Principles of Gender-Specific Medicine (eBook)

Front Cover 1
Principles of Gender-Specific Medicine 4
Copyright Page 5
Contents 8
Contributors 12
Foreword: Gender-Specific Medicine – Environment and Biology 18
Preface 22
SECTION 1 Gender and Normal Development 24
INTRODUCTION 25
CHAPTER 1 The Effects of Gender in Neonatal Medicine 26
INTRODUCTION 26
THE SEX RATIO DURING FETAL LIFE 26
SEX DIFFERENCES IN FETAL AND NEONATAL GROWTH 28
EXCESS MALE MORTALITY 29
THE EFFECT OF GENDER ON THE INCIDENCE AND SEVERITY OF DISEASES IN INFANCY AND CHILDHOOD 30
SUMMARY 35
References 36
CHAPTER 2 Sexual Development, Growth, and Puberty in Children 41
INTRODUCTION 41
SEXUAL DEVELOPMENT 41
GROWTH 45
PUBERTY 48
ACKNOWLEDGMENTS 54
References 54
CHAPTER 3 Gender Differences in Pediatric Pulmonary Disease 58
INTRODUCTION 58
PRENATAL LUNG GROWTH 58
POSTNATAL LUNG GROWTH 60
LUNG DISORDERS OF CHILDHOOD 61
References 69
CHAPTER 4 Gender-Specific Aspects of Pediatric Hematology and Oncology 74
INTRODUCTION 74
NORMAL HEMATOPOIESIS 74
IRON DEFICIENCY ANEMIA 75
GLUCOSE-6-PHOSPHATE DEHYDROGENASE DEFICIENCY 75
SICKLE CELL DISEASE 75
CHRONIC GRANULOMATOUS DISEASE (CGD) 76
COAGULATION DEFECTS 76
CHILDHOOD CANCER 76
SUGGESTIONS FOR FURTHER INVESTIGATIONS 81
References 81
CHAPTER 5 Gender Differences in Neurological Conditions of Children 85
INTRODUCTION 85
ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD) 86
TOURETTE'S SYNDROME (TS) 86
EPILEPSY 86
DUCHENNE MUSCULAR DYSTROPHY 87
FRAGILE X SYNDROME 87
PELIZAEUS–MERZBACHER DISEASE (PMD) 87
CONCLUSION 88
References 88
Further reading 88
CHAPTER 6 Gender and Sports: Past, Present, and Future 90
INTRODUCTION 90
SPORTS IN AMERICA: A CHANGING DEMOGRAPHIC 90
PHYSIOLOGY 90
SPECIFIC ISSUES OF GENDER AND SPORT 91
CONCLUSION 94
Further Reading 95
SECTION 2 Gender and the Nervous System 96
INTRODUCTION 97
CHAPTER 7 Gender Differences in the Functional Organization of the Brain 98
INTRODUCTION 98
SEX DIFFERENCES IN BEHAVIORAL MEASURES 98
SEX DIFFERENCES IN NEUROANATOMIC MEASURES 101
SEX DIFFERENCES IN NEUROPHYSIOLOGIC MEASURES 104
IMPLICATIONS FOR SEX DIFFERENCES IN FUNCTIONAL BRAIN ORGANIZATION 105
QUESTIONS FOR FUTURE 106
ACKNOWLEDGMENT 106
References 106
CHAPTER 8 Sexual Differentiation of Brain Structure and Function 110
INTRODUCTION 110
HISTORICAL OVERVIEW 111
SEX DIFFERENCES IN NEUROANATOMY 112
CELLULAR MECHANISMS ESTABLISHING SEX DIFFERENCES IN BRAIN 114
SEX DIFFERENCES IN PHYSIOLOGY AND BEHAVIOR 117
SUGGESTIONS FOR FUTURE INVESTIGATIONS 120
References 121
CHAPTER 9 The Sexed and Gendered Brain 124
INTRODUCTION 124
TERMINOLOGY 124
SEXUAL DIFFERENTIATION OF THE BRAIN 126
TESTING THE PRENATAL HORMONAL HYPOTHESIS IN HUMANS 127
CONCLUSIONS 132
QUESTIONS FOR FUTURE RESEARCH 133
References 134
CHAPTER 10 Age and Gender-Specific Patterns of Neurologic Illness 136
INTRODUCTION 136
STRATEGIES FOR IDENTIFYING DIFFERENTIAL DISEASE FREQUENCIES 136
