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In men generic paroxetine 30 mg mastercard medicine ethics, testosterone is produced in the testes and adrenal glands; in women 30mg paroxetine with amex treatment vitiligo, it is produced in the ovaries and adrenal glands purchase discount prilosec on line. In general, testosterone is released throughout the body, sending word to your erogenous zones that you are ready for sex. When testosterone is functioning properly, it revs up the hypothalamus, boosting erotic feelings and sensations. Growing research supports the role of testosterone in female desire, with evidence of low desire associated with low testosterone and increased desire with replacement. Women reach their peak testosterone levels in their midtwenties, after which comes a slow but steady decline, about 1 to 2 percent per year, of available testosterone. By menopause, testosterone levels are at half the peak level, mostly due to decline in adrenal production. Since ovaries produce testosterone, women whose ovaries have been excised are suddenly operating with 75 percent less testosterone. Most of these women feel the drop almost immediately, often with hot flashes and a substantial decline in libido, confidence, and verve. If all this talk about mood and libido sounds familiar, it should: testosterone has an overlapping role with our old friend estrogen. You see, testosterone can be converted to estrogen; fat cells contain an enzyme, called aromatase, that converts testosterone to estradiol. The more fat you have, the more likely it is that you’ll create an excess of both androgens and estrogens. We know that excess estrogen may make it extremely difficult to lose weight, which then reinforces the cycle of more fat, estrogen, and weight. We also know that too much testosterone is associated with mood problems such as depression and anxiety, weight gain, and what we call sexual issues (as in, “Back off, Cowboy! Women with too much testosterone have deeper voices, more pubic and facial hair, and more muscular builds than women with normal amounts of this hormone (Figure 4, page 207). Occasionally, high testosterone is so significant that it causes balding, a full beard, or growth of the clitoris. We also know that criminal violence and aggressive dominance in women are linked to higher testosterone. Measuring testosterone levels in the saliva on two occasions two years apart, the researchers found that the women with the highest testosterone levels were the most likely to gamble. Testosterone levels also predicted ultimate career choice: women with higher testosterone were more likely to have chosen riskier careers, such as investment banking and finance. These jobs tend to have fatter salaries, but also less security and a higher probability of turnover. Her libido had been abysmal for the past ten years, yet she loves her new husband and wanted to feel more passionate toward him. Her woes led her to a doctor, who prescribed 2 percent testosterone cream, which she applied to her vagina.

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The course of alopecia areata is extremely variable buy discount paroxetine symptoms zinc toxicity, with hair loss occurring rapidly generic paroxetine 20 mg otc administering medications 7th edition, slowly cheap atorlip-10 10 mg online, or intermittently. In some cases, spontaneous hair regrowth occurs immediately, whereas in other cases, it may take days or even years for normal regrowth to occur. Recurrence and severity of the disease are unpredictable, and it can have a life-long presence for many patients. The etiology of alopecia areata is unknown but many theories have been postulated: (1) a chronic inflammatory disease with an autoimmune basis; (2) genetic predisposition; (3) a result of psychological factors (e. It very well may be that one or more of these plays a role in the disease process. The clinical appearance of alopecia areata varies from small patches of hair loss to total loss of scalp hair (alopecia totalis) to loss of all body hair (alopecia universalis). It is not usually associated with any symptoms, although some indi- viduals may experience pruritus or paresthesias before or coincident with the loss of hair. A variety of other diseases may also occur in association with alopecia areata, including allergic rhinitis, asthma, atopic dermatitis, diseases of the thy- roid gland, vitiligo, systemic lupus erythematosus, discoid lupus erythematosus, rheumatoid arthritis, pernicious anemia, scleroderma, ulcerative colitis, myasthe- Hair Growth Enhancers 67 nia gravis, and lichen planus. Alopecia areata also may occur in association with Down’s syndrome and Turner’s syndrome, as well as in diabetics and patients with human immunodeficiency virus (35). The diagnosis of alopecia