Estrogen pills are a common part of hormone replacement therapy (HRT) for transgender women and non-binary individuals assigned male at birth who wish to feminize their bodies. The hormones work by changing the distribution of body fat, encouraging breast development, reducing muscle mass, and triggering other changes like softening of the skin.

There are different types of estrogen that may be prescribed:

  1. Estradiol: This is the most common form of estrogen used in HRT for transgender women. It’s the same estrogen that cisgender women’s bodies produce naturally.
  2. Ethinylestradiol: This is a synthetic form of estrogen often used in contraceptive pills. It’s rarely used in transgender hormone therapy due to higher risks of blood clots.
  3. Conjugated Estrogens (Premarin): These are a mixture of various types of estrogens derived from the urine of pregnant horses. They are less commonly used now due to the availability of other forms of estrogen.

Estrogen is often taken in pill form but can also be administered through patches, gels, injections, or implants.

Additionally, anti-androgens might also be used in conjunction with estrogen. These medications block the effects of testosterone, which can make the effects of estrogen more pronounced. Common anti-androgens include spironolactone and finasteride.

It’s essential to remember that self-medication can be risky, and these medications should be taken under the guidance of a healthcare provider who can monitor your health and hormone levels to ensure safe and effective treatment. The specific type and dose of medication will depend on individual health factors, and the regimen can take some time to adjust for optimum effect and minimal side effects. Regular check-ups with your healthcare provider are important for monitoring the progress and potential side effects of hormone therapy.

As of my knowledge cut-off in September 2021, hormone replacement therapy for transgender individuals has been shown to be generally safe and effective when overseen by a qualified healthcare provider. However, it can have side effects and risks that should be discussed thoroughly with a healthcare provider.

Transgender

Definition: Transgender is an umbrella term used to describe individuals whose gender identity differs from the sex they were assigned at birth. Gender identity is a deeply-felt sense of being male, female, or another gender, and transgender people may identify as the gender opposite to the one they were assigned at birth.

Key Concepts:

  1. Gender Identity:
    • Transgender individuals have a gender identity that does not align with the sex assigned to them at birth. For example, a person assigned male at birth may identify as female.
  1. Transition:
    • Transitioning is the process by which transgender individuals express their gender identity and may involve social, medical, or legal aspects. Social transition may include changes in name, pronouns, clothing, and lifestyle.
  1. Gender Dysphoria:
    • Some transgender individuals may experience gender dysphoria, which is distress related to the incongruence between one’s gender identity and assigned sex at birth. Access to gender-affirming care, including hormone therapy and surgeries, can help alleviate gender dysphoria for some individuals.
  1. Gender Expression:
    • Gender expression refers to how individuals present their gender to others through clothing, behavior, hairstyle, or other means. It may or may not align with societal expectations associated with the sex assigned at birth.
  1. Hormone Replacement Therapy (HRT):
    • Transgender individuals may undergo hormone therapy to align their secondary sex characteristics with their gender identity. For example, transfeminine individuals may take estrogen to develop more feminine features.
  1. Gender Affirmation Surgery:
    • Some transgender individuals may choose to undergo gender affirmation surgeries, such as chest or breast augmentation, mastectomy, or genital reconstruction surgery, to align their physical appearance with their gender identity.
  1. Non-Binary and Genderqueer:
    • Some transgender individuals identify as non-binary or genderqueer, meaning their gender identity doesn’t fit within the traditional binary of male or female.
  1. Legal Recognition:
    • Efforts are ongoing to advocate for legal recognition of gender identity, including the right to change one’s name and gender marker on identification documents.
  1. Support and Advocacy:
    • Transgender individuals may seek support from community groups, mental health professionals, and advocacy organizations that work towards transgender rights and inclusion.
  1. Challenges:
    • Transgender individuals may face challenges such as discrimination, social stigma, and barriers to accessing gender-affirming care. Advocacy for transgender rights and increased awareness aim to address these challenges.