ARE THERE DATA REGARDING GENDER-SPECIFIC FREQUENCY OF NEUROLOGIC DISEASES? 138
SUMMARY AND DISCUSSION 146
FURTHER UNEXPLORED QUESTIONS 147
References 147
CHAPTER 11 Gender Differences in Stroke 152
INTRODUCTION 152
GENDER DIFFERENCES IN EPIDEMIOLOGY OF STROKE 152
GENDER DIFFERENCES IN PREVENTION OF STROKE 152
GENDER DIFFERENCES IN ACUTE TREATMENT OF STROKE 154
GENDER DIFFERENCES IN STROKE SYMPTOMS AND RECOVERY FROM STROKE 155
GENDER DIFFERENCES IN MECHANISM OF STROKE 155
SUGGESTIONS FOR FUTURE INVESTIGATIONS 156
References 156
CHAPTER 12 Gender Differences in Disorders that Present to Psychiatry 159
INTRODUCTION 159
CHILD PSYCHIATRY 159
ADULT PSYCHIATRY 160
GERIATRIC PSYCHIATRY 162
FUTURE RESEARCH DIRECTIONS 162
CONCLUSION 162
References 163
CHAPTER 13 Hormone Replacement Therapy and Cognitive Function 165
INTRODUCTION 165
LABORATORY STUDIES 165
MENOPAUSE, HORMONES, AND COGNITION 166
MENOPAUSE AND DEMENTIA 166
CLINICAL TRIALS 167
CONCLUSION 169
QUESTIONS FOR FUTURE RESEARCH 169
ACKNOWLEDGMENT 169
References 170
SECTION 3 Cardiovascular Disease 172
INTRODUCTION 173
References 173
CHAPTER 14 Gender and the Heart: Sex-Specific Differences in the Normal Myocardial Anatomy and Physiology 174
INTRODUCTION 174
THE VASCULATURE 174
THE MYOCARDIUM 175
THE MYOFIBER 175
CONTRACTILE PROPERTIES OF THE NORMAL HEART 176
AGING AND MYOCARDIAL CHARACTERISTICS 176
CONGESTIVE HEART FAILURE 177
MYOCARDIAL HYPERTROPY 178
HORMONES AND THE HEART 179
ELECTROPHYSIOLOGY AND GENDER 180
References 181
CHAPTER 15 Gender-Specific Aspects of Selected Coronary Heart Disease Risk Factors: A Summary of the Epidemiologic Evidence 185
CIGARETTE SMOKING 185
HIGH BLOOD PRESSURE 186
DYSLIPIDEMIA 186
OBESITY 187
PHYSICAL ACTIVITY 188
TYPE 2 DIABETES 189
ASPIRIN 190
POSTMENOPAUSAL HORMONE THERAPY 190
ALCOHOL 191
PSYCHOSOCIAL FACTORS 191
CONCLUSION 192
References 193
CHAPTER 16 Dyslipidemia Management in Women and Men: Exploring Potential Gender Differences 198
INTRODUCTION 198
RISK FACTORS FOR DEVELOPING CVD ASSOCIATED WITH DYSLIPIDEMIA 198
DYSLIPIDEMIA 199
HORMONAL EFFECTS ON CVD RISK 202
DYSLIPIDEMIA MANAGEMENT 203
CONCLUSION 206
SUGGESTIONS FOR FURTHER INVESTIGATIONS 206
References 206
CHAPTER 17 Gender Differences in the Role of Stress and Emotion in Cardiovascular Function and Disease 209
CARDIOVASCULAR EFFECTS OF LABORATORY STRESS 209
EMOTIONAL STATES AND CARDIOVASCULAR DISEASE 211
PSYCHOSOCIAL RISK FACTORS IN CARDIOVASCULAR DISEASE 214
PSYCHOSOCIAL INTERVENTIONS WITH CARDIAC PATIENTS 215
CONCLUSION 216
SUGGESTIONS FOR FURTHER INVESTIGATIONS 216
ACKNOWLEDGMENT 216
References 217
CHAPTER 18 The Role of Sex and Gender in Cardiothoracic Surgery 223
INTRODUCTION 223
GENDER AND BIOLOGY 223
GENDER AND RISK FACTORS 225
GENDER AND SURGICAL OUTCOMES 228
GENDER AND RECOVERY AFTER CABG 230
GENDER AND VALVE SURGERY 231
GENDER AND OFF-PUMP SURGERY 231