areata can be challenging given the multitude of concomitant diseases and conditions; how- ever, it can be absolutely confirmed by biopsy of hair follicles in the area of hair loss. Treatment In some cases of alopecia areata, no therapeutic intervention is necessary because of the patient’s spontaneous regrowth of hair. In many cases, however, long-term therapeutic intervention is necessary in order for patients to see cosmetically acceptable hair regrowth. There are many treatment options available for alopecia areata but no one treatment stands foremost because of the variable nature of the disease and its unpredictable course (Table 1). The benefits and risks of each treatment must be carefully evaluated on a case-by-case basis. However, the differential diagnosis of diffuse alopecia versus androgenetic alopecia, partic- ularly in females, can be difficult because of the similar presentation, and biopsy and histological assessment may be required to confirm the diagnosis. Diffuse alopecia may pres- ent as telogen or anagen effluvium and can be caused by drug and chemical exposure, thyroid disorders, nutritional influences, and psychological stress. Common causes are childbirth, febrile illnesses, surgery, psychological stress, crash diets, and drug therapy (38). The excessive shedding usually begins 3 to 4 months after the inciting event (39). Anagen effluvium is characterized by widespread or circumscribed loss of anagen hairs from growing follicles. Alopecia due to anagen effluvium is quite obvious because 90% of the hair follicles are in anagen (growing) phase. In contrast with telogen effluvium, loss of anagen hair begins within days to a few weeks after the inciting event.

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The branches ramify extensively buy paroxetine cheap medicine 1800s, and the conducting tissue undergoes a gradual morphological transition into working myocardium safe paroxetine 30 mg medications hypertension. H H D221 Spring 2009 Page 64 VesselType W h ere Internal C h aracteristics Valves Vasa F unction Elastic Vasorum L am ina E lastic Aorta buy clozaril cheap, Yes Thickm ediawith both N o Som etim esConduction;m aintainbloodpressure Artery com m on m uscleand50-60 underhigh pum ping load >1cm elastic lam ella carotid, subclavian M uscular Iliacs, Yes Thickm edia; N o N o D istributiontoorgans;changevessel Artery vertebrals, m orem usclethan diam eterwith sm ooth m uscle 2-10m m according tosym pathetic control coronaries, elastic fibers cerebralArt. Sm allArtery U biquitous Yes,but 1-6m usclelayers N o N o D istributiontotissues;control Arteriole thin inm edia resistancewith sm. This decrease coincides with a reduction in elastic substance and an increase in smooth muscle in the arteries. Connective tissue under the endothelium contains bands of collagen and fibroblasts. These large specialized cardiac muscle cells contain very few myofibrils and function as part of a specialized conduction system that coordinates the contraction of the heart. With high magnification note the relative proportion of blue stained collagen, pink smooth muscle, and unstained elastic tissue. Slide 56 External ear (Elastic stain) Look in the loose connective tissue near the elastic cartilage in this section and you will see a muscular artery and its companion vein. The internal elastic lamina of this small artery is very prominent because of the elastic fiber stain; in some places the external elastic lamina may be seen. Note the striking refractile internal elastic lamina and the pink staining smooth muscle (25 40 layers) of the tunica media (note that the smooth muscle nuclei are twisted into a corkscrew characteristics of contraction). The external elastic lamina (between the media and adventitia) is less pronounced. The connective tissue comprising the adventitia is oriented mostly longitudinally and most of the collagen bundles here (stained blue) are thus cut in cross section. Remember that in blood vessels the components of the adventitia are arranged longitudinally, those of the media are circular, and those of the intima are longitudinal. Venules, with an equally thin wall but a wider diameter, are found in the same area. These will be a bit lower in the dermis (the connective tissue immediately under the epithelium). Slide 23 Mesentery spread (flat mount, H and E) (C&M 150-156 for ultrastructure) This is not a section, but a piece of mesentery mounted under a coverslip. Observe the large, lymph vessel and smaller blood vessels running alongside it and extending into other parts of the mesentery. The lymph vessel contains valves that consist of a pair of pockets arranged on opposite walls. Arterioles have a smaller lumen, endothelium and a smooth muscle media; venules have a wider lumen and a thin endothelial lining.