Understanding and respecting the experiences and identities of transgender individuals is crucial for fostering inclusivity and promoting their well-being.

Estrogen

Estrogen is a group of primary sex hormones that play a crucial role in the development and functioning of the female reproductive system. While estrogen is more prevalent in females, it is also present, though in lower amounts, in males. Estrogen belongs to a class of hormones called steroids and is produced primarily by the ovaries in females, although smaller amounts are produced by the adrenal glands and, during pregnancy, by the placenta.

Key Concepts:

  1. Types of Estrogen:
    • There are three main types of estrogen: estradiol, estrone, and estriol. Estradiol is the predominant form during the reproductive years and is the most potent.
  2. Role in Female Reproductive System:
    • Estrogen is crucial for the development and maintenance of female reproductive tissues, including the ovaries, uterus, and breasts. It also regulates the menstrual cycle.
  3. Secondary Sex Characteristics:
    • During puberty, estrogen promotes the development of secondary sex characteristics in females, such as breast development, widening of the hips, and the growth of pubic and underarm hair.
  4. Menstrual Cycle Regulation:
    • Estrogen, along with other hormones, regulates the menstrual cycle. It helps stimulate the growth of the uterine lining (endometrium) during the first half of the menstrual cycle.
  5. Bone Health:
    • Estrogen plays a crucial role in maintaining bone density. A decrease in estrogen levels, such as during menopause, can contribute to bone loss and an increased risk of osteoporosis.
  6. Cardiovascular Health:
    • Estrogen has protective effects on the cardiovascular system, including maintaining healthy blood vessel function and influencing cholesterol levels. The hormone’s decline after menopause is associated with an increased risk of heart disease.
  7. Hormone Replacement Therapy (HRT):
    • Estrogen is commonly used in hormone replacement therapy to alleviate symptoms of menopause, such as hot flashes, vaginal dryness, and mood swings. Transgender individuals may also take estrogen as part of hormone therapy to induce feminizing effects.
  8. Pregnancy and Fetal Development:
    • During pregnancy, estrogen levels increase to support fetal development. The hormone contributes to the growth of the uterus, regulates amniotic fluid levels, and helps prepare the breasts for breastfeeding.
  9. Estrogen Receptors:
    • Estrogen exerts its effects by binding to specific receptors, known as estrogen receptors, located in various tissues throughout the body.
  • Regulation and Feedback Loop:
    • The production of estrogen is regulated by a complex feedback loop involving the hypothalamus, pituitary gland, and ovaries. Negative feedback mechanisms help maintain hormonal balance.

Estrogen levels naturally fluctuate throughout a woman’s menstrual cycle, decrease during menopause, and play a crucial role in various aspects of female physiology. The use of estrogen in medical interventions, such as hormone replacement therapy, requires careful consideration and monitoring to manage potential risks and benefits.

Hormone therapy

Hormone therapy, also known as hormone replacement therapy (HRT), is a medical intervention involving the administration of hormones to either supplement a deficiency or create specific effects in the body. Hormone therapy is used for various purposes, including managing hormonal imbalances, alleviating symptoms associated with menopause, and inducing desired physical changes in transgender individuals.

Key Concepts:

  1. Hormones Used in Therapy:
    • Hormone therapy involves the administration of hormones such as estrogen, progesterone, testosterone, thyroid hormones, and others, depending on the specific medical condition or purpose.
  2. Menopausal Hormone Therapy:
    • Menopausal hormone therapy, often used in postmenopausal women, aims to alleviate symptoms like hot flashes, vaginal dryness, and mood swings. It typically involves estrogen and, if applicable, progesterone.
  3. Transgender Hormone Therapy:
    • Hormone therapy is used in transgender individuals to induce desired secondary sex characteristics. Transfeminine hormone therapy involves the administration of estrogen and sometimes anti-androgens, while transmasculine hormone therapy may include testosterone.
  4. Gender Affirmation:
    • In transgender individuals, hormone therapy is a crucial component of gender affirmation, helping align physical characteristics with gender identity.
  5. Dosage and Administration:
    • Hormones are administered through various methods, including oral pills, patches, injections, and topical gels or creams. The chosen method depends on the specific hormone, the desired effects, and individual preferences.
  6. Monitoring and Adjustments:
    • Regular monitoring of hormone levels and overall health is essential during hormone therapy. Dosages may be adjusted based on individual responses and health considerations.
  7. Menstrual Suppression:
    • Hormone therapy may be used to suppress menstruation in certain medical conditions or to address gender dysphoria in transgender individuals.
  8. Bone Health:
    • Estrogen, particularly in postmenopausal women, plays a role in maintaining bone density. Hormone therapy may help reduce the risk of osteoporosis.
  9. Risks and Benefits:
    • The use of hormone therapy comes with potential risks, including cardiovascular issues, blood clot formation, and certain cancers. The benefits must be weighed against these risks, and the decision to undergo hormone therapy should involve informed consent and ongoing medical supervision.
  • Fertility and Family Planning:
    • Hormone therapy may impact fertility, and individuals considering hormone therapy should discuss family planning options with their healthcare providers. Temporary or permanent infertility may occur depending on the hormones used and individual responses.

Hormone therapy is a specialized medical intervention that requires careful consideration of the individual’s overall health, medical history, and specific treatment goals. It should be administered under the guidance of qualified healthcare professionals who can monitor and adjust treatment plans as needed. The decision to undergo hormone therapy should involve a thorough discussion of potential risks, benefits, and individual preferences.

Gender affirmation

Gender affirmation refers to the process by which individuals, particularly transgender and gender-nonconforming individuals, take steps to align their physical appearance, social identity, and overall well-being with their gender identity. It involves various aspects, including social, medical, and legal changes, aimed at achieving a congruence between one’s self-identified gender and the way they are perceived and recognized by society.

Key Concepts:

  1. Social Transition:
    • Social transition is a significant aspect of gender affirmation, involving changes in name, pronouns, clothing, hairstyle, and other aspects of daily life to better align with one’s gender identity.
  2. Gender Expression:
    • Individuals engage in gender-affirming behaviors to express their gender identity authentically. This may include adopting mannerisms, clothing styles, and activities that align with their self-identified gender.
  3. Hormone Therapy:
    • Hormone therapy is a medical intervention used in gender affirmation to induce physical changes that align with an individual’s gender identity. For example, transgender women may undergo estrogen therapy, and transgender men may undergo testosterone therapy.
  4. Gender Affirmation Surgery:
    • Some individuals pursue gender affirmation surgeries to alter their physical characteristics, such as chest or breast augmentation, mastectomy, or genital reconstruction surgery. These procedures are chosen based on individual preferences and needs.
  5. Legal Recognition:
    • Changing legal documents, such as identification cards and driver’s licenses, to reflect one’s gender identity is a crucial step in gender affirmation. Legal recognition helps individuals access rights and benefits consistent with their affirmed gender.
  6. Support Networks:
    • Building support networks, including friends, family, and community groups, is vital for individuals undergoing gender affirmation. Social support can significantly impact mental health and well-being during the process.
  7. Counseling and Mental Health Support:
    • Mental health support, including counseling and therapy, is often an integral part of gender affirmation. Professionals can assist individuals in navigating the emotional and psychological aspects of the process.
  8. Education and Advocacy:
    • Education and advocacy efforts are essential for raising awareness, promoting inclusivity, and combating discrimination. Public understanding of gender diversity helps create a more supportive environment for those undergoing gender affirmation.
  9. Intersectionality:
    • Recognizing and addressing the intersectionality of identities, such as race, ethnicity, and socioeconomic status, is crucial in ensuring inclusive and equitable gender affirmation practices.
  • Continuum of Affirmation:
    • Gender affirmation is a lifelong and evolving process. It is not a one-time event but rather a continuum that may involve ongoing adjustments to reflect changes in identity, preferences, or medical advancements.