CONCLUSION 232
References 232
SECTION 4 Pulmonology 236
INTRODUCTION 237
Bibliography 237
CHAPTER 19 Gender Differences in Asthma 238
INTRODUCTION 238
CLINICAL AND EPIDEMIOLOGICAL STUDIES 238
MECHANISMS 240
CONCLUSION 244
References 245
CHAPTER 20 Gender Issues in Venous Thromboembolism 248
VENOUS THROMBOEMBOLISM: EPIDEMIOLOGY AND RISK FACTORS 248
HORMONAL THERAPY AND VTE 250
PREGNANCY AND VTE 256
CONCLUSION 261
References 261
CHAPTER 21 Sleep in Women: Gender Differences in Health and Disease 267
INTRODUCTION 267
NORMAL SLEEP AND GENDER DIFFERENCES 267
GENDER-SPECIFIC CONDITIONS THAT IMPACT SLEEP 268
GENDER DIFFERENCES IN SLEEP DISORDERS 269
CONCLUSIONS 271
References 271
CHAPTER 22 Are Women More Susceptible to Chronic Obstructive Pulmonary Disease? 275
INTRODUCTION 275
EVOLVING EPIDEMIOLOGY 275
DIAGNOSTIC ERRORS 276
CLINICAL MANIFESTATIONS 278
MANAGEMENT 278
CONCLUSIONS 280
References 280
CHAPTER 23 The Gender-Specific Aspects of Lung Cancer 283
INTRODUCTION 283
ARE LUNG CANCERS IN SMOKERS AND NONSMOKERS DIFFERENT? 283
ARE LUNG CANCERS IN MEN AND WOMEN DIFFERENT? 284
ARE WOMEN MORE SUSCEPTIBLE TO LUNG CANCER? 284
POTENTIAL MECHANISMS FOR A GENDER EFFECT ON LUNG CANCER 285
DO WOMEN WITH LUNG CANCER HAVE A BETTER PROGNOSIS THAN MEN? 287
CONCLUSIONS 288
References 288
CHAPTER 24 Gender-Specific Considerations in Pulmonary Hypertension 293
INTRODUCTION 293
IDIOPATHIC PULMONARY ARTERIAL HYPERTENSION 293
SCLERODERMA 296
SUMMARY 297
References 297
CHAPTER 25 Sex and Gender Differences in Pulmonary Manifestations of Autoimmune Disease 300
OVERVIEW 300
PATHOGENESIS 300
SEX HORMONES AND AUTOIMMUNE DISEASE 301
RHEUMATOID ARTHRITIS 301
SCLERODERMA 302
CONCLUSION 305
References 305
CHAPTER 26 Benign Metastasizing Leiomyoma and Lymphangioleiomyomatosis: Lung Diseases of Women 309
INTRODUCTION 309
BENIGN METASTASIZING LEIOMYOMA 309
LYMPHANGIOLEIOMYOMATOSIS 311
References 312
CHAPTER 27 Gender Differences in Susceptibility, Outcomes, and Pathophysiology of Sepsis 314
INTRODUCTION 314
EPIDEMIOLOGY OF SEPSIS 314
EXPERIMENTAL EVIDENCE OF GENDER-BASED DIFFERENCE IN SIRS AND SEPSIS 316
CONCLUSION 320
References 321
SECTION 5 Gastroenterology 326
INTRODUCTION 327
References 327
CHAPTER 28 Inflammatory Bowel Disease in Women 328
INTRODUCTION 328
GYNECOLOGIC COMPLICATIONS 328
OSTEOPOROSIS 329
FERTILITY AND PREGNANCY 329
SELF-IMAGE 336
CONCLUSIONS 337
References 337
CHAPTER 29 Disorders of Defecation in Women 341
INTRODUCTION 341
PREVALENCE AND ETIOLOGY OF CONSTIPATION 341
EVALUATION OF CONSTIPATION 341
TREATMENT OF CONSTIPATION 343
PREVALENCE AND ETIOLOGY OF FECAL INCONTINENCE 344
EVALUATION OF FECAL INCONTINENCE 345
TREATMENT OF FECAL INCONTINENCE 346
References 347
CHAPTER 30 Idiopathic Gastroparesis: Gender Aspects 349
INTRODUCTION 349
NORMAL GASTRIC EMPTYING 349
GENDER ASPECTS OF GASTRIC MOTILITY 349
GASTROPARESIS 350
