausal women, and if these attitudes differed before and after publication of studies on risks and benefits with hormone therapy (HT).

MATERIALS AND METHODS

In 1999 and 2003 all women aged 53 and 54 years in the community of Linköping, Sweden, were sent a questionnaire about use of HT, menopausal status and attitudes regarding menopause and HT.

RESULTS

Most women regarded menopause as a natural process characterized by both hormonal deficiency and aging and these views did not differ between 1999 and 2003. A majority of women thought that significant climacteric symptoms were a good reason to use HT, but not that women without symptoms should use HT. The fraction of women who supported HT use was, however, significantly lower in 2003 than in 1999. Most women agreed that menopause leads to increased freedom and that it is a relief not to have to think about contraception and pregnancies.

CONCLUSIONS

Most Swedish women had a mainly biological view on menopause but nevertheless they thought that only women with climacteric symptoms should use HT. Women's attitudes towards HT have changed after recent reports on risks from long-term use of HT whereas the attitudes towards the menopausal transition were stable. Other factors than attitudes towards menopause affect women's actual use of HT. Probably women's and health care provider's apprehension of the risk-benefit balance of HT use is one such factor.

The effect of hormone replacement therapy on mood and everyday memory in younger mid-life women

Research on the effect of hormone replacement therapy (HRT) on both mood and memory indicates that oestrogen may enhance verbal memory in younger mid-aged women. This study examined the effect of HRT on everyday memory, while accounting for mood changes, in women between ages 40 and 60. A within-subjects comparison of 17 women, showed that mood, everyday memory, working memory, and delayed verbal memory improved after 3 months of HRT use. The improvement in memory was not mediated by mood, but changes in mood were moderated by exercise habits. The results suggest that verbal memory in particular may be enhanced by HRT in this age group, and everyday memory is an important construct to consider in future research.

Psychological well-being correlates with free thyroxine but not free 3,5,3'-triiodothyronine levels in patients on thyroid hormone replacement

CONTEXT AND OBJECTIVE

An association between mood disorders and overt thyroid dysfunction is well established, but there are few data on the potential for thyroid hormone levels closer to the reference range to correlate with psychological well-being.

DESIGN, SETTING, AND PATIENTS

We analyzed the relationship between psychological well-being and free T(4) (fT4), free T(3) (fT3), TSH, and total rT(3) in 697 patients on thyroid hormone replacement therapy at entry to a randomized, controlled trial of combined T(4) and T(3) replacement therapy. All patients were on 100 mug or more T(4).

INTERVENTIONS AND MAIN OUTCOME MEASURES

Psychological well-being was assessed with General Health Questionnaire-12 (GHQ-12), Thyroid Symptom Questionnaire, and Hospital Anxiety and Depression Scale.

RESULTS

fT(4) and TSH showed a strong correlation with GHQ-12 scores (fT4 - b: -0.16, P = 0.005; TSH - b: 0.663, P = 0.04). No correlations were seen between the GHQ scores and fT3 (b: 0.318, P = 0.275), rT(3) (b: 0.095, P = 0.95), rT(3) to fT4 ratio (b: 71.83, P = 0.09) or fT3 to rT(3) ratio (b: 0.05, P = 0.32). The correlations remained when the data set was limited to patients with TSH in the range 0.3-4.0 mIU/liter. Similar correlations were seen with the Thyroid Symptom Questionnaire, although not with the Hospital Anxiety and Depression Scale scores.

CONCLUSIONS

Differences in fT4 and TSH concentration, even within the reference range, may be a determinant of psychological well-being in treated hypothyroid patients although not necessarily with symptoms typical of anxiety or depression.

Women's Autonomy and the Evaluation of the Information Available on the Internet on Hormone Therapy After Menopause

This study was designed to examine the information in Spanish, provided by different Web sites, related to hormone therapy and climacteric symptoms. Web sites evaluated included those belonging to government and scientific institutions and to a miscellaneous group. In Web sites in Spanish, there was more extensive information on the benefits of hormone therapy than there were on other items. The Web sites of governmental institutions provided significantly more information on the risks (P < .01) and benefits (P = .02) of hormone therapy than did the other sites. Governmental institutions from the United States, unlike those from Spain, did not make recommendations regarding when hormone therapy should be considered and instead emphasized the woman's decision. The variability of information in Spanish on hormone therapy and postmenopausal symptoms presented on the Internet is related to the organization responsible for the Web site. Besides, cultural differences in the concept of patient autonomy could partly explain the differences in emphasis made on women's role in the decision-making process.

