Funds double for orphans-to-be

Image copyright Family handout
Image caption Ella, 14, and 16-year-old Louis Maley face being orphaned after the death of their father and mother’s terminal cancer diagnosis

Thousands of pounds have been raised for a brother and sister who face being orphaned.

Kate Smith set up a fundraising page for Louis and Ella Maley after the death of their father and their mother’s terminal cancer diagnosis.

Their mother Emma, 40, was given the news in February. Her partner of 18 years, Paul Maley, from Solihull, died on 8 March after suffering a stroke.

Ms Smith wanted to raise £5,000 but has more than doubled that in three days.

She said she was “lost for words” at finding out how much has been raised.

In a post on social media, Ms Smith, Emma’s cousin, urged people to keep on giving.

“This is incredible, thank you so much to every single person that has donated.”

Image copyright Family picture
Image caption Emma and Paul Maley, who had been together for 18 years, were due to get married in March

Ms Smith, from Water Orton in Warwickshire, revealed on the fundraising site that Emma had secondary breast cancer and has been given only months to live.

“Ella is my god-daughter – she is autistic and will need full support and care for many years to come, and this is one of the reasons for setting up this page.

“This tragic story has touched so many people who want to try and do something to help Emma and the children.”

Mr Maley had been found to have an arteriovenous malformation, a tangle of blood vessels on his brain, after he collapsed about 18 months ago.

It is thought he was previously unaware of it but had been due to have an operation on 19 March.

Emma was first diagnosed with breast cancer in 2014 but after chemotherapy, radiotherapy and a hysterectomy doctors discovered it had spread, causing secondary breast cancer which has spread to her liver.

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Read more: http://www.bbc.co.uk/news/uk-england-43588221

States Are Passing Laws Telling Women Abortion Can Be Reversed. But That’s Unproven.

The tone of the website abortionpillreversal.com is filled with urgency. Women who have taken the first dose of the “abortion pill” — actually two drugs, mifepristone and misoprostol, taken over the span of several days to terminate a pregnancy — are exhorted to call right away if they regret their decision.

“There is an effective process for reversing the abortion pill, called abortion pill reversal,” the site claims.

Elsewhere, bolded and in all capital letters, the site practically screams: “IT MAY NOT BE TOO LATE, IF YOU CALL QUICKLY.”

Screenshot

The problem? No credible research backs those claims, and the American College of Obstetricians and Gynecologists has dismissed them outright as bad science. There is no quality evidence that taking the hormone progesterone after a first dose of the abortion pill can undo the process. 

That hasn’t stopped so-called “abortion reversal” laws from quietly cropping up around the country, based on little more than conjecture. Last week, Idaho joined Arkansas, South Dakota and Utah in passing a law requiring that medical providers tell every woman who takes the abortion pill that the procedure can be stopped halfway through.

The authors of these bills rely on small case studies that have been disputed by OB-GYNs — insisting time and again that they simply want to give women more information. The laws are predicated on the idea, disputed by substantial research, that women who have abortions frequently regret their decisions — a common tactic used by anti-abortion activists who ignore studies showing that being denied an abortion tends to harm women’s mental health more than getting one.

We should all be concerned when our government forces doctors to recommend an experimental therapy — without making it clear that it’s experimental. Dr. Daniel Grossman, Advancing New Standards in Reproductive Health

“I think it’s one thing to exaggerate the risks of abortion, but it’s far more concerning when a state codifies into law a medical treatment that is completely unproven,” Dr. Daniel Grossman, an OB-GYN and director of Advancing New Standards in Reproductive Health, told HuffPost.

“We should all be concerned when our government forces doctors to recommend an experimental therapy — without making it clear that it’s experimental.” 

A Shaky Claim

The organization Abortion Pill Reversal describes itself as “a network of over 300 physicians worldwide to assist women that call our hotline.” Grossman calls it a crisis pregnancy center, a group that primarily aims to dissuade women from having abortions.

APR was founded by Dr. George Delgado, a family medicine physician, who in 2012 published a small case series in the journal Annals of Pharmacology purporting to show successful abortion reversal in 4 in 6 women who were given progesterone after taking a dose of mifepristone, the first of the two pills needed for a medication abortion.

The theory goes that giving women extra progesterone — a hormone that helps support pregnancy — will “outnumber” and “outcompete” mifepristone and prevent it from working, APR says. Women thenrefrain from taking misoprostol tablets — the second drug used in a medication abortion — which affect the cervix and uterus.

“In all biologic systems where two molecules compete for the same receptor the way mifepristone and progesterone do, when the concentration of one is increased, it will tend to win the battle at the receptor,” Delgado told HuffPost. “Therefore, it makes biologic sense that giving supplemental progesterone can block the effects of mifepristone.”

Delgado also told HuffPost that a larger case series is due out this month showing “successful reversal rates” between 60 and 70 percent among women given progesterone orally or via injection.

But groups like the American College of Obstetricians and Gynecologists have been unequivocal in their stance that abortion reversal is simply not supported by any kind of credible science. 

Delgado’s small study was not overseen by an institutional review board, ACOG says, nor was it subject to any kind of ethical review. Moreover, according to ACOG, case series are the weakest form of medical study. They have no controls and are largely descriptive.  

This is just meant to continue the stigma around the supposed harms abortion has on women. Dr. Sarp Aksel, ACOG Gellhaus Fellow

“The proponents of this idea — and it’s a theory — basically took a guess and said to themselves, ‘Because mifepristone is an anti-progesterone, then maybe administering progesterone can stop the effects of the medication abortion,‘” Dr. Sarp Aksel, ACOG Gellhaus Fellow, told HuffPost. “It’s all conjecture. None of it has been ― I don’t even want to say ‘proven’ ― because there hasn’t even been a proper study set up to potentially identify some sort of association.”

And because it’s an untested medical practice, no one is tracking what happens to any woman who may try and reverse her abortion — or what becomes of her fetus.

How Bad Science Becomes Policy

Numerous states have laws requiring that women be told mistruths about abortion as part of scripted counseling sessions. Some overstate the risk to a woman’s future fertility, while others assert there is a definitive link between abortion and subsequent breast cancer ― a claim that research studies do not bear out. 

In many ways, the intended effect of those laws is clear: to convince women it is risky to have an abortion, even though that is not true.

The purpose of abortion reversal laws is less obvious — perhaps because many lawmakers seem to earnestly believe abortion reversal proponents’ claims are true, or at least might be true. 

“Abortion rights opponents are banking on the idea that there is the off chance that stopping a medication abortion is possible and banking on the fact that it’s hard to prove a negative,” Elizabeth Nash, senior state issues manager with the Guttmacher Institute, the policy and research organization that focuses on reproductive rights, told HuffPost. 