GASTRIC MOTILITY ABNORMALITIES IN GASTROPARESIS 350
TREATMENT 352
CONCLUSION 352
References 352
CHAPTER 31 Liver Disease in Women 354
INTRODUCTION 354
PREGNANCY AND LIVER DISEASES 354
ORAL CONTRACEPTIVES AND THE LIVER 359
AUTOIMMUNE LIVER DISEASES 360
LIVER TRANSPLANTATION AND SURGERY 362
ALCOHOLIC LIVER DISEASE (ALD) 363
References 363
SECTION 6 Reproductive Biology 368
INTRODUCTION 369
CHAPTER 32 Gender Differences in Irritable Bowel Syndrome 370
INTRODUCTION 370
EPIDEMIOLOGY 370
PATHOPHYSIOLOGY 371
RISK FACTORS AND CO-MORBIDITIES 373
OTHER ASSOCIATIONS 374
DIAGNOSIS 374
TREATMENT 374
CONCLUSION 375
References 376
CHAPTER 33 Contraception 380
INTRODUCTION 380
CONTRACEPTIVE COUNSELING 380
CONTRACEPTIVE METHODS 380
PATIENT EDUCATION 386
References 387
CHAPTER 34 Infertility: The Male 389
BASIC EVALUATION 389
ADVANCED EVALUATION 393
TREATMENT 398
CONCLUSION 399
ACKNOWLEDGMENT 400
References 400
CHAPTER 35 Infertility and In Vitro Fertilization 404
INFERTILITY 404
ETIOLOGIES AND EVALUATIONS OF INFERTILITY 404
TREATMENT FOR INFERTILITY 406
CONCLUSIONS 419
References 420
CHAPTER 36 Female Sexual Health 423
PREVALENCE 423
ANATOMY AND PHYSIOLOGY 423
CLINICAL PRACTICE 425
COMMON SEXUAL PROBLEMS 426
TREATMENT 427
CONCLUSION 429
References 429
CHAPTER 37 Male Sexual Dysfunction 431
PHYSIOLOGY 431
DEFINITION AND PATHOPHYSIOLOGY OF ERECTILE DYSFUNCTION 431
EPIDEMIOLOGY 432
RISK FACTORS 432
EVALUATION 432
SPECIAL TESTS 433
NON-SURGICAL THERAPY: PDE5I, URETHRAL SUPPOSITORIES, ICI, VED 433
SURGICAL THERAPY 434
References 434
CHAPTER 38 Pelvic Pain: Urogenital Female Disorders 437
SPECIFIC CAUSES OF VULVAR PAIN 437
TREATMENT 439
VULVAR DERMATOSES 440
CONCLUSION 442
References 442
CHAPTER 39 Lower Urogenital Tract Dysfunction in Men and Women 444
LOWER URINARY TRACT DYSFUNCTION: DEFINITIONS, SYMPTOMS, AND CLASSIFICATION 444
CONDITIONS CAUSING LOWER URINARY TRACT SYMPTOMS IN MEN, WOMEN, AND BOTH SEXES ACCORDING TO SYMPTOMS 446
ASSESSMENT OF LOWER URINARY TRACT DYSFUNCTION IN MEN AND WOMEN 448
THERAPY 450
CONCLUSIONS 453
References 453
CHAPTER 40 Aging and the Lower Urogenital System 455
INTRODUCTION 455
AGE-RELATED CHANGES IN THE LOWER URINARY TRACT 455
URINARY TRACT INFECTIONS 459
URINARY INCONTINENCE IN OLDER PERSONS 460
FUTURE DIRECTIONS 467
CONCLUSIONS 467
RESOURCES 468
References 468
CHAPTER 41 Menopause 472
INTRODUCTION 472
PHYSIOLOGY 473
EVALUATION OF WOMEN 474
ROLE OF HORMONE THERAPY 476
TREATMENT ALTERNATIVES TO HT 477
CONCLUSION 477
References 477
SECTION 7 Oncology 480
INTRODUCTION 481
CHAPTER 42 The Differences between Male and Female Breast Cancer 482
INTRODUCTION 482
ANATOMY AND DEVELOPMENT 482
EPIDEMIOLOGY 482
RISK FACTORS 483
CLINICAL FACTORS AND DIAGNOSIS 485
PATHOLOGIC FEATURES 487
PROGNOSTIC FACTORS 487
TREATMENT 488
PROGNOSIS AND SURVIVAL 491
CONCLUSION 492
References 492
CHAPTER 43 Difference in Germ Cell Tumors of the Reproductive Tract in Men and Women 496