Psychometric properties of two measures of psychological well-being in adult growth hormone deficiency

Background

Psychometric properties of two measures of psychological well-being were evaluated for adults with growth hormone deficiency (GHD): the General Well-being Index, (GWBI) – British version of the Psychological General Well-being Index, and the 12-item Well-being Questionnaire (W-BQ12).

Methods

Reliability, structure and other aspects of validity were investigated in a cross-sectional study of 157 adults with treated or untreated GHD, and sensitivity to change in a randomised placebo-controlled study of three months' growth hormone (GH) withdrawal from 12 of 21 GH-treated adults.

Results

Very high completion rates were evidence that both questionnaires were acceptable to respondents. Factor analyses did not indicate the existence of useful GWBI subscales, but confirmed the validity of calculating a GWBI Total score. However, very high internal consistency reliability (Cronbach's alpha = 0.96, N = 152), probably indicated some item redundancy in the 22-item GWBI. On the other hand, factor analyses confirmed the validity of the three W-BQ12 subscales of Negative Well-being, Energy, and Positive Well-being, each having excellent internal reliability (alphas of 0.86, 0.86 and 0.88, respectively, N from 152 to 154). There was no sign of item redundancy in the highly acceptable Cronbach's alpha of 0.93 (N = 148) for the whole W-BQ12 scale. Whilst neither questionnaire found significant differences between GH-treated and non-GH-treated patients, there were correlations (for GH-treated patients) with duration of GH treatment for GWBI Total (r = -0.36, p = 0.001, N = 85), W-BQ12 Total (r = 0.35, p = 0.001, N = 88) and for all W-BQ12 subscales: thus the longer the duration of GH treatment (ranging from 0.5 to 10 years), the better the well-being. Both questionnaires found that men had significantly better overall well-being than women. The W-BQ12 was more sensitive to change than the GWBI in the GH-Withdrawal study. A significant between-group difference in change in W-BQ12 Energy scores was found [t(18) = 3.25, p = 0.004, 2-tailed]: patients withdrawn from GH had reduced energy at end-point. The GWBI found no significant change.

Conclusion

The W-BQ12 is recommended in preference to the GWBI to measure well-being in adult GHD: it is considerably shorter, has three useful subscales, and has greater sensitivity to change.

The thoughts of breast cancer survivors regarding the need for starting hormone replacement therapy

There is not only a need for scientific data regarding the risk of recurrence of breast cancer by starting hormone replacement therapy (HRT) but also regarding the patients' needs for HRT.

OBJECTIVES

To examine the severity of climacteric complaints in breast cancer patients and to examine if they are willing to take HRT.

METHODS

In November 2003, a questionnaire was sent to 469 breast cancer survivors. The survey examined on a scale base the severity of climacteric complaints and the patient's opinion on starting HRT.

RESULTS

More than 76% of the patients complained that they experience or had experienced hot flushes or night sweating. More than half (53%) of this group found the inconvenience severe to extreme, affecting the patient's quality of life. A majority (80.5%) patients who had already taken HRT, found that it improved their quality of life substantially. When the results of observational studies were explained regarding HRT in breast cancer survivors, a majority said they would take or would consider taking HRT (57.9%).

CONCLUSION

While physicians are more reserved in prescribing HRT in breast cancer survivors, a combination of severe symptomatic climacteric complaints and the willingness of the patient to be treated should at least result in a "consideration" of prescribing HRT.

The thoughts of physicians regarding the need to start hormone replacement therapy in breast cancer survivors

OBJECTIVES

To investigate how physicians felt about HRT use in breast cancer survivors a half year after the WHI trial.

METHODS

In December 2002, a questionnaire was conducted in Flanders (Belgium). The survey contained a presentation of a 35-year-old breast cancer survivor who presented with climacteric symptoms after treatment with tamoxifen.

RESULTS

With a response rate of 33.65%, a majority of the physicians did not prescribe classical oral HRT (5.40%) in this patient. Physicians prefer to prescribe tibolone (30.68%) or other alternative treatment (50.00%). The main reason was the fear for increased recurrence of breast cancer. Furthermore the WHI oestrogen plus progestin trial and its attention in the media, a half year prior to the survey, influenced one-third of the physician's prescribing attitude.

CONCLUSIONS

Two-thirds of the physicians did not change prescribing attitude after the WHI oestrogen plus progestin trial. HRT is a well proven effective treatment in breast cancer survivors with severe climacteric complaints, but a majority of physicians is not convinced of its safety in breast cancer survivors. Therefore, a majority of physicians do not find the need to prescribe HRT in breast cancer survivors.