“A doctor in a white coat can be persuasive,” echoed Grossman, who has published numerous studies on the safety of medication abortions. Since medication abortions were approved by the FDA in 2000 as an alternative to in-clinic procedures, states have sought to pass restrictions limiting their accessibility.

But reproductive rights advocates also see a broader effort to promote the falsehood that the majority of women are unsure of their decision to terminate a pregnancy — and that many are anguished and regretful after the fact. Abortion Pill Reversal’s website has an entire section dedicated to anonymous “stories of regret.”

“This is just meant to continue the stigma around the supposed harms abortion has on women,” Aksel said. “I don’t think it’s based on anything scientific, but it prays on common misconceptions about women being unsure about their abortions and women regretting their abortions.”

Read more: http://www.huffingtonpost.com/entry/state-laws-telling-women-abortion-can-be-reversed_us_5ab544b6e4b008c9e5f71ce7

Women May Have an Alternative to Freezing Their Eggs

Here’s how it could go: Some day in the future, it’s routine for every young woman of a certain age—for argument’s sake, let’s say 21—to undergo a procedure to snip off a piece of tissue from one of her ovaries. Her doctor slices up the tissue into a half-dozen or so microthin sections; these are frozen, to be used whenever she’s ready for a baby. Her ovaries function normally, and she keeps menstruating and ovulating just as she has since puberty. But she doesn’t worry about rushing into baby-making. The timetable of how her life unfolds need not adhere to a pesky biological clock.

Later, maybe much later, maybe not for another 20 years, this woman wants to start a family. She remembers those strips of ovarian tissue in deep freeze. Each strip contains thousands of follicles, the proto-eggs of the ovary, preserved at their peak. The follicles in her body have been getting progressively less robust, but in the lab freezer her proto-­eggs have been in suspended animation, protected from the degradation of age.

So she goes back to the doctor, who defrosts one of the strips and implants it in her ovary. It becomes established there, starts pumping out hormones at the level of a younger woman, and transforms one follicle each month into a mature egg. Each menstrual cycle, the hardy egg of a 21-year-old is deposited into the fallopian tube, where it can be fertilized. Ideally, one of those youthful eggs turns into an embryo that embeds itself in the uterus and grows into a healthy baby. Ideally, that one strip of ovarian tissue keeps producing hormones and releasing eggs for years, long enough for the woman—who might be 45 or even older by the time it’s all done—to have a couple of children.

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Nik Mirus

If the first implant doesn’t work, or if it stops working before the woman’s family is complete, doctors can defrost and implant another strip. And if she doesn’t need the strips for childbearing—maybe she decides not to have children at all, or she gets pregnant naturally without needing to take any strips out of deep freeze—she can use them for a different purpose: postponing menopause. As she enters her fifties, this woman thaws a strip and has it implanted in her forearm, where it releases estrogen and other sex hormones in a way that mimics the feedback loop of a younger woman, in theory with fewer side effects than with artificial hormones. She still menstruates, which is the downside, but she also remains at lower risk of chronic conditions, like heart disease and osteoporosis, that usually get worse after menopause, at least in part because of the drop in estrogen. In this future, the one-two punch of nature’s timetable—first making it harder to have healthy babies after about age 35, then making it harder to stay healthy yourself after about age 50—is something women have finally transcended.

Here’s the reality of where things stand: At the Center for Human Reproduction in New York, there’s a room with a boxy machine that slow-freezes slices of ovarian tissue before they are transferred to a stubby deep-freeze tank that bears an uncanny resemblance to R2-D2. But of the 14 tanks in the room, most contain frozen embryos or frozen eggs or sperm, not ovarian tissue. That’s because right now, removing ovarian tissue involves an expensive surgery requiring a hospital stay. (Infertile men can have a bit of testicular tissue removed via a comparatively simple probe-and-snip procedure; the hope is that a similar procedure can be developed for women.) Transplanting the tissue later requires another operation.

Which is all to say, we already do live in a world where bits of ovarian tissue can be harvested, frozen, and then reimplanted later to make a woman fertile, but it’s harrowing. The process was developed for young women or girls with cancer, who face oncological treatments that are certain to make them sterile; since 2004, about 100 babies have been born to these women using the technique. In the view of most researchers and the American Society of Reproductive Medicine, ovarian tissue extraction is still too experimental to recommend for healthy women.

As she enters her fifties, the woman thaws a strip and has it implanted in her forearm, where it releases estrogen and other sex hormones in a way that mimics the feedback loop of a younger woman.

But soon, say experts like Sherman Silber, director of the Infertility Center of St. Louis, freezing ovarian tissue could become the next big form of what’s known as “social freezing” (or, as it’s called in some waggish circles, “AGE freezing,” short for “anticipated gamete exhaustion”)—whereby women try to prolong their fertility not for a medical reason but just to give themselves the option of delayed childbearing. For now, the only way to pause the biological clock this way is to freeze one’s eggs, a route taken by some 6,200 women in the US in 2015. But egg freezing is expensive (up to $18,000 per cycle) and uncertain. Experts calculate that each egg frozen before age 38 has just a 2 to 12 percent chance of turning into a baby one day. Egg freezing also requires women to inject themselves with hormones powerful enough to produce more than 10 times the normal number of mature eggs at a time. These hormones can lead to mood swings, nausea, and abdominal pain; a slight chance of the serious condition known as ovarian hyperstimulation syndrome; and an unknown risk of ovarian or breast cancer down the road.

So as women wait longer and longer to have kids—more than 26,000 women 40 or older became first-time mothers in 2016, an increase of nearly 30 percent over 2001—there’s plenty of incentive for the fertility industry to figure out how to make ovarian tissue extraction a better bet than egg freezing. For one thing, it would do away with the need for multiple rounds of in vitro fertilization. If all goes well, Silber says, the thawed and transplanted tissue will latch on to the rest of the ovary, become functional within about four-and-a-half months, and lead to pregnancy the old-fashioned way.

Roger Gosden, who helped develop the ovarian tissue-freezing procedure in sheep in the 1990s, worries that the social freezing of ovarian tissue will be fraught with the same hazards and anxieties as egg freezing: “A lot of commercial pressure and social pressure” will promote a procedure that most women end up not even needing—all “at great cost, great inconvenience, and a little bit of risk.” It’s also possible that the whole cold-storage approach to infertility could eventually be replaced by a better one: turning stem cells into egg cells, say, whenever a woman is ready to conceive.

But the biggest benefits of socking away young ovarian tissue may come at the other end of a woman’s reproductive life cycle. “One of the really big health challenges of the future is that we’re getting too old,” says Claus Yding Andersen, a professor at the Laboratory of Reproductive Biology at the University Hospital of Copenhagen. “The longer you’re in menopause, the greater your risk of osteoporosis and cardiovascular disease. The very best thing you can do to reduce those risks is to have your own menstrual cycles.” However they go about managing their fertility, women of the future who wait until their forties to start having children will probably want to put off the indignities of an aging body as long as possible. They will know they’ll need a spring in their step—not to mention sturdy hearts and flexible knees—if they’re going to keep up with those long-awaited kids.

