By MATTHEW PERRONE - AP Health Writer | AP – Tue, Jun 14, 2011

Embarrassment Keeps Women With 'Manly' Health Problems From Treatment

For 10 years, Jeannie Bush rose at 4 a.m. and slipped out of bed to shave her face before sneaking back under the covers, terrified that if she didn't, her husband would snuggle up to her in the morning and become disgusted at the hair on her jaw and chin.

"What an absolute turn-off I felt that would be," Bush, a 55-year-old electrologist in La Crosse, Wis., told LiveScience. "So I hid it."

Hiding her facial hair defined Bush's daily life for decades, starting when she was a teen and continuing until, at age 35, she met a doctor who recognized her eFDA Gives Thumbs Up to  Restylane as Lip Enhancerxcessive hair as a symptom of the hormonal condition polycystic ovary syndrome (PCOS). Treatment for the underlying condition, along with electrolysis, freed Bush from her daily shaving regimen. But she still remembers the shame she felt about her "unfeminine" symptom. Even the moment when her doctor noticed the facial hair was embarrassing, Bush said.

"At first, I was very hurt, because I thought I hid it so well, and she saw it," Bush said.

'Manly' symptoms

The embarrassment Bush felt about her symptoms isn't unique. Many people go without treatment when their medical problems involve stigmatized body parts, such as the bowels; journalist Katie Couric's on-air colon cancer screening in 2000 was an effort to combat that stigma surrounding the disease that killed her husband. But when symptoms are traditionally associated with manliness, the shame is often rooted in a fear of being unfeminine or undesirable. [5 Reasons Being a Woman is Good For Your Health]

"As a woman, I think you really start to feel less than a woman, because you're very different," said Sophia Wastler, 36, who directs an enrichment program for preschool kids in Virginia Beach, Va. Wastler has hyperhidrosis, or excessive sweating, which went untreated until she was 31.

"You know, with women, you don't want to be someone who is sweaty," Wastler told LiveScience. "It's kind of more of a male characteristic than a female characteristic, so it's quite embarrassing."

Hiding medical problems

In some cases, the effort of hiding the symptom spills over into the doctor's office, meaning they don't seek help. Bush's complaints about her excess hair had been brushed aside by doctors before, so she hadn't intended to mention it to her new doctor until the woman gently brought it up. Wastler was used to making excuses about her sweaty palms, but shaking a new doctor's hand one day, she finally snapped.

"Instead of making an excuse that day, I said, 'You know what, my hands are sweaty, I don't know why.'" Wastler said. "And he said, 'You have hyperhidrosis.'"

The simple-as-that diagnosis and treatment changed her life, said Wastler, who now gets periodic Botox shots in her hands to stop the sweating.

"I tell people that's when I started living, at 31," she said. "Not at 16, 18, 20 — all those years? Completely missed." [Top 10 Stigmatized Health Disorders]

Hyperhidrosis isn't just a little extra sweat, said Dee Anna Glaser, a dermatologist at the Saint Louis University School of Medicine in Missouri and the president of the International Hyperhidrosis Society (IHHS). Patients sweat through their clothes even when they aren't warm; teenagers may turn in smeared, sweaty homework. Wastler remembers a particularly humiliating moment in dance class when she ended up standing in a puddle of her own sweat, the whole room staring.

"We still have the problem of social stigma where patients are so embarrassed by it that they don't even want to talk to their family doctor or their parents," Glaser told LiveScience. In her office, she said, a teenager will venture to bring up excess sweating during a checkup, and the parent will often be shocked because the child has been working so hard to hide the condition.

While hyperhidrosis affects both sexes equally, about 66 percent of those seeking treatment are women, Glaser said. That may be because women are more distressed by excess sweat, she said; also women tend to be more open to seeking medical care than men, regardless of the condition.

Getting help

Likewise, the excess facial hair seen in PCOS can be a mental burden, especially for teenagers, said Diana Dowdy, a certified nurse-midwife in Huntsville, Ala., who studied the psychological effects of PCOS for her doctorate degree. Symptoms of PCOS, which often include acne, obesity and painful menstrual periods, begin to emerge in the teenage years, the result of abnormal hormone levels. Girls often spend major time and money on makeup and hair removal in an attempt to fit in, Dowdy told LiveScience.

"When we begin to talk about these things, they are so relieved that there is a condition they can blame this on, that they're not terribly masculine or that there's something wrong with their gender," Dowdy said.