INTRODUCTION 496
ORIGIN OF GERM CELLS 496
GENDER DIFFERENCES IN THE EPIDEMIOLOGY OF GERM CELL TUMORS 497
BIOLOGY AND RISK FACTORS FOR GERM CELL TUMORS: ARE THEY GENDER-SPECIFIC? 498
HISTOLOGY OF GERM CELL TUMORS 499
GENDER DIFFERENCES IN CLINICAL PRESENTATION OF GERM CELL TUMORS 499
DIAGNOSIS OF MALE AND FEMALE GERM CELL TUMORS 500
TREATMENT OF MALE AND FEMALE GERM CELL TUMORS 500
SUGGESTIONS FOR FURTHER INVESTIGATIONS 502
References 502
CHAPTER 44 Gender Differences in Hereditary Cancer Syndromes: Risks, Management, and Testing for Inherited Predisposition to Cancer 504
CANCER GENETICS: OVERVIEW 504
BREAST CANCER 505
ENDOMETRIAL AND GASTROINTESTINAL CANCER 508
TESTICULAR CANCER 510
MULTIPLE ENDOCRINE NEOPLASIA TYPE 2 (MEN2) 511
PROSTATE CANCER 511
CANCER RISK ASSESSMENT, COUNSELING, AND TESTING 512
CONCLUSION 514
References 514
SECTION 8 Infectious Disease 518
INTRODUCTION 519
CHAPTER 45 Gender Differences in Emerging Infectious Diseases 520
INTRODUCTION 520
EMERGING VIRAL INFECTIONS 521
EMERGING BACTERIAL INFECTIONS 528
EMERGING PRION INFECTION 533
References 535
CHAPTER 46 Sexually Transmitted Infections in Men and Women 539
INTRODUCTION 539
GENDER DIFFERENCES IN BEHAVIORAL SUSCEPTIBILITY 539
GENDER DIFFERENCES IN BIOLOGICAL SUSCEPTIBILITY 540
SEXUALLY TRANSMITTED BACTERIAL INFECTIONS 543
SEXUALLY TRANSMITTED VIRAL INFECTIONS OTHER THAN HIV 547
OTHER ORGANISMS AND SYNDROMES 549
References 550
CHAPTER 47 Infections in Pregnancy 554
INTRODUCTION AND SIGNIFICANCE 554
MECHANISMS OF INCREASED SUSCEPTIBILITY TO INFECTION IN PREGNANCY 554
INFECTIONS FOR WHICH PREGNANCY ALTERS MATERNAL SUSCEPTIBILITY OR COURSE 559
INFECTIONS IN WHICH FETAL TRANSMISSION OR OTHER FETAL MORBIDITY IS THE PRIMARY CONCERN 567
HIV 573
EMERGING INFECTIONS 577
POTENTIAL AGENTS OF BIOTERRORISM 579
ISSUES REGARDING ANTIBIOTIC MANAGEMENT IN PREGNANCY 579
VACCINATION 580
References 580
CHAPTER 48 Adult Immunization in Women and Men 586
INTRODUCTION 586
HUMAN PAPILLOMAVIRUS G 586
ZOSTER IMMUNIZATION 588
INFLUENZA VACCINE 589
HEPATITIS B VACCINE (HBV) 591
HEPATITIS A VACCINE 592
PNEUMOCOCCAL VACCINE 593
TETANUS/DIPTHERIA/PERTUSSIS 595
MENINGOCOCCAL VACCINE 596
IMMUNIZATION ISSUES FOR PREGNANT WOMEN 597
References 599
SECTION 9 Immunology 606
INTRODUCTION 607
CHAPTER 49 Gender Differences in Autoimmune Diseases: Immune Mechanisms and Clinical Applications 608
GENERAL REMARKS 608
SPECIFIC REMARKS IN AUTOIMMUNITY 608
SPECIFIC AUTOIMMUNE DISEASES WITH GENDER DIFFERENCES 611
FUTURE APPLICATIONS AND CONCLUDING REMARKS 612
ACKNOWLEDGEMENTS 612
References 612
CHAPTER 50 Hormones and Cytokines: Gender-Specific Effects 615
INVOLVEMENT OF SEX HORMONES AND CYTOKINES IN AUTOIMMUNE RHEUMATIC DISEASES 615
PERIPHERAL SEX HORMONE METABOLISM IN AUTOIMMUNE DISEASES 616
SEX HORMONES AND CYTOKINES 617
CONCLUSIONS 617
References 618
CHAPTER 51 Prolactin and Autoimmunity 620