Read More

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Robin Marantz Henig (@robinhenig) is a science writer and the author of nine books, including Pandora’s Baby.

This article appears in the April issue. Subscribe now.

Read more: https://www.wired.com/story/reboot-reproduction-modern-fertility/

The story of one mans pregnancy: It felt joyous, amazing and brilliant

Pregnancy is increasingly common among trans men. For Jason Barker, who has made a film about the experience, it changed his life

Its hard to perform a somersault at 36 weeks pregnant. Towards the end of his debut feature film, Jason Barker is swimming in the London Fields lido in east London, a short walk from the flat he shares with his partner, Tracey. The screen is rinsed blue. Barker dances, makes a star. And then, very slowly, he turns full height in the water, his Hawaiian swim shorts flapping, his stomach a perfect, firm dome.

This is the viewers first sight of Barkers pregnant belly in A Deal With the Universe, which premieres at the BFI Flare festival next week. And after seven years in which he and Tracey tried to conceive, it is a moment of pure levity and joy. That swimming stuff that you see? he says. It felt like the first time I could ever say, Yeah! I actually like this body. Love it. Its brilliant.

Barker was born female. He transitioned roughly 20 years ago, at 26, soon after he met Tracey though, as Barker says, before and after dont really work in this story. The process of transitioning was gradual, without hard edges. The two of them hoped to start a family, but after a few years of Tracey trying to conceive with her own eggs, in 2003 they resorted to plan B. Tracey would be impregnated; Barker, who had undergone chest surgery but kept his ovaries, would supply the eggs. He bought a new camera to document it. Soon they would have a baby and a film.

So Barker stopped taking testosterone. He delayed an appointment to discuss a hysterectomy. Well, it was just a short film. Not too disruptive. But the filming went on and on and Barker ended up telling a very different story to the one he planned. The pregnancy he chronicled was not Traceys, but his own. And it changed his sense of who he was.

Pregnancy among transgender men is increasingly common. Sally Hines, a professor at the University of Leeds who is leading a three-year research project into the subject, says: In the UK, if you look at how many people are accessing blogs and online forums and support groups, asking about healthcare because they are pregnant, or young guys thinking about the future There is lots of anecdotal evidence that more people are doing it. When something becomes visible, more people think its possible.

But 10 years after Thomas Beatie, from Hawaii, made headlines with his combination of beard and baby bump the first publicised case of a legal male, in a traditional marriage to a woman, to give birth the data remains scant. In Australia, 54 people who identified as men gave birth in 2014, according to Medicare statistics. In the UK, the Office for National Statistics collects no information on the gender of the birthing parent; neither does the NHS. Last year, British newspapers including the Sun and the Independent hailed Hayden Cross as Britains first pregnant man. Soon afterwards, they had to hail another man, Scott Parker, after he got in touch to say that he had given birth a few months earlier.

There have been about six first pregnant men, Barker notes wryly. His son turns eight this year.

And yet the idea of transmasculine pregnancy as a novelty holds sway. Each birth is greeted as the first. It is perennially surprising, and I wonder if this is because it is conceived by cis people as a double-edged contradiction that undermines both the common conception of pregnancy as inherently female and the sense of a completed transition as if a trans man carrying a child constitutes a sort of U-turn. But, as Hines says, Transition is not a straightforward A to B Pregnancy is not an interruption, just another part of a long and complex journey.

Barker,
Barker, whose son is now seven. Photograph: David Levene for the Guardian

Barkers film begins with him prizing a state of heightened masculinity. When Tracey cant conceive, he longs for a penis and testicles. He strikes muscular poses while washing the windows of their caravan, and the thought of his eggs entering her makes him feel like cock of the walk. He says it in a way that emphasises the pun. But, as the film progresses, a subtler story emerges.

I had this fantasy picture, he says. I thought, Ill have a baby, and that night Ill go and have a pint, and about two weeks after that Ill start on the testosterone again Job done. Pregnancy was a transient state, a strange bit of my life, after which normality would be restored.

But, pretty quickly, the film begins to transmit more mixed messages. As soon as he is pregnant, Jason appears in a pair of denim dungarees, that classic of 1970s maternitywear. In labour, he looks forlorn in a cerise nightie with a cute animal motif. He laughs when I ask why, in pregnancy, he resorted to these conventional cues for femininity. You just grow so massive and youve got nothing! he says. Retailers of pregnancy clothing arent exactly teeming with options for trans men. Tracey went to New Look and bought a load of maternity trousers, but even the combats were embroidered with flowers. She had to get a needle and unpick them.

In pregnancy, Barker mostly passed as a fat bloke. No one offered him a seat on the bus. No one batted an eyelid when, dressed in jeans and a cardie, he walked along the canal towpath to Nandos two days before giving birth. He was both in plain sight and, owing to the relative rarity of pregnant men, hidden. In an antenatal class, when the teacher instructed all the pregnant folks to feel their hips, and he obeyed, the man beside him gave a nudge and said: I dont think we have to bother, mate!

For as long as he could remember, Barker had had a body that didnt fit. And now youre here, he tells his son in the film, and I cant think like that any more.

It would be easy to imagine pregnancy as a time of heightened gender dysphoria for trans men. I had expected most people to have more dissonance with their body during pregnancy, says Alexis Hoffkling, a researcher and medical student at the University of California, San Francisco who is trans herself. A few years ago, she started interviewing trans men who had been pregnant and found that while some had a lot harder time with their bodies [others] felt empowered. Some found it masculinising. They were more like a fat dude than they had ever felt before. As their body got bigger, they felt stronger.

When Barker began to piece together the 25 hours of tape he had recorded over eight years of trying to start a family, a worry began to form. The proper story, he thought, would be that somebody keeps their gender identity regardless. Im a man and Im pregnant but Im still a man, and this is a mans pregnant tummy. But for me, it felt really different.

Barker says he is naturally a very binary person. Ive been ever so serious about gender in my life. That its this thing you have to be fully committed to. Because my generation of trans people had to be fully committed in order to access treatment. It took a while, but slowly he began to let go of his self-interrogation, what he calls the whole pregnant man thing. He stops to think. The closest comparison, he says, is that being pregnant was like watching Mo Farah run. He is so graceful. Hes not having to go, Im trying to run! like the rest of us. And thats how it felt for me: Wow. Im just doing this. It felt joyous and amazing and brilliant.

In the same way that Barker would always stand up for his friends against transphobic strangers, now he felt compelled to protect his pregnant body against his own sense of incongruence. I would defend that body. That body is a beautiful thing because of what its doing and what its done, he says. The body was all about my kid.