To that end, both patients and medical professionals agree: If there is something wrong, talk to a doctor, no matter how embarrassing or hopeless it might seem.

"I would just say, we can usually find something for everyone," Glaser said of hyperhidrosis treatments. The IHHS maintains a physician finder at sweathelp.org to direct patients to doctors with an expertise in the disorder. The simple realization that symptoms are the result of a medical condition and not due to something "wrong" with the person, can lift a huge burden, Glaser said.

Wastler agreed.

Since starting treatment, "it's like I'm a completely new person," she said. "I left my job, I started a company, I met my husband. … the whole psychological veil of hiding just came off."

from LiveScience.com

Stephanie Pappas

 FDA Gives Thumbs Up to  Restylane as Lip Enhancer

April 27, 2011 — Today, the US Food and Drug Administration's General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee recommended the injectable wrinkle-filler Restylane (Medicis Aesthetics Inc) for use as a lip enhancer.

Restylane, an injectable gel composed of hyaluronic acid, is indicated for mid- to deep-dermal implantation to correct moderate to severe facial wrinkles and folds, such as nasolabial folds. The company is seeking to amend the product's indication to include submucosal implantation for lip augmentation.

The panel voted 6 to 0 (1 abstaining) that Restylane for lip augmentation is generally safe and effective for this purpose and that the benefits outweigh the risks.

The FDA still has to make a final decision on Restylane injectable gel for lip augmentation, but the agency usually follows the advice of its advisory panels, which consist of outside experts.

The panel heard an overview of data from the pivotal 12-center study of 180 patients randomly assigned to lip augmentation with Restylane injectable gel or to no treatment.

After weighing the evidence of effectiveness, "the panel generally believes that Restylane has been shown to be effective for lip augmentation," Susan Galandiuk, MD, professor of surgery, University of Louisville in Kentucky, who chaired the panel, said.

In general, treatment emergent adverse events in the study were common, transient, and mild. No unanticipated adverse events occurred; anticipated adverse events included bruising, redness, swelling, pain, tenderness, and itching.

After weighing the evidence on safety, "the panel generally believes that Restylane for lip augmentation is generally safe," Dr. Galandiuk said. Panel member Michael J. Miller, MD, chief of the Division of Plastic Surgery, The Ohio State University, Columbus, noted that, overall, adverse effects are "self-limited and most [patients] came back for further treatment."

FDA statistician Alvin Van Orden noted that in the pivotal study on Restylane for lip augmentation, a "wide range of volume" of Restylane gel was used and an increase in injected volume did not predict increased effectiveness; "volume injected was not a predictor of lip fullness in any model," he said, "but a higher injected dose does appear to increase safety concerns."

Summing up the panel's discussion on this issue, Dr. Galandiuk said that in general, "the panel has no significant concern regarding the lack of correlation between the injected dose and the change in lip fullness, and the panel does not feel a need to cite a maximum injectable dose."

However, she said, the panel recognizes that the product will have "widespread applicability to numerous types of physicians, and possibly dentists, and feels there is a need to set some type of limit for an individual dose per lip and that there should be training guidelines for physicians and users of this product."

Data on Restylane as a lip enhancer in people with darker skin types and men are limited. However, panel consensus was that no additional premarket studies are necessary in these 2 populations.

Several panel members also had "philosophical" concerns about its use in younger patients age 18 to 22. Only 4 patients in the pivotal 180-patient study were in this age group.

The majority of the panel also do not feel that a postmarketing study is required, but several members believe that a registry should be created to follow outcomes, particularly in younger patients.

During the public comment portion of the meeting, Gloria Duda, MD, board-certified plastic surgeon from McLean, Virginia, who was representing the American Society for Aesthetic Plastic Surgery, noted that Restylane is commonly used off-label to augment and contour the lips, and she encouraged the panel to support its use for this indication.

Lip augmentation is a "very frequently" requested procedure, Dr. Duda said, and, in her experience, the results are "immediate and reproducible and the risks with hyaluronic acid are minimal."

General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee. Meeting held April 27, 2011, in Gaithersburg, Maryland.

From:  Medpulse Newsletter May 3, 2011; Medscape Medical News;  Megan Brooks

It wasn't long ago that looking young, even when you weren't, was the domain of the rich and famous. Not so anymore. Today, a more youthful look is possible thanks in large part to a new generation of nonsurgical injectable wrinkle fillers. Most fill your lines and wrinkles in less than 30 minutes with results that last from four to six months to a year or longer -- all for a fraction of the cost of a traditional face-lift. And while results aren't as dramatic as a face-lift, they can certainly help hold back the hands of time for at least a little while longer.