Trends in middle-aged women's reports of symptoms, use of hormone therapy and attitudes towards it

OBJECTIVES

To investigate changes in middle-aged women's attitudes towards hormone therapy (HT), use of HT and reports of symptoms between 1995 and 2003.

METHODS

All women (n = 2209) in two primary health-care districts received a questionnaire, when aged 45, 50, 55 or 60. The questionnaire consisted of quality of life instruments and items concerning menopause, health, symptoms, attitudes towards HT and use of it.

RESULTS

A total of 1681 women (76%) responded to the questionnaire. Thirty-one percent had used HT, with a mean duration of 4 years. A shift from mainly positive attitudes towards HT and increasing use of HT in the 1990s to largely negative attitudes and decreasing use became evident in 2002-2003. In comparison, current HT users in 2002-2003 were older and had used HT for longer than users in previous years. The number of general symptoms reported tended to increase successively and satisfaction with health to decrease during the period. Women with a history of HT continuously reported a greater number of symptoms than those women who had never used it. Reports of vasomotor symptoms did not change over time.

CONCLUSIONS

The changes that have occurred in beliefs regarding HT have had an impact both on attitudes towards HT and on use of HT among the women we surveyed. The increase in number of general symptoms is discussed in relation to perception of menopause, prescription patterns of HT and changes at the societal level.

[Social and healthy circumstances of women's decision about applying hormonal replacement therapy]

The aim of the study was to evaluate the frequency of hormonal replacement therapy (HRT) application among Polish women aged 40-65, patients of five selected health care institutions located in south-eastern Poland and to determine the most significant factors that influence women's decision to initiate HRT. The next purpose was to establish how the women learned about the possibility of receiving HRT. Women, who never decided to take sex hormones, were asked about the reasons of such decision.

MATERIAL AND METHODS

The study comprised a group of 1033 women aged 40-65 years living in south-eastern Poland, the patients of various hospital wards and outpatient clinics. The study was conducted from January 2003 to December 2004 using categorized interview technique. The interview questionnaire was constructed by the authors. The statistical analysis was performed on the basis of the chi2 test of independence; log-linear analysis and Pareto's analysis were also used.

RESULTS

Research result analysis proves that 30.5% of the examined women have used HRT currently or in the past. The sociodemographic and healthy variables that showed positive correlation with receiving hormonal treatment by midlife women were: age 51-65 years, the presence of climacteric ailments, the absence of monthly bleedings, possessing of permanent life partner and good self-estimation of one's financial status. It was not revealed that better educated women more frequently decide to take HRT. The main sources of women's knowledge about HRT were the mass media and health service employees. Among the reasons for not taking up hormonal treatment the most significant were: lack or small intensification of menopausal ailments as well as the fear of side effects of hormonal replacement therapy.

Differential effect sizes of growth hormone replacement on Quality of Life, well-being and health status in growth hormone deficient patients: a meta-analysis

Background

Patients with growth hormone deficiency (GHD) frequently report to suffer from an impaired Quality of Life (QoL) and growth hormone (GH) substitution is found to improve this. However, the same test may be used for measuring QoL, well-being or health status in different studies. QoL has been defined as the subjective appraisal of one's current life based primarily on psychological function. The most important in the appraisal of well-being is mental function and concerning health status patients evaluate physical function as most important. To differentiate the effects of GH replacement on psychological variables in patients with GHD we carried out a number of meta-analyses, classifying questionnaires into instruments measuring QoL, psychological well-being and health status.

Methods

We searched the electronic databases PUBMED and PiCarta from 1985 to 2004. Studies were included that evaluated the effect of GH on patient-reported outcomes in adults with GHD (aged 18 years and above). According to generally accepted definitions we classified the questionnaires as instruments measuring QoL, well-being and health status. By means of meta-analyses the average effect size (d) for QoL, well-being and health status was calculated.

Results and Discussion

Based on open studies GH replacement is found to improve QoL with a small effect size (d = 0.18), well-being with a medium effect size (d = 0.47) and health status with a small effect size (d = 0.26). As the effect size of well-being is most pronounced the generally reported effects of GH replacement on QoL may be overestimated and actually reflect the effect on well-being.

Conclusion

To get more insight in the specific psychological effects of GH treatment it is recommended that instruments selected for these studies should be more consistently classified as instruments measuring QoL, well-being or health status.