So, in a way, it was a selfless body? It didnt feel right when Barker was its sole occupant, but when it acquired another, an other, it became a better fit? I wonder if Barker felt less male when pregnant. But he says only: Honestly, I had a really lovely time.

Im going to ask you a very personal question, he says, leaning forward. When people talk about getting broody again, its pretty ick, isnt it? Its icky because none of us likes to think we are ruled by our hormones?

Thats true, I say. But, speaking personally, I did get broody again.

Yes, so did I! he exclaims, delighted. He and Tracey knew that they wouldnt try for another child, because it had taken them a decade to conceive and they didnt want to lose their sons infancy in endless rounds of IVF. But for a long time after the birth, Barker lived with a sort of second, shadow baby.

Id have these fantasies that somehow, a few months later, theyd say, Just a minute! We think theres a twin in there! Id think about it all the time, that I was somehow accidentally pregnant and nobody knew. Kangaroos do it, Id think. Would there possibly be a way? Theyd say, We dont know how its happened but its like your body stored it. And Id be, Well, there you go! A miracle!, he says.

He never had the hysterectomy. He hasnt taken testosterone in 15 years, since he and Tracey embarked on their plan B.

Barker
Barker and his partner Tracey. Photograph: Sara Davidmann/A Deal With the Universe/BFI

There is, as yet, no guidebook to pregnancy for trans men, though Barkers film will fortify others who wish to follow in his footsteps. There is a memoir, Wheres the Mother? Stories from a Transgender Dad, by Trevor MacDonald, who lives in Manitoba, Canada, and who carried his own children, now three and seven. MacDonald founded a Facebook group on birthing and breast- or chestfeeding for men.

The questions that come up repeatedly are practical ones. What is the impact of testosterone on a trans mans chances of conceiving? (Barker took it for three years.) How does chest surgery affect lactation? (This subject is off-limits for Barker, but MacDonald fed his own children and became the first openly trans volunteer at La Leche League, the breastfeeding support group, after they initially told him it was inappropriate for them to help him. From his own research conversations with trans men, he knows that some found nursing reduced their experience of gender dysphoria around their breasts: It seemed to have to do with those body parts serving a purpose that they otherwise didnt, he says.)

Once, in hospital, the nurses called Barker Mum. But after racking his brains, that is the single misstep he can recall. MacDonald says he is amazed that Barker had such a smooth experience with his healthcare providers. There are plenty of stories of those who dont specimen bottles routinely given to thin female partners instead of the pregnant man, and so on.

Registering the birth was a hurdle, though. Barker had no choice but to officially be his sons mother. As well as his name, he included his birth name under the designation AKA, because he dreaded some kind of clerical error that would make the baby not mine. That sounds completely paranoid, he says, but growing up with section 28 had given him the idea of not thinking that you deserve to be spoken about, do certain jobs or have certain things. And those things included, presumably, a child.

Mostly, though, parenthood has been free of administrative challenges. In fact, Being out and about as a dad with a small baby attracted more attention than being a pregnant man did! he says. Barker is a writer, but he is also his sons prime carer. I remember him crying on a bus and a woman shouted, Not as easy as you thought, was it? Also I once shocked the whole Stay and Play when I told them that my partner had gone back to work two weeks after the baby was born.

Their little boy has grown up with an understanding of his family, how he came about. Ever since he was born, they have told it to him almost like a bedtime story. (He has heard it so often, he sometimes rebukes his dad for boasting about being trans.) Discussing Harry Potter one day, Barkers son wanted to know which of the characters Barker would be if he could choose anyone. Hagrid, Barker replied. In the films, the hirsute, giant gamekeeper is played by Robbie Coltrane. Well, youve already got the beard, his son said, appreciatively.

A film needs an arc, of course to end somewhere other than where it started. Barkers worry about this, when he began to edit the footage last year, was, My God, will somebody think Im cured [of being trans]? Its a horrible thought, he says. Its all right for Tracey, his indomitable partner, whose eyes continue to sparkle even through a mastectomy for breast cancer. She didnt need an arc. She could just be brilliant all the way.

I think my arc, he says, is going from somebody who thinks being an ordinary man is the best thing you can be to somebody who sees a different way of being. To a certain extent its about femininity, he says, tapping the table as if hes put his finger on it. Id pushed [it] away from a really young age, and I think its about bringing some of that back. And you realise how undervalued this work is And it does make you think, What was I pushing away? What was I scared of?

Its about vulnerability, I think, he says, and it is a surprise to hear him say it, because the quality he most wants to surface in the film is resilience. Of course, the two go together, and Barkers story is about both of those things, and the personal regrowth that can come from giving birth. He not only challenged boundaries in the world around him, but in his own understanding of himself.

A Deal with the Universe is at BFI Flare: London LGBTQ+ film festival on 26 March at BFI Southbank

Read more: https://www.theguardian.com/lifeandstyle/2018/mar/22/story-one-mans-pregnancy-trans-jason-barker

Does testosterone make you mean?

The risk-taking male hormone is blamed for everything from sexual violence to the financial crisis, but some researchers are starting to question the supposed links

Charles Ryan has a clinic in San Francisco at which he regularly relieves men of their testosterone. This chemical castration, as it is sometimes known, is not a punishment, but a common treatment for prostate cancer. Testosterone doesnt cause the disease (currently the third most deadly cancer in the UK), but it fuels it, so oncologists use drugs to reduce the amount produced by the testicles.

Ryan gets to know his patients well over the years, listening to their concerns and observing changes in them as their testosterone levels fall. Because it involves the so-called male hormone, the therapy poses existential challenges to many of those he treats. They know that every day, millions of people from bodybuilders and cheating athletes to menopausal women enhance their natural levels of testosterone with the aim of boosting their libido, muscle mass, confidence and energy. So what happens when production is suppressed? Might they lose their sex drive? Their strength? Their will to win?

The fears are not always groundless. Side-effects can also include fatigue and weight gain. But Ryan has witnessed positives, too. As professor of medicine and urology at the University of California, he has noticed that the medical students who have passed through his clinic in the 18 years that he has been treating prostate cancer invariably comment: Dr Ryan, your patients are so nice. He replies, jokingly: Its because they dont have any testosterone. They cant be mean.

Could there be some truth in that glib reply? Ryan knew his patients hadnt always been so kind. Before being robbed of their testosterone, they might have been personable and adept at small talk, but they werent nearly as interested in other people. He could feel a hypothesis coming on: that as mens testosterone levels lower, their capacity for empathy will rise. In his new book, The Virility Paradox, he argues that the fact that reducing testosterone in these ageing men may lead to increased empathy, more emotional engagement in relationships and a softening of aggression could be something of a silver lining.

Ryan started measuring his patients empathy quotients, using a survey developed for studying autism. Its too early to release detailed results, he says, but we do see increases in the empathy scores in many patients on the treatment.