Unlike Botox injections, which relax the muscle under a wrinkle, injectable wrinkle fillers actually fill the line or crease with one of several different substances, so it seems to nearly disappear.

Moreover, wrinkle fillers are also now being used as "volumizers," plumping and lifting the cheeks, filling out thin lips, and plumping sagging hands.

And while the treatment is fast and easy, all wrinkle fillers have a downside, including the risk of allergic reaction and the formation of tiny bumps under the skin that in some instances may be permanent. Typically, wrinkle fillers with longer-lasting effects are more likely to cause side effects. A bluish skin discoloration known as the Tyndall effect is also possible. The color change can last for several months, but treatments are available. In very rare instances, death of skin cells can occur if the wrinkle fillers are not administered properly.

Perhaps more important, however, is that not every wrinkle is right for every type of wrinkle filler. In fact, experts agree that using the right wrinkle filler in the right way not only reduces risks, but also ensures a better result overall -- one reason why it is vital to have wrinkle fillers performed by a board-certified dermatologist or plastic surgeon.

To help you discuss all your options with your doctor, what follows is a breakdown of all the wrinkle fillers currently available, including their basic ingredients, how they work, risks and benefits, and the best areas for treatment. Your doctor can help you decide with wrinkle filler is right for you.

Wrinkle Filler Options

Hyaluronic Acid Wrinkle Fillers

By far the most popular category of wrinkle fillers is hyaluronic acid, a natural component of all connective tissue. Each type of hyaluronic acid wrinkle filler works in a slightly different way to fill lines and wrinkles with a varying range of lasting results.

For the most part, side effects of these injections are rare but can include the risk of redness, swelling, and bruising at the injection site, as well as the possibility that the substance may be seen beneath the skin in the form of tiny bumps, a problem which typically improves over time.

While the length of the results may vary from several months to up to a year or longer, there is some medical evidence beginning to emerge that repeated injections of these fillers over time may help stimulate the body's own natural production of collagen, which in turn helps to naturally decrease some of the lines and wrinkles. There is also some evidence that less filler is needed over time to achieve the same look.

Hyaluronic wrinkle fillers include:

Wrinkle Filler: Juvederm Ultra/Juvederm Ultra Plus
Ingredient: Gel made of hyaluronic acid
Effects:  Up to one year
FDA Approved for: Moderate to severe facial wrinkles and folds
FYI: Not recommended for use in patients with severe allergies, particularly to bacterial proteins.

Wrinkle Filler: Restylane/Perlane
Ingredient: Hyaluronic acid particles suspended in a gel.
Results: six months or longer
FDA Approved for: Moderate to severe wrinkles and folds.
FYI: Not recommended for use in patients with severe allergies

Synthetic Wrinkle Fillers

This somewhat smaller category of wrinkle fillers is composed of substances that are considered synthetic -- in that they are not related to anything found naturally in the skin.  

In all formulations, however, side effects are similar with the risk of redness, swelling, or bruising at the site of the injection among the most common. Other risks include the development of nodules or bumps under the skin that can be seen and felt and in rare instances may require surgical removal.

The benefits of this category of injections include a longer-lasting effect, with at least one offering permanent filling of lines and creases. Products with longer-lasting effects are more likely to cause side effects. Several studies have reported that when used incorrectly, synthetic wrinkle fillers can lead to permanent disfigurement.

Synthetic wrinkle fillers include:

Wrinkle Filler: Radiesse
Ingredient: Micro-spheres of the mineral calcium hydroxylapatite suspended in gel
Effects: Typically one year; some research shows that the body begins producing collagen around the micro-spheres, which might lead to longer lasting effects over time.
FDA approved for: Long-lasting fill of deep lines, including folds around the nose.
FYI: Clumping of the filler can develop when injected into the lips. There is a risk of allergy.

Wrinkle Filler: Sculptra
Main Ingredient: Synthetic poly-L-lactic acid in micro-spheres
Effects: Typically up to one year
FDA approved for: Volumizing of HIV patients suffering from loss of facial structure.
FYI: The ingredients in this filler are made for deep injections below the muscles and not as an injectable into fine lines.

