Author Archives: dnaserver

Heart Health and Diabetes

Type 2 Diabetes Quick Facts

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What is type 2 diabetes?
Diabetes is a metabolic disorder that occurs when the pancreas is no longer able to make sufficient insulin, or when the body cannot make good use of the insulin it produces. This inhibits the control of blood glucose (sugar) levels and leads to raised blood glucose (hyperglycemia), which causes damage to various tissues and organs in the body.

Type 2 diabetes is by far the most common form of diabetes, accounting for 90–95% of all diabetics. Type 2 diabetics cannot use insulin efficiently and therefore cannot keep their blood sugar at normal levels. This form of diabetes develops over many years and is usually diagnosed in adulthood, although it is becoming a more frequent diagnosis in children and teens (1).

Other forms of diabetes are type 1 diabetes and gestational diabetes. Type 1 diabetes occurs due to an autoimmune reaction that targets the body’s own insulin-producing cells in the pancreas. It usually develops quickly and is often diagnosed during childhood or the teenage years. Gestational diabetes develops in pregnant women and is associated with health risks for the unborn baby, as well as an increased risk of developing type 2 diabetes later in life for both the mother and child (1).

What are the signs of type 2 diabetes?
The symptoms of type 2 diabetes can slowly develop over several years, while some type 2 diabetics may not notice any signs at all (2). If symptoms are present, they can include:

  • Increased frequency and need for urination
  • Often thirsty
  • Often hungry
  • Fatigue
  • Increased frequency of infections, e.g., yeast infections

What increases the risk of type 2 diabetes?
Type 2 diabetes is caused by your cells in the body not responding well to insulin. The pancreas increases insulin production to try to overcome this, but eventually, it cannot produce enough insulin, and blood sugar rises.

Several factors increase the risk of type 2 diabetes (3), including:

  • Obesity
  • Family history of type 2 diabetes
  • High blood pressure
  • Altered lipid levels (e.g., elevated LDL “bad” cholesterol)
  • Lack of physical activity
  • Smoking
  • Previously had gestational diabetes 

How is type 2 diabetes diagnosed?
Type 2 diabetes is diagnosed by measuring blood sugar (glucose) levels. The most effective method for this is with an HbA1c test, which is available here (4). HbA1c is glycated hemoglobin. It forms when hemoglobin within red blood cells joins with glucose. HbA1c levels reflect the average blood glucose level during the preceding 2-3 months. This differs from a blood glucose test, which measures the concentration of glucose at only the point at which the blood sample was collected.

  • Healthy HbA1c levels are less than 5.7%
  • 5.7% – 6.4% indicates prediabetes (increased risk of developing diabetes)
  • >6.5% supports a diabetes diagnosis

How can type 2 diabetes be prevented and treated?
Simple, proven lifestyle changes can help prevent or delay the onset of type 2 diabetes. These include losing excess body weight, eating healthier (especially reducing sugar and carbohydrate intake), and getting regular physical exercise. There are also different medication options available to help lower blood sugar levels. Read our previous article here for more tips to lower your blood sugar.

References:
1. What is Diabetes. CDC. June 2020.
2. Diabetes Symptoms. CDC. April 2021.
3. What causes diabetes? Find out and take control. American Diabetes Association.
4. Manage Blood Sugar, Diabetes. CDC. Reviewed April 2021.

Women's Health

What is polycystic ovary syndrome (PCOS)?

Posted on by dnaserver

Polycystic ovary syndrome (PCOS) is a complex condition that affects 6–12% of reproductive-age women in the United States (1). Affected women may have elevated androgen levels (hyperandrogenemia) and/or small cysts on one or both ovaries (polycystic ovaries) (2).

What are the symptoms associated with PCOS?
Androgens are male sex hormones, such as testosterone. Usually, women only have low androgen levels, but elevated androgen levels are a characteristic of PCOS (2). This hyperandrogenemia can cause numerous symptoms, including:

  • Problems with the menstrual cycle
  • Fertility issues
  • Excess body hair (e.g., on the chest, stomach, and back)
  • Weight gain, especially in the abdomen
  • Acne
  • Male-pattern baldness
  • Skin tags (excess skin on the neck or armpits)

What causes PCOS?
Both genetic and environmental factors are thought to contribute to PCOS. A family history of PCOS is relatively common, with current literature suggesting an autosomal dominant pattern of inheritance (2).

Being overweight and physically inactive can increase the risk of PCOS, but many women of normal weight have PCOS, and many overweight women don’t have PCOS (1).

Insulin resistance is a big factor linked to PCOS. Insulin-resistant people are able to make insulin but their body doesn’t respond to it very well. Usually, insulin helps to regulate ovarian function, and if there is excess insulin, the ovaries respond by producing more androgens (2). Often lifestyle choices, such as poor diet and lack of exercise, are contributing factors towards insulin resistance (1).

What serious health complications are associated with PCOS?
The insulin resistance that is a contributing risk factor for PCOS significantly increases the risk of developing type 2 diabetes. In fact, more than half of women with PCOS develop type 2 diabetes by 40 years of age, with a higher risk among those who are overweight. Gestational diabetes is another possible complication linked to PCOS, insulin resistance, and being overweight. Gestational diabetes is diabetes during pregnancy and can put the pregnancy and baby at risk, and also increase the likelihood of type 2 diabetes later in life for both the mother and child (1).

The risk of heart problems also increases for women with PCOS, again with a heightened risk for those that are also overweight. Elevated LDL (“bad”) cholesterol and low HDL (“good”) cholesterol can occur and increase the risk of heart disease. There is also an increased risk of blood clots and stroke when the elevated LDL cholesterol can cause plaques to clog the blood vessels (1).

Sleep apnea is another possible complication of PCOS. This disorder causes breathing to stop during sleep and is also linked to an increased risk of heart disease and type 2 diabetes. Depression and anxiety are also more common in women with PCOS (1).