He also dived into the literature on testosterone, attempting to understand what exactly was happening to them. Try as he might, however, he found little conclusive evidence for many of the claims made about testosterone, such as a link between hormone levels and risk-taking or sexual violence. Theres so much ambiguity in the science, he says. Many of the studies had been carried out on disappointingly small numbers of people.

Ryan is one of several researchers who are questioning the accepted wisdom about testosterone. It is often wheeled out as an excuse for patriarchal society, in arguments along the lines of: women, with their lower testosterone levels, have evolved to nurture and multitask in the domestic sphere, while men are hardwired to take risks, compete and furnish as many women as possible with sperm, thus ensuring the future of the species. But, as Ryan points out, obviously behaviour and cognition are extraordinarily complex and dont pivot on one molecule.

The psychologist Cordelia Fine makes a compelling case that it is our culture rather than our hormones that most influences gendered behaviours. As she writes in Testosterone Rex (winner of the Royal Societys science book prize for 2017) testosterone has been blamed for the financial crash of 2007-08, yet studies show that, although women have lower levels than men, they can have a higher appetite for risk even when it comes to financial decisions. She uncovered similar stories when it came to the evolutionary need for more sexual partners (more babies get made if women sleep around, too) and competition for status.

Fines pluck in challenging the scientific status quo could itself be viewed as classic testosterone-fuelled behaviour. She has cojones, you might say. She asserts that many typically female behaviours, such as deciding to have babies, are riddled with risk, only womens risks dont seem to count when it comes to testosterone mythology.

While Ryan comes at the subject from a different angle, both authors highlight how little research there is into testosterone in women. And yet we know it is vital to them (for example, oral contraception reduces testosterone levels, which can lead to low mood and libido). It can also influence sexual orientation, Ryan writes, with studies showing that self-described lesbians are likely to have [indications of] higher foetal testosterone levels than women who identify as heterosexual.

The lack of research, meanwhile, hasnt prevented a fierce debate about testosterones role in womens sports, with high levels seen as conferring an unfair advantage. The athlete Caster Semenya, who won a gold medal in the womens 800m at the 2016 Olympics, has extremely high natural testosterone levels for a woman. She had to prove her gender, and medically suppress the hormone before competing (although this ruling is currently suspended). Meanwhile, in 2016, the International Olympic Committee ruled that transgender women could compete without having had surgery, on condition that their testosterone levels were no higher than cisgender womens.

Not that testosterone levels are consistent in anyone. They rise and fall all the time, according to season, health, relationship and parental status, age, time of day (higher in the mornings) and emotional responses. When a man hears a woman cry, his testosterone goes down. When a person cares for their child, the bonding or love hormone oxytocin rises, while testosterone falls. If a threat to status or territory is perceived, testosterone rises again. Its the situations, the culture even, that seem to pull the hormones strings. Testosterone, in both men and women, also works in a feed-forward system: when you win at something, you get a spike in testosterone that as well as making you feel dominant and confident, increases your sensitivity to the hormone encouraging further swagger and quests to win.

Another of the hazards when studying testosterone is that there are three significant measures of how strong its force is in you. You can check levels in the bloodstream, but we already know how they fluctuate. The second measure is the number and sensitivity of androgen receptors, which vary significantly from person to person. (Testosterone is one of three hormones known as androgens, and receptors are what allow them to act on the cells in our bodies.) Third is the amount of testosterone to which we were exposed in the womb, most of which is produced by the foetus itself. This exposure is harder to gauge, although the difference between the lengths of the index and ring fingers is often used as a marker. The smaller the difference, the theory goes, the greater that foetal exposure.

This complex web, says Ryan, means that responses to hormonal suppression therapy are highly variable, based on [individuals] intrinsic biology. I have patients whose testosterone I take away and they dont have any [unwanted] side-effects. In fact, they say: I feel better. My brain is less clouded with intrusive thoughts about sex and things like that.

In a sort of mirror-image experiment, the writer Ann Mallen recently told how she accidentally rubbed testosterone cream into her skin every day for a month due to a mixup at the pharmacy. She wrote in the Washington Post that her sexual appetite became a constant distraction, as did her new persistent bouts of irrational anger. She concluded that underneath the high-pitched whine of our sex hormones, we are neither [male nor female].

Because women are more responsive than men to supplemental testosterone, they were used in one of the key studies into how testosterone essentially removes the burden of empathy from moral decision-making. Its known as the trolley car experiment. Picture a runaway tram hurtling down the tracks towards five unsuspecting workers. Theres a lever that would divert the tram to another track, but theres someone working on that track, too. You have to kill somebody to save five others, says Ryan, and you have to act fast.

The researchers at Utrecht University gave some of the subjects a shot of testosterone the night before presenting them with the dilemma. The number of respondents who were willing to kill in order to save people, and their confidence in carrying out the act were enhanced, says Ryan. And the equivocation they demonstrated was significantly reduced.

This isnt to say that empathetic people cant make tough decisions. Hormones are a bit-part in a complex cognitive picture. Aaron, a high-flying lawyer treated by Ryan, was adept at suppressing his empathy in order to win a case. But as his testosterone dissipated, he grew more caring and started asking Ryan about his family. At one appointment he asked whether getting emotional was a side-effect of his treatment, after he had wept at the end of a long-distance visit to his elderly mother. Like many patients, writes Ryan, Aaron regards these developments with a measure of surprise. Hormonal therapy hasnt been as bad as he expected, and he admits he has actually come to appreciate some of the effects it has had on him.

However, this outcome posed one worry for Ryan. A major case is heading to trial and Aaron is the lead attorney. Will having a testosterone level at 10% of normal affect his performance? he writes. The answer, it turns out, is no: Aaron had not lost his killer instinct in the courtroom.

You get the sense that Ryan sees toning down testosterone as a force for social good. Take his patient Marcus, an octogenarian who is still a keen runner. When his cancer risk was sufficiently low, he came off hormone suppression therapy and started taking supplemental testosterone to counter its effects. He would come in and talk about his half-marathon, weightlifting, his younger girlfriend, says Ryan. He never talked about anybody but himself. Eventually, he had to quit the supplements because his markers for cancer rose again. He disappears for more than a year, and comes back and is now taking care of his daughter, picking up his grandkids and being a nice grandpa. I think it is misguided for ageing men to think they should necessarily want to have high testosterone levels, because they may pay a price for that in terms of their relationships. They may be more self-centred, lack empathy.

But again, its complicated and depends on the individual. Many men, as they age, feel sluggish and lose muscle mass, lose their self-esteem, so I dont say we shouldnt ever use supplemental testosterone.

Its estimated that one in 10 men aged over 40 in the UK have low testosterone levels, which is in a large part related to obesity. Fat tissues will produce an excess of oestrogen, says Ryan, which leads to reductions in testosterone. Artificially boosting the latter could help them lose the weight, but any other benefits, Ryan warns, could be transient. A study published in the New England Journal of Medicine found that while [their participants on supplemental testosterone] felt good at first and their libidos went up, there werent long-term beneficial effects.

