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Prostate Cancer: What You Should Know

When Dennis Hopper died of prostate cancer at age 74, my husband asked me: “Hey, I thought prostate cancer is slow-growing and doesn’t kill men.”

Well, he’s right about it usually being slow-growing, but prostate cancer is still the second leading cause of cancer death in men. His question made me realize that there are some facts that everyone should know about prostate cancer. Read more »

*This blog post was originally published at EverythingHealth*

Condoms With Handles Help Keep “The Mood”

According to Grove Medical, disruption of “the mood” is a main barrier to condom use. With their Sensis condoms with QuikStrips, the company tries to overcome this mental handicap by offering a new condom technology to protect the passion while practicing safer sex.

The QuikStrips are little handles on the side of the condom that work much like the pull-off tabs on a bandage, creating an application that helps to apply the condom quickly in the right way.

Presumed benefits include appropriate spacing at the reservoir, no touching of the condom as it’s being applied, and less chance of accidental inside-out-then-flip contamination. Read more »

*This blog post was originally published at Medgadget*

A Medical Transgender Primer

Transgender issues have been in the news with the recent announcement that Cher’s daughter, Chaz Bono, is transitioning from female to male. This subject has been plagued by misunderstanding and fear of the unknown. Transgender children are often shamed, bullied, and made to feel totally alone. As adolescents and adults, they face denial of adequate medical coverage and other forms of discrimination – and worse. Just two months ago, a Colorado man was found guilty of murdering an 18 year old transgender woman in what was judged to be a hate crime.

Chaz’s decision to go public with his private struggle is extremely brave. His publicist said,

“It is Chaz’s hope that his choice to transition will open the hearts and minds of the public regarding this issue …”

Step one in reaching the public is defining terms. The terminology surrounding gender issues can be confusing. “Transgender man,”, “transmale,” and “affirmed male” have all been used to refer to a biological female who transitions to a male. I found a glossary of transgender terminology offered by the NCTE to be extremely helpful.

What exactly does transitioning mean? It’s the period during which somebody starts to live as his/her new gender. It can include changing a name or legal documents, taking hormones, and getting surgery. One misconception is that transitioning requires surgery. It doesn’t. As Mara Keisling, the Executive Director for the National Center for Transgender Equality (NCTE) told me, “Most transsexuals don’t get surgery. This is about gender identity, not about genitals.”

There’s a lot of controversy and confusion but experts agree on two crucial concepts:

1) Being transgender is not a choice.
2) Biological sex and gender identity are two different things.

There are people whose external appearance is female but who have felt they were male since they were toddlers – and vice-versa. Norman P. Spack, M.D., an endocrinologist at Children’s Hospital in Boston, Dept. of Pediatrics, Harvard Medical School, has been treating transgender patients since 1985 and significant numbers of teenagers since 1998. Most of his patients have told him “as far back as they can really remember that they were in the wrong body.” Dr. Spack said, “there’s a heavy skew to under 6 years.”

Dr. Spack points out that because transgender has been labeled as a psychiatric illness (“Gender Identity Disorder”) by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), patients are not adequately covered by health insurance. He says that the insurance industry will cover psychiatric costs but denies hormonal and surgical therapy, claiming they are non-covered cosmetic treatments. A step forward came in 2008 when the American Medical Association House of Delegates passed a resolution supporting “public and private health insurance coverage for treatment of gender identity disorder in adolescents and adults” and opposing “categorical exclusions of coverage for treatment of gender identity disorder in adolescents and adults when prescribed by a physician.” But for now, many transgender patients continue to receive inadequate medical coverage and therefore inadequate medical care.

Nobody knows how many transgender people exist. The very definition of transgender can differ from study to study. Some only count people undergoing hormonal/surgical treatment; others rely on self-identification. In the Netherlands and Belgium, estimates based on patients receiving surgery and/or hormones were about 1 in 12-13,000 for transfemales and 1 in 30-34,000 for transmales.

But Mara Keisling told me those estimates are way too low. “Our best estimate is that one quarter to three quarters of one percent of Americans are transsexuals.” That’s 2.5 to 7.5 in a thousand. Dr. Spack’s estimate is about one in a thousand.