PROLACTIN 620
PROLACTIN AND HUMAN AUTOIMMUNE DISEASE 622
PROLACTIN-LOWERING THERAPY FOR AUTOIMMUNE DISEASES 628
SUGGESTIONS FOR FURTHER INVESTIGATIONS 631
References 631
CHAPTER 52 Sex Hormones and Immune Function 638
INTRODUCTION 638
AN OVERVIEW OF SEX HORMONES AND THE IMMUNE SYSTEM 638
NORMAL ESTROGEN AND ANDROGEN METABOLISM 640
USE OF HORMONES TO ALTER DISEASE STATES 643
SEX HORMONES, BEHAVIOR, AND AUTOIMMUNE DISEASES 644
References 645
CHAPTER 53 Pregnancy and Autoimmune Rheumatic Disease 650
PREGNANCY AND THE RHEUMATIC DISEASES 650
IMMUNE FUNCTION IN THE CONNECTIVE TISSUE DISEASES AND PREGNANCY 650
A BRIEF OUTLINE OF THE IMMUNOLOGY OF IMPLANTATION, PREGNANCY, AND LABOR AND DELIVERY 651
MANAGEMENT OF REPRODUCTIVE ISSUES IN THE RHEUMATIC DISEASES 651
SYSTEMIC LUPUS ERYTHEMATOSUS 651
RHEUMATOID ARTHRITIS 655
SERONEGATIVE SPONDYLOARTHROPATHIES 657
SCLERODERMA (PROGRESSIVE SYSTEMIC SCLEROSIS) 658
PHARMACOLOGIC TREATMENT OF RHEUMATIC DISEASE AND REPRODUCTION 659
CONCLUSION 662
References 662
CHAPTER 54 Oral Contraceptives and Autoimmune Diseases 668
INTRODUCTION 668
ORAL CONTRACEPTIVES 668
RHEUMATOID ARTHRITIS 669
SYSTEMIC LUPUS ERYTHEMATOSUS 670
ANTIPHOSPHOLIPID SYNDROME 672
SJÖGREN'S SYNDROME 672
SCLERODERMA 673
VASCULITIS 674
SUMMARY AND CONCLUSIONS 675
References 676
CHAPTER 55 Gender-Specific Issues in Organ Transplantation 680
ORGAN FAILURE 680
ORGAN DONATION 683
TRANSPLANTATION 684
OUTCOME POST-TRANSPLANTATION 685
GENERAL CONSIDERATIONS 690
CONCLUSIONS 691
AREAS FOR FURTHER STUDY 692
References 692
SECTION 10 Endocrinology 700
INTRODUCTION 701
CHAPTER 56 Endogenous Sex Hormones and Risk of Type 2 Diabetes Mellitus in Men and Women 702
INTRODUCTION 702
GENDER DIFFERENCES IN THE ASSOCIATION BETWEEN ENDOGENOUS TESTOSTERONE AND RISK FACTORS FOR TYPE 2 DIABETES 702
PATHOPHYSIOLOGY OF ENDOGENOUS SEX HORMONES AS RISK FACTORS FOR TYPE 2 DIABETES 711
FUTURE DIRECTIONS AND CONCLUSIONS 714
References 714
CHAPTER 57 Thyroid Disorders and Pregnancy 717
INTRODUCTION 717
AUTOIMMUNE THYROIDITIS 717
References 728
CHAPTER 58 Sexual Function and Dysfunction in Men and Women 730
INTRODUCTION 730
MALE SEXUAL HEALTH 730
FEMALE SEXUAL HEALTH 733
CONCLUSIONS 737
References 737
CHAPTER 59 Osteoporosis in Men and Women 739
EPIDEMIOLOGY OF OSTEOPOROSIS 739
FINANCIAL BURDEN OF OSTEOPOROSIS 740
SKELETAL DEVELOPMENT 740
RISK FACTORS FOR OSTEOPOROSIS 742
DIAGNOSIS, SCREENING, AND RISK FACTOR ASSESSMENT 743
TREATMENT 746
CONCLUSION 753
References 754
CHAPTER 60 Testosterone Replacement Therapy in Men and Women 760
ANDROGEN PHYSIOLOGY 760
ANDROGEN PRODUCTION IN MEN 761
ETIOLOGY AND PREVALENCE OF HYPOGONADISM IN MEN 761
ANDROGEN PRODUCTION IN WOMEN 771
CONCLUSION 777
References 777
Index 784
A 784
B 785
C 785
D 786
E 787
F 787
G 788
H 788
I 789
J 790
K 790
L 790
M 791
N 791
O 791
P 792
R 794
S 794
T 795
U 796
V 796
W 797
Y 797
Z 797