Collagen Wrinkle Fillers

One of the very first wrinkle fillers developed was derived from a purified form of collagen extracted mostly from cows. Although it worked well to offer a natural looking line and crease fill, the results were short lived, with most collagen injections beginning to degrade as soon as one month after treatment. Because these wrinkle fillers were derived from an animal source, they also prompted a higher rate of allergic reaction and the need for allergy testing prior to treatment.

Fast-forward several decades, and collagen injections take a big leap forward. New ways of processing the bovine sources have helped reduce risks, plus new forms of synthetic collagens are making these injections safer and more useful for a wider range of people. Although by comparison the results are generally shorter lived than other wrinkle fillers, many believe the results are better and more natural looking.

Side effects of collagen injections still include some risk of allergic reaction (mostly for those still using bovine sources) and bruising and redness at the site of the injection.

Collagen injections include: 

Wrinkle Filler: Cosmoplast/Cosmoderm
Ingredient: Collagen derived from purified human tissue grown in a lab. Does not require a skin test.
Effects: Up to six months depending on area that is treated.
FDA approved for: Frown lines, crow's feet, forehead lines, vertical lip lines (also called bleeding lipstick lines, nose-to-mouth lines, lip border, scar filling. Cosmoplast is used for deeper, more pronounced wrinkles.
FYI: One of the few fillers that is recommended for treating fine lines around the eyes.

Autologous Wrinkle Fillers

This category includes wrinkle fillers derived from substances, usually fat, taken from your own body. The fat is normally harvested from the thighs, buttocks, or stomach.

While these are among the least performed wrinkle fillers, for some they can be a viable and important option.

Risks for these injections are similar to other wrinkle fillers, including bruising, redness, and swelling at the site of the injection. However, because the use of these fillers includes the need for two procedures (one to remove the fat, one to inject -- the two procedures may be done in one visit) plus additional purification steps taken in the laboratory, they can be both costly and time consuming. Rarely, results can be permanent. Because they don't involve any foreign substances, these injections do not require FDA approval. They are most frequently used for fine lines and creases on the face.

Minimizing Risks and Increasing Good Outcomes for All Wrinkle Fillers

Though wrinkle fillers are among the safest cosmetic procedures in use today, there are things every consumer can do to help ensure their treatment is everything they hope for.

• Don't let price be your guide. If you are offered a wrinkle filler treatment that costs far less than the standard fare, there are typically some compromises being made, either in the skill of the provider or the quality of the ingredients being used. Never make a bargain with your face.
• All wrinkle fillers should be administered in a medical setting using sterile instruments. Treatments offered in homes, hotels, spas, or resorts are not considered medical environments, regardless of who is doing the injection.
• Do not get injectable wrinkle fillers outside of a doctor's office. Know what you are being injected with, and ask your physician specifically if they are using an FDA-approved wrinkle filler and if it was purchased directly from the manufacturer. Reports have emerged of everything from industrial grade silicone to baby oil to unapproved fillers being used. If your provider will not give you the information about what is being used in your treatment, then seek another provider.

WebMD Medical Reference

Dr. Richard Harbison

Low Testosterone Raises Heart Death Risk
Study Shows Men With Heart Disease Die Sooner if Testosterone Levels Are Low
By Daniel J. DeNoon
WebMD Health NewsReviewed by Laura J. Martin, MDOct. 19, 2010 - Men with heart disease die sooner if their testosterone levels are low, a U.K. study shows.

It's becoming clear that low testosterone is a risk marker for heart disease in men. Now it appears low testosterone predicts worse outcomes in men who already have heart disease.

What isn't clear is whether low testosterone causes or worsens heart disease -- and whether testosterone replacement therapy would help.

"We don’t know yet whether normalizing the [testosterone] level will reduce the excess risk we identified in our paper, but many studies have shown that you will feel better," study leader Kevin S. Channer, MD, tells WebMD.

But observational studies like Channer's can be misleading, notes William O'Neill, MD, professor of cardiology at the University of Miami Miller School of Medicine. O'Neill, who was not involved in the U.K. study, warns that only a clinical trial can prove whether hormone replacement therapy can improve heart health.

"There is no proof that fractures or cancer or heart disease significantly improve for men on testosterone replacement therapy," O'Neill says. "A lot of men want to feel younger and more virile and have more sex drive. In this regard it is similar to estrogen replacement for middle-aged women. They feel more youthful and have better vaginal tone, but other long-term benefits aren't proven."

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