How is PCOS diagnosed?
The symptoms of PCOS can vary from person to person, so diagnosis can be difficult and often delayed. Commonly women find out they have PCOS when they have difficulty getting pregnant, but often they have actually had PCOS for many years by this point. Generally, a doctor will check for at least two of these three symptoms for a PCOS diagnosis (1):

  • Irregular periods or a lack of periods
  • Elevated male hormones (e.g., testosterone) detected through blood tests such as this
  • Multiple cysts on the ovaries detected by ultrasound

Blood tests can also be used to detect elevated levels of luteinizing hormone (LH), which is common in PCOS (2). We offer a test here for LH. Commonly other blood tests are also conducted to provide a broad health overview, including measuring glucose and lipid levels.

How is PCOS treated?
The treatment options for PCOS vary depending on what symptoms and other health complications are also present. If type 2 diabetes (or prediabetes) is also diagnosed, losing excess weight and increasing physical activity can help prevent and manage diabetes and delay the onset of other health problems (1). Losing weight also helps to decrease androgen and LH levels (2).

Other medications are also available to help ovulation (and enable pregnancy), reduce acne, and control hair growth (1). For women who are not aiming to get pregnant, oral contraceptives can be effective for regulating menstrual cycles, as well as reducing excess body hair, acne, and androgen levels (2).

References:
1. PCOS (Polycystic Ovary Syndrome) and Diabetes. CDC. March 2020.
2. Ndefo UA et al. (2013) Polycystic Ovary Syndrome. Pharmacy and Therapeutics. 38(6): 348-355.

HPV

HPV Quick Facts

Posted on by dnaserver

What is HPV?
Human papillomavirus (HPV) is a common sexually transmitted DNA virus. It is transmitted through vaginal, anal, or oral sex, and can be spread even when an infected individual does not show any symptoms. Although most women effectively clear HPV infections within 6 to 12 months (1), there are specific HPV genotypes that increase the risk of cervical cancer (2).

How common is HPV?
HPV is the most common sexually transmitted disease in the United States. An estimated 43 million Americans were infected with HPV in 2018, with many infections among people in their late teens and early 20s. Almost every non-vaccinated sexually active individual will get HPV at some time in his or her life (3).

Are there different types of HPV?
There are more than 100 genotypes of HPV, of which 14 are considered high-risk for cervical disease – genotypes 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68. Women who have persistent infection with one of these pathogenic genotypes have an increased risk for cervical carcinoma or severe dysplasia (4).

What are the symptoms of an HPV infection?
Usually, HPV does not cause any symptoms and is effectively cleared without any medical interventions. However, in some cases, warts can occur on the cervix, vagina, anus, or back of the throat. These warts may lead to itching or burning sensations and unusual discharges.

Other types of HPV can cause cell changes that lead to cervical cancer and other cancers of the vulva, vagina, penis, anus, or throat. Generally, the types of HPV that cause warts differ from those that cause cancer (3).

Who is at risk of HPV? How can I lower my risk?
Anybody who is sexually active is at risk of catching HPV, as HPV is a very common sexually transmitted infection.

Using condoms correctly lowers the risk of catching HPV, but HPV can still infect areas that are not covered by a condom, so condoms do not provide full protection.

HPV vaccination is safe and effective to prevent diseases (including cancer) caused by HPV. It is recommended at age 11 or 12 years, and for everyone through to 26 years, if not vaccinated already. Vaccination for individuals older than 26 years provides less benefit, as most sexually active adults have already been exposed to HPV (3).

Routine screening for cervical cancer with pap smears is also recommended for women aged 21–65 years (3). 

How is HPV diagnosed?
Most HPV infections are asymptomatic and clear up without medical intervention within 6 to 12 months. Hence, most infected individuals are unaware of their diagnosis. There are no tests to find out a person’s “HPV status”, as there are so many different types of HPV (3). However, nucleic acid tests (such as this one) are available to accurately identify individuals who are infected with one of the 14 high-risk HPV strains. Detection of HPV nucleic acid (a positive test result) is indicative of an active HPV infection but does not mean that cervical dysplasia or cervical cancer is present.

Follow-up testing is recommended for any positive results, with protocols varying based on the results of recent pap smears. Another HPV test and/or pap smear in a shorter time period from routine testing may be all that is required. Alternatively, a colposcopy to further examine the cervix, vagina, or vulva can be used to detect abnormal cells or blood vessels. Other options include tissue biopsies, removal of abnormal cervical cells, and referral to a gynecologist (5).

How is HPV treated?
There is no treatment for HPV itself; however, there are treatments for the health problems associated with HPV. Genital warts can be treated with prescription medication, and cervical precancer can be effectively treated. Any cancers that are associated with HPV are more treatable when diagnosed and treated early; hence the importance of routine screening (5).

References:
1. Cuschieri KS, Whitley MJ, & Cubie HA. (2004). Human papillomavirus type-specific DNA and RNA persistence–implications for cervical disease progression and monitoring. J Med Virol, 73 (1), 65-70.
2. Cervical Cancer. WHO.
3. Genital HPV Infection – Fact Sheet. (2021, January). CDC.
4. Kjaer SK, et al. (2002). Type-specific persistence of high-risk human papillomavirus (HPV) as an indicator of high grade cervical squamous intraepithelial lesions in young women: population-based prospective follow-up study. BMJ, 325 (7364), 572-579.
5. Human Papillomavirus (HPV) Treatment and Care. (July 2021). CDC.

Posted in HPV
Kidney, Liver, and Thyroid Health

What are the signs of liver disease?

Posted on by dnaserver

The liver is a very hard-working organ with multiple roles, including helping with the digestion of food to convert the food to energy and filtering toxic substances out of the blood. So, when the liver isn’t functioning as well as it should, there can be a multitude of different symptoms.