And, of course, they may end up impairing their capacity for empathetic relationships. But there are non-medical ways to boost empathy. In Testosterone Rex, Fine cites a 10-year US study targeting boys at high risk of behaving antisocially later in their lives. Some of them were given coaching to improve their emotional resilience, relationships and educational performance, while their parents were trained to manage their childrens behaviour. The goal was to enable the boys to respond more calmly and less vociferously to provocation. Years later, when the participants had reached their mid-20s, about 70 were deliberately provoked by someone stealing points from them in a game. Not only were the group who had been given coaching as boys less likely to retaliate; their testosterone levels rose less.

Another way, according to Ryan, is to do more childcare. Testosterone levels are 33% lower in fathers of newborns than in non-fathers, making way for a good 25% more oxytocin. This hormone, says Ryan, induces men to spend more time with their children and respond more quickly to their needs. It enables fathers to play more closely with their children, and get less rattled if they cry. (One of Ryans patients started getting down on the floor to play with his grandkids for the first time during hormone suppression therapy.) Romantic love, friendship and pet ownership open the floodgates to oxytocin, too (even a dogs oxytocin rises when it stares into its humans eyes). Less testosterone, more oxytocin, more bonding, says Ryan. Thats another, perhaps more fulfilling, feed-forward system.

Read more: https://www.theguardian.com/science/2018/mar/20/testosterone-myth-male-hormone-behaviour-risk-taking

AI Beats Humans At Emotional Recognition Test In Landmark Study

Artificial intelligence (AI) has the potential to bring about a technological renaissance. Although it can’t properly mimic human behavior or thought just yet, it is trouncing us in one particular area: pattern recognition.

We’re pretty good at recognizing patterns, sure – after all, that’s essentially what basic scientific thought is. AIs, however, are now able to detect breast cancer and pick IVF-suitable embryos more accurately than medical professionals, and a new study suggests that this could apply to recognizing emotions too.

A team at The Ohio State University have applied a method humans automatically seem to use to read emotions to an AI. Ultimately, the AI proved to be better at detecting emotional states in this way than humans – although, rather surprisingly, the AI isn’t even the key finding of the research.  

Cognitively processing emotional content is something else entirely, but when it comes to detecting how someone is feeling based on their facial expression, there are multiple visual cues.

One is the hue of someone’s face, which is partly controlled by localized blood flow – something technically known as “vascular response”. As the authors note in their study, these facial blood flow changes match up to the type of expression, and its “valence” – its nebulously defined inherent “good” or “badness”.

Writing in the Proceedings of the National Academy of Sciences, the team’s hypothesis went one step further. Can a person, using blood flow color changes alone, detect the type of emotion and its valence on another person’s face if their facial expression doesn’t change?

In order to test this, they took hundreds of images of 18 facial expressions of 184 people from different genders, ethnicities, and overall skin tones, and quickly found that, via digital analysis, emotions – from simple “happy”, “sad”, and “disgusted” to more nuanced “happily surprised” and “angrily surprised” – fit into color patterns influenced by facial blood flow.

They’re not simple or uniform across the face for each emotion, mind you. When someone feels disgust, for example, the hue around the lips is different from that around the nose and forehead.

In any case, using this complex emotional palette, the team then superimposed various hues corresponding to a range of emotional states onto neutral expressions, and asked a handful of participants to guess how the person was feeling.

Remarkably, most of the time, the participants guessed correctly, including for happy hues (70 percent), sad hues (75), and angry hues (65). This all strongly suggests facial hue is a strong indicator of emotions that we quickly and involuntarily register.

They upped the ante by applying mismatching hues to other expressions too; for example, adding a “sad” hue to a happy expression. Although more difficult, the participants picked the correct emotion most of the time.

“The emotion information transmitted by color is at least partially independent from that by facial movement,” the study concludes. Based on the fact that we have little facial hair compared to our far floofier primate cousins, the study authors suggest that “recent evolutionary forces” have allowed us to transmit emotions in this unique way.

Using this new database, the team generated a basic AI that had an understanding of this emotional palette, and it’s at least as good, and sometimes better, than humanity. According to a press release, it recognized happiness 90 percent of the time, with anger (80), sadness (75), and fear (70) also being frequently detected, based on hues alone.

Once again, all this is pattern recognition, but it’s hard not to be impressed by how easily humans are defeated in this regard. In fact, this AI is so effective that the researchers have already patented and commercialized it.

Read more: http://www.iflscience.com/technology/ai-beats-humans-emotional-recognition-test-landmark-study/

Most Rigorous Study Yet Concludes Abortion Practices In US Are Safe, Restrictions Are Riskier

A groundbreaking report from the National Academies of Sciences, Engineering, and Medicine concludes – with no margin for rational disagreement – that the abortion procedures used in the United States are safe and effective.

The 186-page review, available online in its entirety or as a tidy summary, is based on a review of the available clinical and real-world data regarding the medical outcomes and quality of the four current methods – medication, aspiration, dilation and evacuation (D&E), and induction.  

Moreover, the diverse team of expert authors found no evidence to supporting the benefit of regulations, varying state-by-state, that require abortion-providing clinics to meet stringent facilities criteria, offer pre-procedure counseling, observe waiting periods, and limit which providers can perform the procedures. Their analysis proves that these laws, passed under the thinly veiled claim that they protect women’s wellbeing, accomplish the opposite instead.

“Abortion is safer when it’s performed earlier in gestation,” Dr Hal Lawrence, CEO of the American College of Obstetricians and Gynecologists, told NPR. “And so delaying and making people wait and go through hoops of unnecessary, extra procedures does not improve the safety. And actually by having them delay, can actually worsen the safety.”

The recent national decline in abortions has been attributed to the increasing use of long-acting contraceptives, historic declines in the rate of unintended pregnancy, and increasing numbers of state regulations that limit the availability of legal abortion services. Infographic credit: The Guttmacher Institute

Although all four methods are safe, undergoing an abortion before 10 weeks is the least invasive, as women can simply take one oral dose of the medication mifepristone combined with a vaginal suppository of misoprostol. Thus, any delay to accessing an abortion runs down the clock to a point at which she would need a more intensive procedure that carries a greater risk of complications (and is offered at fewer locations).

According to the report, about 17 percent of women had to travel more than 50 miles to obtain an abortion due to the scarcity of operating clinics. And 27 states mandate that women receive counseling and then wait a prespecified time (usually 24 hours) before they can return and undergo the procedure. When these logistical situations are combined, as is common in the middle American states, women in need of abortions who lack adequate time away from work/family obligations or reliable transportation (i.e. low-income individuals) may face unjust difficulty.

