It was the ethical questions that were new. Is GH not a wise use of finite healthcare resources, or is the physician’s primary responsibility to the patient? If GH is given to most extremely short children to make them taller, will the definition of “extremely short” simply rise, negating the expected social benefit? If GH is given to short children whose parents can afford it, will shortness become a permanent mark of lower social origins? More of these issues are outlined in the ethics section. Whole meetings were devoted to these questions; pediatric endocrinology had become a specialty with its own bioethics issues.
Hormone levels may be drawn and evaluated before therapy is started. This may include an FSH, estradiol, and testosterone (free and total) for women. Men need a PSA (prostate specific antigen), estradiol, testosterone, and blood count prior to starting therapy. Thyroid hormone levels (TSH) may also be evaluated. In men, follow up levels, including a PSA, blood count and estradiol, may be obtained prior to some of the subsequent testosterone implantation. Men are encouraged to notify their primary care physician and obtain a digital rectal exam each year. Women are advised to continue their monthly self-breast exam and obtain a mammogram and/or pap smear as advised by their gynecologist or primary care physician.
Water soluble hormone s, however, act indirectly on target cell s. Since the cell membrane has a lipid bi-layer, it is hydrophobic, or water fearing. This simply means that anything that is water soluble is not getting through. Unlike lipid soluble hormone s, water soluble hormone s have to bind to receptor s on the surface of the target cell . Once the hormone is bound to the receptor , enzyme activity inside the cell is altered. Depending on the hormone , enzyme activity is increased or decreased. Water soluble hormone s include those that are derived from amino acids and polypeptide hormone s.