Liver disease can be caused by various different things, such as hepatitis, autoimmune conditions, genetics, excess alcohol, obesity, and toxic chemicals or drugs (1). Hence, the symptoms of liver disease can vary, but there are also general symptoms that usually occur in all different types of liver disease. In this article, we will discuss those general symptoms.

Jaundice
In jaundice, the skin and whites of the eyes take on a yellow tinge. This is due to having too much bilirubin in the blood. Bilirubin is a yellow pigment that forms as part of the normal process of red blood cell recycling. Usually, bilirubin travels to the liver, where it binds to bile and is moved through the bile ducts into the digestive tract. It is then eliminated from the body predominantly in the stool but also in the urine. However, when the liver is not functioning properly, bilirubin accumulates in the blood and is deposited in the skin (2).

Dark urine
Dark urine can also be caused by too much bilirubin in the blood due to reduced liver function (2). However, it is important to note that the most common cause of dark urine is dehydration. Other abnormal urine causes include kidney injury, which can lead to bloody, or reddish-colored, urine. It is very important to see a doctor if you notice any bloody urine. 

Abnormal stools
Pale stools can occur if the bilirubin that is usually excreted in the stools is instead excreted in the urine (causing the dark urine mentioned above). This may be due to a blockage in the usual pathways or another problem preventing bilirubin from being eliminated in the stool (2).

Stools can also be bloody, and appear as bright red or black and tar-like stools. Bloody stools are usually caused by bleeding from varicose veins in the esophagus or stomach. These varicose veins can form from new veins that are created to bypass the liver and are very fragile and bleed easily (3).

Swelling in the abdomen
Liver disease can cause high blood pressure in the veins that bring blood to the liver. This can lead to an accumulation of protein-containing fluid in the abdomen, known as ascites. This ascitic fluid leaks from the surface of the liver and intestine, and also due to the leakage of albumin from blood vessels into the abdomen (4).

There may be no symptoms with only a small amount of fluid accumulation. However, increasing amounts can lead to weight gain, increased waist size, and discomfort. The pressure on the stomach can cause a loss of appetite, while pressure on the lungs can result in shortness of breath. Sometimes the excess fluid can also accumulate in the ankles, causing swollen ankles and lower legs. If a spontaneous bacterial infection occurs in the ascites, it can be fatal if left untreated (4).

Other disorders can also cause ascites, including cancer, kidney failure, heart failure, pancreatitis, and tuberculosis, but liver disease is the most common cause (4).

Nausea, loss of appetite, and fatigue
Most people with liver disease will eventually suffer from general symptoms, including nausea, loss of appetite, and fatigue (3). Various underlying causes can lead to these symptoms, such as fluid accumulation in the abdomen putting pressure on the stomach.

Itchiness
Severe itchiness is another symptom that affects some people with liver disease. It is more common in liver disease caused by autoimmune disorders and biliary obstructive diseases, which may occur due to stones or cancer. Drug-induced liver disease and liver damage due to viral hepatitis can also lead to itchy skin. However, it is rare in alcohol-induced liver disease and fatty liver disease (5).

There are various possible causes of itchy skin in relation to liver disease, including higher levels of bile salts and/or alkaline phosphatase, raised histamine levels, and varying levels of female sex hormones (6). Of course, itchy skin can also occur due to other health issues, such as psoriasis, eczema, allergic reactions, other internal diseases, and nerve disorders.

Easily bruised and abnormal bleeding
The liver is important for producing blood clotting factors; hence, when the liver is not functioning normally, there is a decreased ability to help injured blood vessels stop bleeding. This can result in more bruising than normal, prolonged bleeding after just minor cuts, and unexplained nose bleeds (7).

Liver disease is one of the most common causes of easy bleeding. Other causes can include severe platelet deficiency, anticoagulants to inhibit clotting (e.g. warfarin), and hemophilia (7).

Conclusions:
Other symptoms of liver disease are also possible and depend on the underlying cause of the liver disease. It is also important to note that many of the symptoms described in this article are not just specific to liver disease. An accurate diagnosis of liver disease requires a thorough doctor’s evaluation and blood tests to detect abnormal levels of specific blood components.

We offer a comprehensive Liver Health Panel to measure a broad range of proteins and enzymes in the blood, as well as individual tests for each of the tested components. These tests just require a simple finger-prick blood sample, which can easily be collected at home. However, we do recommend that you discuss your results with a healthcare provider.

References:
1. The Progression of Liver Disease. American Liver Foundation.
2. Tholey D. (2021) Jaundice in Adults. Merck Manual Consumer Version.
3. Tholey D. (2021) Liver Failure. Merck Manual Consumer Version.
4. Tholey D. (2021) Ascites. Merck Manual Consumer Version.
5. Hegade VS (2015). Itch and liver: management in primary care. Br J Gen Pract. 65(635): e418-e420.
6. Pietrangelo A (reviewed by Sethi S) (2019). What causes itching in liver disease and how to treat it. Healthline.
7. Moake JL (2020). Bruising and Bleeding. Merck Manual Consumer Version.

Women's Health

Estrogen and progesterone: Why are they so important?

Posted on by dnaserver

Estrogen and progesterone are the primary female sex hormones. They are essential for female reproductive health and pregnancy, but they also have a number of other roles in the body too. In this article, we will go over the major roles of these two hormones in females.

Fertility
The primary function of estradiol (the strongest estrogen hormone) in females is to mature and maintain the reproductive system, including the mammary glands, uterus, and vagina. During each menstrual cycle, estradiol levels increase to trigger the maturation and release of the egg. Increasing levels of progesterone are required to cause the thickening of the uterus lining to allow a fertilized egg to implant (if conception occurs) (1).