We are not close to understanding all the variables that go into determining why someone feels trapped in the body of the wrong sex. Parents often feel guilty but the wide consensus is that parenting does not cause a child to be become transgender. Research in animals suggests that there are critical periods of development during fetal or neonatal life during which exposure to testosterone influences the sexual differentiation of the brain But we’re far from putting together any sort of unified theory of gender identity that weaves together genes, cell biology, hormones, brain wiring, and nurturing.

Experts stress that transgender is part of a wide continuum of gender identity. As Stephanie Brill and Rachel Pepper say in The Transgender Child: A Handbook for Families and Professionals, “Today, gender can no longer really be considered a two-option category.” They emphasize the importance of patients and families understanding that they are not alone and that there are competent professionals who can help. They say they wrote the book, which I found to be very helpful, to “provide caring families with helpful tools they can use to raise their gender-nonconforming children so they may feel more comfortable both in their bodies and in the world.” The authors quote Dr. Spack who, referring approvingly to the Dutch treatment of adolescents by delaying puberty and giving them hormones, said: “Suicide attempts, so frequent elsewhere, are almost unknown because parents and children know that they will be taken care of and will ultimately join a society known for its tolerance.” Referring to his own patients, Dr. Spack told me “They may be anxious, they may be depressed, but many, many no longer have psychiatric diagnoses after they are treated properly.”

In today’s video segment of CBS Doc Dot Com, I speak to Dr. Ward Carpenter of the Callen-Lorde Community Health Center in NYC, a facility that provides care to patients across the spectrum of gender identity and sexuality. In the segment that follows, Dr. Carpenter explains what surgery and hormones can entail. A warning: it’s a graphic description. Its purpose is not to shock but to educate. Hopefully, better education will lead to less misunderstanding, less fear, and wider acceptance for people like Chaz Bono.

Other Resources:

NCTE: Understanding Transgender Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline

True Selves: Understanding Transsexualism by Mildred L. Brown and Chloe Ann Rounsley

Watch CBS Videos Online;contentBody

Post Vasectomy Pain Syndrome: More Common Than You Might Think

Photo of crossed legs

My friend Dr. Joe Scherger and I enjoyed a sunny Sunday brunch at a garden eatery in DC. Unfortunately for the neighboring restaurant-goers, we engaged in a very loud and animated conversation about vasectomies. Joe is a family physician and men’s health expert who has recently become aware of “post vasectomy pain syndrome” through an online group that he leads. I noticed two men nearby crossing their legs reflexively and pretending not to be eavesdropping.

Apparently, as many as 10-15% of men may experience a prolonged period of testicular pain after undergoing a vasectomy. As common a complication as this is, Joe believes that very few men are sufficiently warned about it during the informed consent process. The pain may be caused by swelling (once the vas deferens is cut there is no exit point for newly generated sperm) or inflammation. In some cases, the body forms “anti-sperm” antibodies and attacks the sperm generating tissues in the testes. In other cases, small nerves in the area are damaged and heal poorly (causing neuromas).

So if you or your loved one is considering a vasectomy, it’s important to learn all the facts first. You may want to stop by Joe’s online group to ask a question as well.

Davis Phinney And Parkinson’s Disease

Photo of Davis Phinny

Davis Phinny

Davis Phinney has won more cycling races than any other American. He is charming, articulate, handsome, and requires a deep brain stimulator to keep him from experiencing incapacitating tremors. Davis was diagnosed with Parkinson’s Disease at age 40.

I attended the Parkinson’s Action Network 15th Annual Morris K. Udall Awards Dinner in Washington DC last week. Davis was interviewed by Diane Rehm and I recorded the conversation for my blog readers. It was an exceptional interview.

Davis explained how he was initially diagnosed – he felt tired, slow, experienced foot cramps and began tripping more frequently. As a young, seemingly invincible athlete who worked long hours, he assumed that he was just tired and in need of a massage. Eventually his symptoms became so persistent that he went to see a physician. After many tests and many different doctors examined him, a retired neurologist made the diagnosis. Davis says that it was a tough blow to his family. He felt as if he were Superman, now saddled with a permanent kryptonite necklace. Read more »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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