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Hormone Replacement Therapy

HRT involves administration of estrogen and progesterone hormones to counteract their dipping levels during menopause. Earlier ERT (Estrogen Replacement Therapy) was followed but this is now replaced by combined hormone therapy. HRT provides relief from symptoms such as increased fatigue and irritability and depression. Hormone Replacement Therapy is usually followed for a few months or a couple of years.


HRT is known to prevent or alleviate any bone loss that leads to osteoporosis. Women who have been on HRT experience enhanced sexuality and improved pelvic floor muscles. It may prove beneficial in preventing Alzheimer's disease and macular degeneration. Cyclic hormone therapy involves taking estrogen pills for 25 days, switching to progestin in between 10 - 14 days and then taking a combined pill for the next 25 days. Stopping the HRT for about 4 days brings on the menstrual bleeding.

The other form of administering HRT is continuos or combined therapy - whereby estrogen and progestin are taken everyday in combined form. Women on HRT complain of a bloated feeling as well as terrible headaches and fluid retention.

HRT Side Effects Some women experience post-menopausal bleeding when on HRT. Tender and swollen breast are yet another side effect of HRT. Swelling of the legs and increased weight are also noticed by women on HRT. Other associated risks of HRT are increased incidence of venous thrombosis or worsening of any existing liver condition. Long-term use of HRT is associated with breast cancer.


HRT patch

An HRT patch is an alternative to hormone tablets and vaginal creams. When ingested in tablet form, the hormone moves from the stomach and intestines to your liver. This necessitates higher dose of estrogen to be administered. HRT patches allow the skin to absorb estrogen through the bloodstream. HRT patches are worn on any location below your waist.

But it must never be applied on or near the breasts. Women suffering from sore or irritated skin must not use HRT patches. Vaginal creams containing estrogen are yet another method of administering HRT. This reduces the feeling of dryness experienced by most peri-menopausal women.

Pseudohermaphroditism

Pseudohermaphroditism is the term normally employed to describe people born with secondary sexual characteristics. In this condition of sexual ambiguity, the individual pseudohermaphrodite possesses gonadal tissue of one sex but exhibits external phenotype of the opposite sex. The external sex organs in some of these people look intermediate between the typical vagina or penis. In some others, the appearance is that of an 'opposite' gonadal tissue. Due to this factor, pseudohermaphroditism is difficult to detect until puberty. This is a congenital condition.


The term 'male pseudohermaphrodite' is used when the testis is present; 'female pseudohermaphrodite' is used when the ovary is present. In pseudohermaphroditism the genital and sex determinations are discordant, for instance an apparently female individual may have testes, a male pseudohermaphrodite. Some symptoms of pseudohermaphroditism include, abnormal female external genitalia, enlarged clitoris, fusion of labia and sealed vagina.


In male pseudohermaphroditism, the individual has male chromosomal and gondal gender with female external genitalia. Male pseudohermaphroditism is a defect in the male embryo and usually a genetic deficit in androgen production or action. Accurate diagnosis and careful assessment of all clinical features is vital in treatment of pseudohermaphroditism conditions. The sex hormone binding globulin suppression test using anabolic steroid is used in confirming the diagnosis. This is performed during the neonatal period. Tests involving administration of gonadotrophic hormones are also useful in determining whether the body can produce testosterone or whether the problem involves ability to use testosterone.


Surgery is sometimes performed to alter the appearance of the genitals. The modern day approach is to delay the surgery and wait for the child to mature in order to express a preference. Hormone therapy, support and counseling are other treatment methods usually employed.


PSA blood test

The Prostate Specific Antigen (PSA) test enables the medical practitioner to detect prostate cancer at an early stage. prostate Specific Antigen (PSA) is a protein produced in small amounts in the cells of the prostate gland. A PSA blood test helps to determine whether stage of prostate cancer is advanced enough to perform a biopsy of the prostate gland or not. When the prostate gland enlarges, PSA level in the blood tends to rise. This is indicative of cancer or benign non-cancerous conditions. PSA is called biological marker or tumor. As men age, both benign prostate conditions and prostate cancer become more frequent. The most common benign prostate conditions are prostatitis which is inflammation of the prostate, and benign prostatic hyperplasia - BPH which refers to the enlargement of the prostate.


BPH - Benign Prostatic Hyperplasia is not usually dangerous by itself. Any strain on the bladder owing to urine retention can lead to complications like bladder/kidney damage, kidney stones, Urinary tract infection (UTI) or incontinence. The etiology of BPH is still not clear while most agree that the metabolism of testosterone can partially exacerbate BPH. A part of the secreted testosterone ends up as DHT - Dihydrotestosterone which may accentuate other conditions other than BPH - like male pattern baldness.

When the PSA test is combined with rectal examination, 90% of prostate cancers can be detected. In the U.S., the American Cancer Society recommends PSA blood test at least once a year to avoid the risk of prostate cancer.

The PSA test has been called the 'male PAP test'. The normal range for a PSA blood test is between 0 - 4 ng/ml (nanograms per milliliter). A PSA level of 4 - 10 ng/ml is considered slightly elevated. Levels between 10 -20 ng/ml are considered moderately elevated. Anything about 20 ng/ml is considered highly elevated. Although the higher the PSA level, the higher the risk of cancer, one abnormal PSA test result does not necessarily mean it is cancer that is present, as various other factors may cause PSA levels to fluctuate.


The PSA test is a radioimmunoassay. In a diagnostic laboratory, the patient's blood sample is exposed to the antibody against PSA. That moment the amount of antigen (PSA) can be measured. It should be borne in mind that a man who is undergoing hormone therapy for prostate cancer may have a low PSA test reading during or immediately after the treatment. The low level may not be a true measurement of PSA in the patient's body. It is essential that such patients brief the doctor who may probably advise him to wait a few months after hormone treatment before having a PSA test done.

PSA test does not help a man with fast-growing tumors or aggressive cancer. It helps only in detection of small tumor and slow growing tumors which are unlikely to threaten a man's life. PSA test also cannot detect cancers spreading to the other parts of the body beforehand. There is a fear of false positives test results in PSA testing. Sometimes PSA level could be elevated but that does not necessarily mean cancer is present. A fear of false negative test result can also occur in PSA testing. That is the PSA test result will show negative even if prostate cancer is actually present in the patient. PSA blood test is often followed by other diagnostic tests such as ultrasound, x rays and cystoscopy to determine the presence of cancer or any other problem in the prostate.

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Bibliography / Reference

Collection of Pages - Last revised Date: October 22, 2019