Pregnancy
In females of reproductive age, estradiol levels rise and fall twice during each menstrual cycle. At the beginning of the follicular phase of the cycle (when menstruation occurs), estradiol levels are low, with levels gradually increasing, until a rapid increase just before ovulation occurs (when an egg is released), followed by a rapid decrease. During the luteal phase, estradiol levels gradually increase again, along with an increase in progesterone to prepare the uterus and to stimulate the secretion of nutrients to provide the perfect environment for the implantation of a fertilized egg. Progesterone also inhibits muscular contractions of the uterus that would prevent a fertilized egg from implanting (2).

During pregnancy, estradiol levels keep increasing, until they reach levels as high as 40,000 pg/mL during the third trimester (3). After a fertilized egg becomes implanted, the placenta forms and takes over the production of progesterone at around 6-12 weeks. The placenta continues to produce progesterone for the remainder of the pregnancy, with progesterone levels steadily rising throughout pregnancy (4).

Throughout the pregnancy, progesterone is important for the development of the fetus, as well as stimulating the growth of maternal breast tissue in preparation for breastfeeding and strengthening the pelvic wall muscles in preparation for labor (4).

Libido
Studies have shown that both estrogen and progesterone levels influence sexual desire. Higher levels of estrogen are linked to increased libido (but with a two-day lag). In contrast, higher levels of progesterone have a negative effect on libido. This influence on sexual desire, particularly for higher estrogen levels, is thought to be linked to the time of the menstrual cycle when a woman is the most fertile (5).

Puberty
Increasing estrogen and progesterone levels in young girls stimulate the development of female secondary sexual characteristics, (such as breasts, female fat distribution, and pubic hair), as well as triggering the menstrual cycles to begin (6). 

Bone health
Estrogen and progesterone work in sync for optimum bone health. Estrogen controls the rate of bone resorption, while progesterone is important for bone formation (7). In healthy bone, resorption (breakdown) and formation are kept in balance. However, if estrogen and progesterone levels are low, bone resorption exceeds bone formation, resulting in a weakening of the bone and an increased likelihood of osteoporosis.

After menopause, both estrogen and progesterone are at much lower levels than in pre-menopausal women. This contributes to increased bone loss during postmenopause, with an average bone mineral density loss of 1–2% each year after menopause (8), while some women can lose up to 20% of their bone density in just the 5–7 years following menopause (9).

Skin and hair health
Estrogen plays a prominent role in overall skin health. It is associated with increased collagen production, so is beneficial for maintaining skin thickness, as well as reducing the appearance of wrinkles. Estrogen also helps maintain skin moisture and topical estrogen has even been found to improve wound healing (10). Progesterone is also important for skin health, with evidence showing how topical progesterone can increase skin elasticity and decrease wrinkling (11).

Estrogen and progesterone are also required for optimum hair growth and health, which is evident with slower hair growth and thinner hair in postmenopausal women with lower levels of these two important hormones. The sharp decline in estrogen and progesterone that occurs at menopause is also linked to increased or imbalanced androgen levels (e.g., testosterone). Androgens tend to shrink hair follicles on the head, resulting in hair loss and thinner hair, but can also cause more hair to grow on the face. This is why some women at perimenopause and postmenopause have increased hair on the chin and upper lip (12).

Cardiovascular system
Estrogen has many protective effects on the cardiovascular system, including increasing nitric oxide activity (in coordination with progesterone) to improve blood flow (13) and lower blood pressure (14), soaking up free radicals that can damage arteries and other tissues, and helping regulate blood clotting (15). Estrogen is also important to keep cholesterol levels under control (16), which helps explain why females generally have lower cholesterol levels than males until postmenopause when estrogen levels are very low in females.

How can I measure my estrogen and progesterone levels?
Estradiol is the strongest of the three estrogen hormones and we offer several different tests to measure your estradiol levels. We also have tests available to measure your progesterone levels. These tests just require a small blood sample collected from a simple finger-prick in the privacy of your own home. Test results are available through our online portal, thereby avoiding the need to make any doctor or lab appointments. Of course, you may also wish to discuss your results with your healthcare professional, and this is highly recommended if you receive any results that fall outside the normal range.

The Estradiol (E2) and Progesterone (P4) tests measure just your estradiol levels and progesterone levels, respectively. For females of reproductive age, it is helpful to know what stage of your menstrual cycle your sample was collected at, as normal levels vary throughout each cycle.

There are various combination tests available for females that include estradiol and/or progesterone along with other important hormones:

References:
1. Oestradiol. You and your Hormones, an education resource from the Society for Endocrinology. Reviewed Mar 2018.
2. Progesterone. Encyclopedia Britannica. (Edited August 2020)
3. Speroff L, Glass RH, and Kase NG. (1994). The Endocrinology of Pregnancy. In: Mitchell C, editor. Clinical Gynecologic Endocrinology and Infertility, 5th ed. Baltimore: Williams and Wilkins. 251-289.
4. You and Your Hormones. An education resource from the Society of Endocrinology. (Reviewed July 2021)
5. University of California – Santa Barbara. “Hormone levels and sexual motivation among young women.” ScienceDaily. 25 April 2013.
6. Estrogen’s Effects on the Female Body. John Hopkins Medicine.
7. Seifert-Klauss V & Prior JC. (2010) Progesterone and Bone: Actions Promoting Bone Health in Women. J Osteoporos. 2010: 845180.
8. Ahlborg HG, et al. (2003) Bone Loss and Bone Size after Menopause. N Engl J Med. 349: 327-334.
9. What Women Need to Know. Bone Health & Osteoporosis Foundation.
10. Shah MG, Maibach HI. (2001) Estrogen and skin. An overview. Am J Clin Dermatol. 2(3): 143-50.
11. Holzer G, et al. (2005) Effects and side-effects of 2% progesterone cream on the skin of peri- and postmenopausal women: results from a double-blind, vehicle-controlled, randomized study. Br J Dermatol. 153: 626–34.
12. Cappelloni L (reviewed by Sullivan D). (2019) Menopause Hair Loss Prevention. Healthline.
13. Prior JC. (2011). Progesterone for Symptomatic Perimenopause Treatment – Progesterone politics, physiology and potential for perimenopause. Facts Views Vis Obgyn, 3 (2), 109-120.
14. Thomas P & Pang Y. (2013). Protective actions of progesterone in the cardiovascular system: potential role of membrane progesterone receptors (mPRs) in mediating rapid effects. Steroids. 78(6): 583-588.
15. Mendelsohn ME (2002). Protective effects of estrogen on the cardiovascular system. Am J Cardiol. 89(12, S1): 12-17.
16. What is Estrogen? Hormone Health Network. Updated August 2018.