When examining what resources an abortion clinic truly needs, the authors determined that the equipment, personnel, and hospital availability necessary for patient safety are no different than what other outpatient medical centers that perform procedures of similar complexity offer. As the majority of abortions are simple, they estimate that 95 percent can be performed in an office setting.

Finally, the paper calls out the misleading nature of many states’ informed consent requirements.

“Some states require abortion providers to provide women with written or verbal information suggesting that abortion increases a woman’s risk of breast cancer or mental illness, despite the lack of valid scientific evidence of increased risk,” the authors wrote. 

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Read more: http://www.iflscience.com/health-and-medicine/most-rigorous-study-yet-concludes-abortion-practices-in-us-are-safe-restrictions-are-riskier/

New Trial Vaccine Could Treat Ovarian Cancer, But Chlamydia Increases Risk Of The Disease

Two coincidentally timed announcements offer good and bad news on ovarian cancer. Despite not being one of the most common forms of cancer, ovarian cancer is particularly hard to treat, so it causes a disproportionate number of deaths. Now, a new approach to treatment has passed Phase I clinical trials, but the problem could become worse before it reaches the market, since a separate study found that chlamydia, whose frequency is rising, is a risk factor.

Although the ovaries are less susceptible to cancer than the breasts or bowel, 22,000 American women are diagnosed with the condition each year, with similar rates elsewhere. Moreover, the disease has fewer distinctive early symptoms than many of its counterparts, so by the time it is detected, surgery, chemotherapy, and radiation may all be required. With less than half of those diagnosed surviving after five years, even with good medical facilities it is a major cause of death. Even pre-emptive action, such as that taken by Angelina Jolie to have her ovaries removed, doesn’t totally guarantee protection.

In a webinar briefing on research to be presented at the American Association for Cancer Research (AACR) Annual Meeting in April, Dr Britton Trabert of the National Cancer Institute announced two independent studies reporting cancer rates are higher among women with Pgp3 antibodies, which indicate past chlamydia infection.

Antibodies for a variety of other sexually transmitted infections were not associated with increased risk of ovarian cancer. Given that chlamydia is the most common cause of pelvic inflammatory disease (PID), and PID has been associated with ovarian cancer before, the results are unsurprising, but still concerning as chlamydia rates rebound.

Hopes for better treatment options rose, however, with the publication in Clinical Cancer Research of a trial of an immune therapy to treat the disease. Like all Phase I trials, this was done on a small sample of people, in this case, just 14. Consequently, it’s too early to tell just how effective the TPIV200 therapeutic vaccine used in the trial really is, particularly since there was no randomized control group.

Nevertheless, the trial succeeded in its goals of generating a lasting immune response, and almost doubled the usual period before disease progression began. Only one patient experienced a serious side effect. The findings were sufficiently promising and a Phase II trial is already underway. The trial also tested the responses of eight breast cancer patients to the vaccine, with similar positive effects.

TPIV200 targets the Folate Receptor Alpha, implicated in ovarian and some breast cancers. It stimulates the immune system’s helper cells to attack tumors, which should, in theory, produce far fewer side effects than chemotherapy, and has the potential to be extended to many other types of cancer.

Read more: http://www.iflscience.com/health-and-medicine/new-trial-vaccine-could-treat-ovarian-cancer-but-chlamydia-increases-risk-of-the-disease/

Longtime Democratic Rep. Louise Slaughter Dies At 88

WASHINGTON ― Rep. Louise Slaughter (D-N.Y.), one of the longest-serving women in the U.S. House, died early Friday at the age of 88.

She died at George Washington University Hospital, her office confirmed in a statement. She had been hospitalized for a concussion after a fall at her Washington home last week, according to the Rochester Democrat and Chronicle.

“As the first chairwoman of the House Rules Committee, Louise blazed a path that many women continue to follow,” said her chief of staff, Liam Fitzsimmons. “It is difficult to find a segment of society that Louise didn’t help shape over the course of more than thirty years in Congress, from health care to genetic nondiscrimination to historic ethics reforms. The Slaughter family is incredibly grateful for all the support during this difficult time. Details on funeral arrangements will be provided when they are available.”

Slaughter was elected to Congress in 1986. She was known for championing women’s and reproductive rights during her time in the House. In 2007, she became the first woman to chair the powerful House Rules Committee.

Having grown up in Kentucky coal country, Slaughter went on to obtain a bachelor’s degree in microbiology and a master’s degree in public health. She then moved to New York City to work for Procter & Gamble, at which point she became interested in politics. In 1982, she was elected to New York’s State Assembly, where she remained until she won her U.S. House seat and became the first woman to represent western New York.

Some of the first policies she helped pass reflected her work as a defender of women: the allocation of $500 million in federal funding for breast cancer research and the mandated inclusion of women and minorities in all federal health trials. She co-authored the 1994 Violence Against Women Act, which offered legal avenues to women who were victims of crime.

Slaughter was part of the group of seven Democratic congressional women who in 1991 marched up the steps of the U.S. Capitol, attempting to delay the confirmation process for then-Supreme Court nominee Clarence Thomas. They were unsuccessful in demanding the male leaders of the Senate to fully investigate Anita Hill’s sexual harassment allegations against Thomas.

“There’s no monolithic way that women respond to this. But we are the people who write the laws of the land. Good Lord, she should have some recourse here,” Slaughter said at the time, according to The New York Times.

In 1996, she was one of only a handful of Democrats who voted against the Defense of Marriage Act, which the Supreme Court struck down in 2013, paving the way for LGBTQ couples to legally marry.

She marked her time as the first female chairwoman of the House Rules Committee from 2007 to 2011 by playing a role in passing other historic legislation, including the Affordable Care Act, the Lilly Ledbetter Fair Pay Act of 2009 and the Student Aid and Fiscal Responsibility Act. Slaughter was a co-chair and founding member of the Congressional Pro-Choice Caucus.

House Minority Leader Nancy Pelosi (D-Calif.) commemorated Slaughter as “a trailblazer.”

“Her strong example inspired countless young women to know their power, and seek their rightful place at the head of the decision-making table,” she said in a statement on Friday.

Rep. Pete Sessions (R-Texas), who currently chairs the Rules Committee, remembered Slaughter as “a fearless leader, deeply committed to her constituents, and a dear friend.”

“As the first female Chairwoman of our Committee, she was a force to be reckoned with, who always brought her spunk, fire, and dynamic leadership to every meeting,” Sessions said in a statement. “Although we sat on different sides of the aisle, I have always considered her a partner and have the utmost respect for her.”

Slaughter was married to husband Bob Slaughter for 57 years, until his death in 2014, according to her office. She is survived by three daughters, seven grandchildren, and one great-grandchild. 

This story has been updated with statements from Pelosi and Sessions.