Women's views of the climacteric at the time of low menopausal hormone use, Estonia 1998

OBJECTIVES

This study examined women's opinions about the climacteric and hormone therapy (HT) after menopause and compared women's and physicians' opinions in a country of low-HT use.

METHODS

In 1998, a postal questionnaire was sent to a random sample of 2000 Estonian 45-64-year-old women; 69% (n=1312) responded. In 1999, a postal questionnaire was sent to a random sample of 500 Estonian gynaecologists and general practitioners; 68% (n=342) responded.

RESULTS

Mean age at menopause was 49.8 years (S.D. 4.0), and there was no difference by socioeconomic classes or by age in self-rated health. Ten percent of women reported having used HT, with 3% currently using it. Most women reported some symptoms, with vasomotor symptoms more frequently reported by 50-54 years old; women most often reported tiredness (48%). Half of the women but under a fifth of physicians considered the climacteric a normal phase of life. Women's awareness about HT was low and about half had no opinion on its health effects. Half of the women had visited a gynaecologist, older women less so. Women with contacts with health care were more aware of HT.

CONCLUSIONS

Women reported symptoms by age-group as similarly found in high-HT use countries and it verifies that many symptoms experienced were not due to menopause. As in other low-HT use countries, women were unfamiliar with HT and their attitudes were traditional, although physicians' attitudes were more positive. Estonian women seemed to have escaped the period of the preventive use of HT.

The impact of the Women's Health Initiative Randomized Controlled Trial 2002 on perceived risk communication and use of postmenopausal hormone therapy in Germany

OBJECTIVE

The purpose of this representative, nationwide telephone survey was to collect information about postmenopausal hormone therapy (HT) use in relation to women's knowledge about the Women's Health Initiative Randomized Controlled Trial 2002 (WHI-RCT) in Germany.

DESIGN

During July 2003, telephone interviews were conducted with randomly selected women aged 45 to 60 years (N = 10,030; response 59.9%; completed interviews n = 6,007). They were asked about information sources regarding the WHI-RCT, and use of HT in conjunction with it.

RESULTS

Most women stated that they knew about the WHI-RCT (88.6%), and those with high educational status appeared to have more information than those with middle or low educational status. Among informed women (uninformed excluded), 46.6% continued, 25.7% stopped, and 14.2% ceased use of HT before the WHI-RCT. The prevalence of lifetime use of HT was higher in West Germany (37.4%) than in East Germany (29.2%), the highest prevalence of use was in the group aged 55 to 59 years. The most common reason to continue HT was the benefit risk assessment by physicians (58%); the most common reason to stop HT were women's perceptions that the risks of HT exceeded the benefits (56%). If information was solely given by physicians, women were more likely to continue HT (60.4%), compared with mass media (46.1%), as a source of information.

CONCLUSIONS

The survey demonstrates the impact of the WHI-RCT in Germany, and shows that both the media and advice given by physicians were important. Women who continued to use HT did so largely because of their physician's advice. Women who discontinued were mainly those who had a negative subjective perception about risk of HT.

Use of hormone replacement therapy by postmenopausal women after publication of the Women's Health Initiative Trial

BACKGROUND

After publication of the Women's Health Initiative (WHI) trial in July 2002, many physicians discontinued hormone replacement therapy (HRT) in most of their postmenopausal patients. However, little is known about the women who remain on HRT.

METHODS

We performed a retrospective chart analysis of 1000 postmenopausal women seen at an internal medicine practice to establish the prevalence of continued HRT use after publication of the WHI trial, determine the reasons for its use, and establish the prevalence of conditions adversely affected by HRT.

RESULTS

Of 1000 postmenopausal women, mean age 66 +/- 9 years, 445 (45%) had used or still were on HRT (HRT users) at the time of the review. Of 445 HRT users, 159 (36%) were still on HRT, whereas 286 women (64%) had discontinued therapy. Of the latter, 181 women (63%) had stopped using HRT after the WHI publication, and 136 women (48%) reported the study as the direct cause of HRT cessation. Of the 159 women still on HRT, the main reasons for continued use were severe menopausal symptoms in 39 women (25%), osteoporosis or osteopenia in 31 women (20%), and patient preference in 20 women (13%). Of the 159 women still on HRT, 41 had atherosclerotic disease (26%), 7 had previous venous thromboembolic disease (4%), 8 had a history of breast cancer (5%), and 12 had a family history of breast cancer (8%).

CONCLUSIONS

Despite the widespread impact of the WHI trial results, many women still remained on HRT in an internal medicine practice for a variety of reasons and despite relative contraindications to its use.