HIV

HIV and AIDS: Debunking the myths

Posted on by dnaserver

At the end of 2020, there were an estimated 37.7 million people living with HIV around the world, with over two-thirds of the cases occurring in the WHO African Region (1). In the United States, 36,801 new cases of HIV were diagnosed in 2019, with an estimated 1,189,700 people predicted to have HIV at the end of 2019. Yet, about 13% of HIV-positive people in the U.S. are unaware of their HIV status (2).

Major medical advances have drastically improved life for people with HIV, but there is still a lot of misinformation about HIV and AIDS. In this article, we debunk 10 common myths about HIV and provide you with the facts instead.

#1 Touching someone with HIV puts me at risk of catching HIV
This is one of the biggest misconceptions about HIV. HIV can only be passed from one person to another via specific bodily fluids:

  • Blood
  • Semen (including pre-cum)
  • Vaginal fluid
  • Rectal fluid
  • Breastmilk

And it is necessary for the infected bodily fluid to enter the blood of another person for transmission to occur. This can be through:

  • Unprotected sex (both rectal and vaginal, but only very rarely through oral sex)
  • From mother to child during pregnancy, childbirth, or breastfeeding
  • Sharing needles, syringes, or other drug-injection equipment

This means that it is usually not possible to catch HIV from kissing and hugging, sharing food, insect bites, toilet seats and bathing, sneezes and coughs, or sweat.

Nowadays with thorough testing of donated organs and tissues, it is also very unlikely that HIV will be transmitted from blood transfusions, blood products, or organ and tissue transplants.

#2 Washing after sex will prevent me from catching HIV
No, washing immediately after sex will not prevent the transmission of HIV if bodily fluids have already been exchanged. Other common myths about HIV prevention include a belief that pulling out prior to ejaculation or being on the contraceptive pill will prevent HIV transmission. Pre-ejaculate (pre-cum) can also contain the HIV virus so transmission can still occur. The contraceptive pill in no way protects against HIV (or any other STD for that matter!). It is for preventing pregnancy, but not for preventing infectious disease transmission.

The only ways to really protect yourself from catching HIV through sex are by using condoms or taking pre-exposure prophylaxis (PrEP). PrEP is a prescription medication that is very effective at preventing HIV when taken exactly as prescribed. It is also important to get tested and treated for other STDs, as if you have another STD it can increase your chance of catching HIV.

#3 HIV has very distinct symptoms
Some people believe that it is easy to spot those with HIV as they have distinct disease symptoms. Or they think that they will know if they have caught HIV by experiencing the symptoms themselves.

However, the early symptoms of HIV are actually not at all easy to spot. Some people may not even show any symptoms at all in the early stages. While others just display general symptoms typical of many other types of infections, e.g., fever, fatigue, general malaise.

The only way to accurately determine if you have caught HIV is to get tested. Saliva testing is an option but testing of blood is more accurate and detects an HIV infection at a much earlier time point post-exposure. We offer a 4th generation HIV test that detects both HIV antigen and HIV antibodies from just a simple finger-prick blood sample.

#4 I will definitely catch HIV if I have sex with someone with HIV
This is another false belief. Correct condom use and PrEP prevent HIV transmission. In addition, antiretroviral (ART) medication is very effective at controlling the viral replication of HIV. Although ART does not cure HIV, it can ensure that the amount of virus in the blood (viral load) is very low. HIV viral suppression is defined as less than 200 copies of HIV per milliliter of blood and ensures that HIV transmission through sex does not occur (2).

#5 HIV always leads to AIDS and death
In the past, this statement was true, as untreated HIV typically develops into AIDS after about 10 years. AIDS patients often display the symptoms that many people associate with HIV, including rapid weight loss and skin discoloration, and are very susceptible to other health complications, including pneumonia, tuberculosis, and certain cancers. And it is these opportunistic infections and cancers that lead to the death of most untreated AIDS patients within three years.

Nowadays, effective ART medication can reduce the replication of HIV in the blood to an undetectable level, meaning that HIV patients can live relatively normal lives and their HIV never develops into AIDS.

#6 Only men who have sex with men can catch HIV
False. Although men who have sex with men account for the most cases of HIV in the U.S. (65% in 2019), HIV can also be transmitted through heterosexual contact (23% of cases in 2019) (2).

During anal sex, the risk of catching HIV is much higher in the receptive partner, but transmission to the insertive partner is still possible. During vaginal sex, either partner can get HIV.

Oral sex is also a potential transmission pathway but the risk is a lot lower than anal or vaginal sex. Generally other factors must also be present for transmissions to occur, such as mouth ulcers, bleeding gums, and the presence of another STD (2).