Read more: http://www.huffingtonpost.com/entry/louise-slaughter-dies_us_5aabd5e2e4b0337adf8340f9

I have prostate cancer. But I am happy | George Monbiot

The three principles that define a good life will protect me from despair, says Guardian columnist George Monbiot

It came, as these things often do, like a gunshot on a quiet street: shocking and disorienting. In early December, my urine turned brown. The following day I felt feverish and found it hard to pee. I soon realised I had a urinary tract infection. It was unpleasant, but seemed to be no big deal. Now I know that it might havesavedmy life.

The doctor told me this infection was unusual in a man of my age, and hinted at an underlying condition. So I had a blood test, which revealed that my prostate-specific antigen (PSA) levels were off the scale. An MRI scan and a mortifying biopsy confirmed my suspicions. Prostate cancer: all the smart young men have itthisseason.

On Monday, I go into surgery. The prostate gland is buried deep in the body, so removing it is a major operation: there are six entry points and it takes four hours. The procedure will hack at the roots of my manhood. Because of the damage that will be caused to the surrounding nerves, theres a high risk of permanent erectile dysfunction. Because the urethra needs to be cut and reattached to the bladder, I will almost certainly suffer urinary incontinence for a few months, and possibly permanently. Because the removal of part of the urethra retracts the penis, it appears to shrink, at least until it can be stretched back into shape.

I was offered a choice: radical surgery or brachytherapy. This means implanting radioactive seeds in the parts of the prostate affected by cancer. Brachytherapy has fewer side effects, and recovery is much faster. But theres a catch. If it fails to eliminate the cancer, theres nothing more that can be done. This treatment sticks the prostate gland to the bowel and bladder, making surgery extremely difficult. Once youve had one dose of radiation, they wont give you another. I was told that the chances of brachytherapy working in my case were between 70 and 80%. The odds were worse, in other words, than playing Russian roulette (which, with one bullet in a six-chambered revolver, gives you 83%). Though I have a tendency to embrace risk, this was not an attractive option.

It would be easy to curse my luck and start to ask, Why me? I have never smoked and hardly drink; I have a ridiculously healthy diet and follow a severe fitness regime. Im 20 or 30 years younger than most of the men I see in the waiting rooms. In other words, I would have had a lower risk of prostate cancer only if I had been female. And yet I am happy. In fact, Im happier than I was before my diagnosis. How can this be?

The reason is that Ive sought to apply the three principles which, I believe, sit at the heart of a good life. The first is the most important: imagine how much worse it could be, rather than how much better.

When you are diagnosed with prostate cancer, your condition is ranked on the Gleason Score, which measures its level of aggression. Mine is graded at seven out of 10. But this doesnt tell me where I stand in general. I needed another index to assess the severity of my condition, so I invented one: the Shitstorm Scale. How does my situation compare to those of people I know, who contend with other medical problems or family tragedies? How does it compare to what might have been, had the cancer not been caught while it was still apparently confined to the prostate gland? How does it compare to innumerable other disasters that could have befallen me?

When I completed the exercise, I realised that this bad luck, far from being a cause of woe, is a reminder of how lucky I am. I have the love of my family and friends. I have the support of those with whom I work. I have the NHS. My Shitstorm Score is a mere two out of 10.

The tragedy of our times is that, rather than apply the most useful of English proverbs cheer up, it could be worse we are constantly induced to imagine how much better things could be. The rich lists and power lists with which the newspapers are filled, our wall-to-wall celebrity culture, the invidious billions spent on marketing and advertising, create an infrastructure of comparison that ensures we see ourselves as deprived of what others possess. It is a formula for misery.

The second principle is this: change what you can change, accept what you cant. This is not a formula for passivity Ive spent my working life trying to alter outcomes that might have seemed immovable to other people. The theme of my latest book is that political failure is, at heart, a failure of imagination. But sometimes we simply have to accept an obstacle as insuperable. Fatalism in these circumstances is protective. I accept that my lap is in the lap of the gods.

So I will not rage against the morbidity this surgery might cause. I wont find myself following Groucho Marx who, at the age of 81, magnificently lamented: Im going to Iowa to collect an award. Then Im appearing at Carnegie Hall, its sold out. Then Im sailing to France to pick up an honour from the French government. Id give it all up for one erection. And today theres Viagra.

The third principle is this: do not let fear rule your life. Fear hems us in, stops us from thinking clearly, and prevents us from either challenging oppression or engaging calmly with the impersonal fates. When I was told that this operation had an 80% chance of success, my first thought was thats roughly the same as one of my kayaking trips. And about twice as good as the chance of emerging from those investigations in West Papua and the Amazon.

There are, I believe, three steps to overcoming fear: name it, normalise it, socialise it. For too long, cancer has been locked in the drawer labelled Things We Dont Talk About. When we call it the Big C, it becomes, as the term suggests, not smaller, but larger in our minds. He Who Must Not Be Named is diminished by being identified, and diminished further when he becomes a topic of daily conversation.

The super-volunteer Jeanne Chattoe, whom I interviewed recently for another column, reminded me that, just 25 years ago, breast cancer was a taboo subject. Thanks to the amazing advocacy of its victims, this is almost impossible to imagine today. Now we need to do the same for other cancers. Let there be no moreterriblesecrets.

So I have sought to discuss my prostate cancer as I would discuss any other issue. I make no apologies for subjecting you to the grisly details: the more familiar they become, the less horrifying. In doing so, I socialise my condition. Last month, I discussed the remarkable evidence suggesting that a caring community enhances recovery and reduces mortality. In talking about my cancer with family and friends, I feel the love that I know will get me through this. The old strategy of suffering in silence could not have been more misguided.

I had intended to use this column to urge men to get themselves tested. But since my diagnosis, weve discovered two things. The first is that prostate cancer has overtaken breast cancer to become the third biggest cancer killer in the UK. The second is that the standard assessment (the PSA blood test) is of limited use. As prostate cancer in its early stages is likely to produce no symptoms, its hard to see what men can do to protect themselves. That urinary tract infection was a remarkably lucky break.

Instead, I urge you to support the efforts led by Prostate Cancer UK to develop a better test. Breast cancer has attracted twice as much money and research as prostate cancer, not because (as the Daily Mail suggests) men are the victims of injustice, but because womens advocacy has been so effective. Campaigns such as Men United and the Movember Foundation have sought to bridge this gap, but theres a long way to go. Prostate cancer is discriminatory: for reasons unknown, black men are twice as likely to suffer it as white men. Finding better tests and treatments is a matter of both urgencyand equity.

I will ride this out. I will own this disease, but I wont be defined by it: I will not be prostrated by my prostate. I will be gone for a few weeks but when I return, I do solemnly swear I will still be the argumentative old git with whom you are familiar.

George Monbiot is a Guardian columnist

Prostate Cancer UK can be contacted on 0800 0748383

Read more: https://www.theguardian.com/commentisfree/2018/mar/13/prostate-cancer-happy-diagnosis-operation