#7 If myself and my partner are both HIV-positive, there is no need to use protection
This statement only holds true if both partners are on ART and maintaining viral suppression and have an undetectable viral load, which prevents HIV transmission. If both partners do not have viral suppression, it is very important to use condoms during every sexual encounter. This is because there are different strains of HIV. If you each are infected with a different strain, it is possible that you (or your partner) could become infected with two different strains. This is known as HIV superinfection and may cause problems with treatment and cause some people to get a lot sicker a lot faster, particularly if the new strain is resistant to the ART medicine that was controlling the original HIV strain (2).

#8 HIV can be cured
Unfortunately, there is still no cure for HIV. Although ART significantly reduces the amount of HIV in the blood and can achieve viral suppression in most people, it does not eliminate the virus completely. ART medications must be taken as prescribed for life otherwise the viral load will increase and can eventually lead to AIDS.

Some people choose to take alternative medicines (e.g., herbal medicines) with the misconception that they will provide a cure for HIV. However, herbal remedies do not work, and can even interfere with the effectiveness of ART medicines if taken concurrently.

#9 An HIV diagnosis means that I can never safely have a child
Thankfully an HIV diagnosis is not the death sentence it used to be, nor does it prevent most people from making a family.

If an HIV-positive mother-to-be maintains viral suppression throughout her entire pregnancy (including labor and delivery), as well as giving HIV medications to the baby for the first 4-6 weeks, it can reduce the risk of HIV transmission to less than 1% (2).

In addition, an HIV-positive man can still safely father a child, by ensuring that the HIV is not transmitted to his female partner. This is through keeping an undetectable viral load with ART medication. The female partner may also opt to take PrEP to further reduce the risk of catching HIV during sex.

#10 A negative HIV test result means that I definitely don’t have HIV
Unfortunately, this is not always the case. Even with advanced laboratory testing techniques, there is still a “window period” post-exposure where an HIV-positive person will still test negative on an HIV test. This is because a certain level of the virus is required in the blood before it is detectable by HIV tests.

The 4th generation HIV test that we offer can usually detect the p24 antigen from HIV within 18–45 days weeks post-exposure. However, in some cases, an HIV infection may not be detected from a finger-prick blood sample until 90 days post-exposure. Therefore, a false-negative test result may occur within the first three months. Retesting after three months is recommended.

If a potential exposure is suspected, post-exposure prophylaxis (PEP) is available as an emergency medication to reduce the risk of infection. This must be started within 72 hours of exposure to be effective.

Conclusions:
Although there are still many common misconceptions about HIV, the good news is that it is now a very treatable disease, and most infected people can live long, productive lives using adequate antiretroviral medication.

References:
1. HIV/AIDS Fact Sheet. WHO Reviewed July 2021.
2. HIV Basics. CDC Reviewed 2021.

Posted in HIV
Men's Health

Is there such a thing as ‘male menopause’?

Posted on by dnaserver

Maybe you’ve heard the term ‘male menopause’ and wondered what it is. Isn’t menopause what women go through and not men?

The answer is yes and no. Menopause literally means “the end of monthly cycles” and is retroactively defined as the final menstrual period followed by 12 months of no menstruation. Menopause in females is usually a natural change, yet may be accompanied by some very unnatural feelings! Think hot flashes, night sweats, and rapid heart rate.

So, what is male menopause?
Male menopause is a commonly used term, but isn’t the most accurate, as it actually refers to a gradual decline in androgen (particularly testosterone) levels, rather than a sudden drop in sex hormones and the end of a monthly cycle like in women. Although that is not to say that men don’t have hormonal cycles. In fact, testosterone levels in men tend to cycle throughout the day (highest in the morning and lowest in the evening), month, and maybe even with the seasons (1).

More accurate terms for the age-related decline of testosterone in males include testosterone deficiency syndrome, androgen deficiency of the aging male, and late-onset hypogonadism (2).

Testosterone declines in all males with age
Male testosterone levels decline as much as 0.4–2% a year from the age of 30 years onwards (3). This gradual decline is mainly due to a reduction in Leydig cell mass in the testicles and/or dysfunction in the normal hormonal control of testosterone production (4). Most men still have testosterone levels within the normal range even as they get older, but there is an estimated 10–25% who have levels that are considered low.

What are the symptoms of low testosterone?
The signs and symptoms of low testosterone are changes that can also occur for a variety of other reasons; hence low testosterone often goes unnoticed. The symptoms can include:

  • Reduced libido
  • Erectile dysfunction
  • Breast discomfort or swelling
  • Infertility
  • Height loss
  • Reduced bone mineral density and muscle mass
  • Increased body fat
  • Hot flushes or sweats
  • Mood changes and/or depression
  • Fatigue
  • Poor concentration

What can affect testosterone levels in males?
Aside from age, there are various other things that can influence testosterone levels. Obesity is linked to lower testosterone levels, as well as lower physical activity. Other contributing factors may include exposure to environmental toxins and increased temperatures in homes and offices. Each of these factors is thought to also contribute to the gradual overall decline in male testosterone levels, with some reports showing that average levels (across all ages) are declining at a rate of about 1% per year (5).

Can low testosterone be treated?
Treatment recommendations vary for males who have low testosterone that is associated with increasing age. The American College of Physicians recommends testosterone therapy in men with sexual dysfunction, while the Endocrine Society recommends testosterone therapy for men who are showing typical signs and symptoms of low testosterone. However, other experts recommend offering testosterone therapy to men with low testosterone levels even if they are not showing any symptoms.

There are possible risks associated with testosterone therapy including stimulated growth of prostate and breast cancer, and increased risk of heart attack, stroke, or blood clots. Therefore it is important for every individual to consider the pros and cons of testosterone therapy.

Should you get your testosterone levels checked?
Usually, testosterone testing is only recommended for older men who are showing possible signs of symptoms. If low levels are indicated, it is often recommended to repeat the test to confirm the results. Follow-up testing may also be required to determine the cause, such as testing of the pituitary gland.

We offer several different tests that include testosterone:

Each of these tests can be ordered online with at-home sample collection and results available online immediately after testing is complete. No need to make a doctor’s appointment for sample collection. However, if any abnormal results are detected in these tests, we do recommend consulting with your health care professional to discuss additional testing and/or treatment options.

References:
1. Law BM. (2011) Hormones and desire. American Psychological Association. 42(3), 44.
2. Male Menopause. (March 2015) Hormone Health Network.
3. McBride JA, Carson CC, Coward RM. (2016) Testosterone deficiency in the aging male. Therapeutic Advances in Urology. 47-60.
4. Gould DC. (2000) The male menopause: does it exist? West J Med. 173(2): 76-78.
5. Howe N. (2017) You’re not the man your father was. Forbes

Kidney, Liver, and Thyroid Health, Women's Health

Why is hypothyroidism more common in women?

Posted on by dnaserver

Thyroid problems can affect men, women, children, and even infants. However, by far the most commonly affected group is middle-aged and older women, with one in eight women likely to develop a thyroid disorder during her lifetime. This rate is five to eight times higher than the rate in men (1). So, the question is, why are rates so much higher in women?

First, let’s quickly go over the functions of the thyroid
The thyroid gland is a small organ located just under the skin in the neck. This bow tie-shaped organ is usually only about 5 cm across and normally can’t be felt or seen. The thyroid releases specific hormones (chemical messengers) that act on almost every tissue in the body (2). These thyroid hormones help regulate so many vital body functions, including:

  • Heart rate
  • Skin maintenance
  • Heat production
  • Fertility
  • Growth
  • Digestion
  • Rate at which calories are burned

What happens when the thyroid isn’t functioning properly?
Thyroid hormones influence so many different parts of the body, so when they are out of balance, lots of different symptoms can occur.

Hypothyroidism is an underactive thyroid, so it does not release enough thyroid hormones. This causes many of the body’s functions to slow down, causing symptoms like fatigue, slow heart rate, constipation, weight gain, and constantly feeling cold (3).

Hyperthyroidism is an overactive thyroid, so too many thyroid hormones are released into the bloodstream. This speeds up many of the body’s functions, causing symptoms like weight loss (even though appetite is increased), rapid or irregular heart rate, frequent bowel movements, sweating, and shaky hands (4).

To learn more about things that can affect your thyroid health, read our previous article here.

So, why are thyroid problems more common in women?
The risk of thyroid problems, in particular hypothyroidism, increases as a woman ages, as well as during pregnancy and the postpartum period (5). This is thought to be linked to the female hormone fluctuations that occur during each menstrual cycle, during pregnancy and the postpartum period, and especially the major hormonal changes that occur around menopause (6). Read our previous article here to learn more about the changes that occur at menopause.

Another reason for the increased risk of thyroid problems in women is because thyroid problems are often triggered by autoimmune responses, and these autoimmune responses are more common in women than in men (6).

What health problems in women are linked to thyroid disorders?
Thyroid problems in women are not only more common than in men, but they also can cause multiple additional symptoms. These symptoms can include:

  • Delaying or speeding up of puberty
  • Affecting period regularity and flow
  • Fertility issues
  • Premenstrual syndrome (PMS)
  • Increasing risk of ovarian cysts
  • Complications during pregnancy, including severe morning sickness, premature labour, or miscarriage
  • Earlier menopause

How can I get my thyroid function checked?
Checking the function of your thyroid is simple with a range of tests offered by us. Take our simple Thyroid Stimulating Hormone (TSH) Test for TSH alone, our Thyroid Health Panel to also include T4 and T3 along with TSH, or opt for the Thyroid Health, Complete Panel to also include Anti-Tg and Anti-TPO.

References:
1. General Information/Press Room. American Thyroid Association.
2. Hershnan JM. (Modified Oct 2020). Overview of the Thyroid Gland. Merck Manual Consumer Version
3. Hypothyroidism (Underactive Thyroid). National Institute of Diabetes and Digestive Kidney Diseases. NIH. Reviewed March 2021.
4. Hyperthyroidism (Overactive Thyroid). National Institute of Diabetes and Digestive Kidney Diseases. NIH. Reviewed August 2021.
5. Dunn D & Turner C (2016). Hypothyroidism in Women. Nursing for Women’s Health. 20(1): 93-98.
6. Why Women Are More Prone to Thyroid Problems? The Harley Street Ear Nose & Throat Clinic. (March 2018).

Women's Health

The importance of luteinizing hormone (LH)

Posted on by dnaserver

What is luteinizing hormone?
Luteinizing hormone (LH) is a crucial hormone in both males and females. In females, it regulates the function of the ovaries, while in males, LH regulates the function of the testes (1).

Why is luteinizing hormone so important in females?
In the first half of each menstrual cycle, LH stimulates the ovarian follicles of the ovary to produce estradiol. At mid-cycle (around day 14), there is a sharp increase in LH levels (known as the “LH surge”), which causes ovulation–the rupture of the ovarian follicle and release of an egg from the ovary. LH then stimulates the corpus luteum (formed from the ruptured ovarian follicle) to produce progesterone. Progesterone is needed to support a pregnancy if fertilization of the egg has occurred (1).

Why is luteinizing hormone so important in males?
LH is essential for testosterone production by the stimulation of the Leydig cells in the testes. This testosterone is needed for sperm production, as well as other effects all around the body, including increased muscle mass, growth of facial and body hair, and generation of a deeper voice (1).

What issues are related to elevated luteinizing hormone levels?
Both too much or too little LH can affect fertility. High levels of LH are associated with polycystic ovary syndrome (PCOS) in women, which is estimated to affect 6–12% of U.S. women of reproductive age (2). PCOS is characterized by an imbalance in LH and follicle-stimulating hormone (FSH) levels, which leads to higher-than-normal levels of testosterone causing irregular periods and ovulation issues (1). Elevated LH levels have also been linked to an increased risk of miscarriage (3).

High LH levels can also be caused by decreased sex steroid production (estrogen from the ovaries), which can occur in premature ovarian failure, where the ovaries stop working earlier than the normal menopause age of 40–58 years (1).

There are also genetic conditions that cause high LH levels, including Klinefelter’s syndrome in males and Turner syndrome in females. Generally, people affected by these conditions are infertile (1).

What issues are related to low luteinizing hormone levels?
Healthy LH levels are required for normal testicular and ovarian function, so if there is not enough LH, infertility can occur.

Kallmann’s syndrome is an example of a male condition associated with low LH levels. This occurs due to lower levels of gonadotrophin-releasing hormone and therefore reduced stimulation of the pituitary gland to synthesize and release LH (1).

Low LH levels in females can result in irregular periods and an absence of ovulation, therefore meaning that egg fertilization is impossible (1). Various conditions can contribute to low LH levels, including eating disorders, hyperprolactinemia, and hypopituitarism (4).

How can I check my LH levels?
We offer a Luteinizing Hormone test to measure your LH levels from a small blood sample self-collected from a finger prick. LH is also included in several of our larger Women’s Health panels: Women’s Fertility Panel, Women’s Hormone Panel, Women’s Health Hormone Panel, and Women’s Perimenopause Panel.

Please note that due to fluctuating LH levels in women of reproductive age, the blood sample should be collected on the third day of your menstrual cycle for optimal results.

References:
1. Luteinising hormone. You and your hormones, an education resource from the Society for Endocrinology. Reviewed Feb 2018.
2. PCOS (Polycystic Ovary Syndrome). CDC. Reviewed March 2020.
3. Homburg R, et al. (1988). Influence of serum luteinising hormone concentrations on ovulation, conception, and early pregnancy loss in polycystic ovary syndrome. BMJ. 297 (6655), 1024-1026.
Ross GT. (1985). Disorders of the ovary and female reproductive tract. In: Wilson JD, Foster DW, editors. Williams Textbook of Endocrinology, 7th ed. Philadelphia: WB Saunders Co. 206-258.

Women's Health

Perimenopause and postmenopause: what are they?

Posted on by dnaserver

Menopause is that time in a woman’s life when menstruation ceases and various hormonal changes occur. It signals the end of the reproductive part of a woman’s life. This normal, natural life event usually occurs between ages 40 and 58, with an average age of 51.

Menopause is defined as the final menstrual period and is confirmed after 12 consecutive months of no menstruation. However, the whole transition period, sometimes known as “the change”, can actually last for several years. This period is more technically called perimenopause, which translates to “around menopause”.

Perimenopause can last for 4 to 8 years, so that means that most women enter this life stage in their 40s. However, some women start to notice changes as early as their mid-30s. Perimenopause starts with variation in the length of time between periods and ends 1 year after the final menstrual period. So, although some people may consider perimenopause as the time prior to menopause, it actually includes the time of the last menstrual period (menopause) (1).

What changes occur during perimenopause?
Irregular menstrual periods occur in every woman during perimenopause. The time between periods can vary, as well as the length of each period, and the flow may be lighter or heavier. In some women, this is the only physical change that they notice.

Most women experience hot flashes–a sudden wave of heat usually in conjunction with sweating, skin reddening, and a faster heart rate. These hot flashes are severely problematic in about 1/3 of women, with some suffering from them for a decade or more (2).

Poor sleep is common during perimenopause. This is often due to hot flashes occurring during the night, known as night sweats (1). Depressed mood and increased anxiety are other relatively common changes during perimenopause (2).

Vaginal dryness is another common symptom, especially in the later stages of perimenopause (2). This can cause vaginal tightness during sex, along with pain or burning. Vaginal lubricants and moisturizers are often required to improve comfort during sex (1).

What hormonal changes occur during perimenopause?
The major hormonal changes are a gradual decrease in estrogen levels (although often in an irregular fashion), and increased follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels. These hormonal changes can all be detected in our Women’s Perimenopause Panel (E2, FSH, LH).

Postmenopause is the stage of a woman’s life after 12 consecutive months of no menstruation. The perimenopause symptoms described above usually occur for 1-2 years after menopause, but some women suffer from symptoms for 10 years or longer (2).

Are there any other changes that occur in postmenopause?
Two major hormonal changes that occur in postmenopause are very low levels of estrogen and progesterone. These hormonal changes can be detected in our Women’s Postmenopause Panel (E2, P4), and can increase the risk of various health complications in postmenopausal women, including (3):

  • Heart disease. Before menopause, women make plenty of estrogen to help keep blood vessels in good health and maintain a healthy balance of “good” and “bad” cholesterol. However, in postmenopause, estrogen levels are a lot lower and the risk of heart disease increases.
  • Stroke. Lower estrogen levels in postmenopause may also increase the risk of cholesterol build-up in the blood vessels supplying the brain.
  • Osteoporosis. Low estrogen increases the breakdown of bone, which can lead to brittle and weak bones and an increased risk of bone fractures.
  • Lead poisoning. The increased breakdown of bones also releases lead into the blood that has been stored in the bones over a woman’s lifetime. This lead can increase the risk of high blood pressure, atherosclerosis, kidney issues, and cognitive impairments.
  • Urinary incontinence. Lower estrogen may weaken the urethra, increasing the risk of urinary incontinence.
  • Oral issues. The risk of cavities and dry mouth increases after menopause.

References:
1. Menopause 101: A primer for the perimenopausal. The North American Menopause Society.
2. Santoro N. (2016) Perimenopause: From Research to Practice. J Women’s Health (Larchmt). 25(4):332–339.
3. Menopause and your health. Office of Women’s Health, U.S. Department of Health & Human Services. Updated September 2018.