Gender affirmation is a deeply personal journey, and the steps taken vary among individuals. It is a process that evolves over time, and each person’s experience is unique. Cultivating a supportive and understanding environment, both personally and societally, is essential in fostering positive outcomes for those undergoing gender affirmation.

HRT (Hormone Replacement Therapy)

Hormone Replacement Therapy (HRT) is a medical intervention that involves the administration of hormones to replace or supplement the body’s natural hormone levels. HRT is commonly used to address hormonal imbalances due to aging, medical conditions, or, in specific cases, to induce desired physical changes in transgender individuals.

Key Concepts:

  1. Menopausal Hormone Therapy:
    • In postmenopausal individuals, especially women, HRT is used to alleviate symptoms associated with the decline in estrogen and progesterone levels. This can include hot flashes, vaginal dryness, mood swings, and sleep disturbances.
  1. Transgender Hormone Therapy:
    • HRT is a crucial component of gender-affirming care for transgender individuals. Transfeminine hormone therapy typically involves the administration of estrogen and anti-androgens, while transmasculine hormone therapy includes testosterone.
  1. Estrogen Therapy:
    • Estrogen, a hormone primarily associated with female reproductive health, is commonly used in HRT. It plays a key role in the development and maintenance of female secondary sex characteristics.
  1. Progesterone Therapy:
    • In individuals with a uterus, progesterone may be included in HRT to protect the uterine lining from overstimulation by estrogen and reduce the risk of endometrial hyperplasia.
  1. Testosterone Therapy:
    • Testosterone, a hormone primarily associated with male reproductive health, is used in transmasculine HRT to induce the development of male secondary sex characteristics.
  1. Anti-Androgen Therapy:
    • Anti-androgens may be prescribed in transfeminine HRT to suppress the effects of testosterone, allowing estrogen to have a more significant impact on the development of female secondary sex characteristics.
  1. Dosage and Administration:
    • Hormones in HRT can be administered through various methods, including oral pills, patches, injections, and topical gels or creams. The choice of administration depends on the specific hormone, desired effects, and individual preferences.
  1. Monitoring and Adjustments:
    • Regular monitoring of hormone levels and overall health is essential during HRT. Dosages may be adjusted based on individual responses, health considerations, and treatment goals.
  1. Fertility Considerations:
    • HRT may impact fertility, and individuals considering HRT should discuss family planning options with their healthcare providers. Temporary or permanent infertility may occur depending on the hormones used and individual responses.
  1. Risks and Benefits:
    • The use of HRT comes with potential risks, including cardiovascular issues, blood clot formation, and certain cancers. The benefits must be weighed against these risks, and the decision to undergo HRT should involve informed consent and ongoing medical supervision.

HRT is a specialized medical intervention that requires careful consideration of the individual’s overall health, medical history, and specific treatment goals. It should be administered under the guidance of qualified healthcare professionals who can monitor and adjust treatment plans as needed. The decision to undergo HRT should involve a thorough discussion of potential risks, benefits, and individual preferences.

 

Transition

Transition, in the context of gender identity, refers to the process by which individuals, particularly transgender people, take steps to align their gender expression and identity with their affirmed gender. Transitioning is a deeply personal and unique journey, and it can encompass various aspects of one’s life, including social, medical, and legal changes.

Key Concepts:

  1. Social Transition:
    • Social transition involves changes in external aspects of one’s life to align with their gender identity. This can include adopting a new name, using preferred pronouns, changing clothing styles, and adjusting other aspects of daily life.
  1. Gender Expression:
    • Individuals in the process of transitioning often explore and express their gender identity authentically. This can involve changes in hairstyle, clothing, and overall appearance to better reflect their affirmed gender.
  1. Coming Out:
    • Coming out is a significant part of the social transition, where individuals disclose their gender identity to friends, family, colleagues, and others. This process can be both liberating and challenging, and it varies for each individual.
  1. Hormone Replacement Therapy (HRT):
    • Some individuals may choose to undergo hormone therapy as part of their transition. Hormones, such as estrogen or testosterone, are administered to induce physical changes that align with one’s affirmed gender.
  1. Gender Affirmation Surgeries:
    • Gender affirmation surgeries, also known as gender confirmation surgeries, may be a part of the transition process for some individuals. These surgeries can include procedures like chest or breast augmentation, mastectomy, or genital reconstruction surgeries.
  1. Legal Changes:
    • Legal aspects of transition involve changing identification documents to reflect one’s affirmed gender. This can include updating names and gender markers on identification cards, driver’s licenses, and other official documents.
  1. Support Networks:
    • Building support networks is crucial during the transition process. Supportive friends, family, and community groups can provide emotional assistance and validation.
  1. Mental Health Support:
    • Mental health support, including counseling and therapy, is often an integral part of the transition process. Professionals can assist individuals in navigating the emotional and psychological aspects of the journey.
  1. Self-Discovery and Exploration:
    • Transition is a process of self-discovery and exploration, allowing individuals to better understand and express their gender identity. It involves ongoing self-reflection and growth.
  1. Intersectionality:
    • Recognizing the intersectionality of identities, such as race, ethnicity, and socioeconomic status, is crucial in ensuring inclusive and equitable support for individuals undergoing transition.

Transition is a unique and individualized journey, and there is no one-size-fits-all approach. It is important to respect each person’s autonomy in determining the steps they wish to take in their transition. Cultivating a supportive and understanding environment, both personally and societally, is crucial in fostering positive outcomes for those undergoing transition.

 

Feminizing hormones

Feminizing hormones are a key component of hormone replacement therapy (HRT) for transgender individuals assigned male at birth who wish to develop physical characteristics that align with a female gender identity. These hormones are typically administered as part of a comprehensive gender-affirming care plan. The primary goal of feminizing hormone therapy is to induce changes in secondary sex characteristics to promote a more feminine appearance.

Common Feminizing Hormones:

  1. Estrogen:
    • Estrogen is the primary hormone responsible for promoting feminine secondary sex characteristics. It plays a crucial role in breast development, fat redistribution, and softening of the skin.
  2. Anti-Androgens:
    • Anti-androgens are medications that block or reduce the effects of testosterone, the male sex hormone. Suppressing testosterone helps minimize masculine features and allows estrogen to exert feminizing effects more effectively.

Effects of Feminizing Hormones:

  1. Breast Development:
    • Estrogen contributes to the growth of breast tissue, resulting in breast development. The extent of development varies among individuals.
  2. Fat Redistribution:
    • Feminizing hormones promote the redistribution of body fat from a male-typical pattern (such as abdominal and upper body) to a more female-typical pattern (such as hips and thighs).
  3. Skin Changes:
    • Estrogen influences changes in skin texture, making it softer and potentially reducing oiliness.
  4. Body Hair Reduction:
    • Anti-androgens, in combination with estrogen, may lead to a reduction in body hair growth, including facial and chest hair.
  5. Softening of Facial Features:
    • Feminizing hormones can contribute to a softening of facial features, such as a reduction in jawline prominence.
  6. Decreased Muscle Mass:
    • Anti-androgens and estrogen may lead to a decrease in muscle mass, contributing to a more feminine body shape.
  7. Changes in Libido:
    • Hormone therapy can impact libido and sexual function. Some individuals may experience changes in sexual desire.

Administration and Monitoring:

  1. Administration:
    • Feminizing hormones are typically administered through oral pills, patches, injections, or topical gels. The chosen method depends on individual preferences, health considerations, and medical guidance.
  2. Monitoring:
    • Regular monitoring of hormone levels and overall health is essential during feminizing hormone therapy. Adjustments to dosages may be made based on individual responses and health considerations.

Considerations and Risks:

  1. Individual Responses:
    • Responses to feminizing hormones vary among individuals. Factors such as age, genetics, and overall health can influence the extent and speed of changes.
  2. Health Risks:
    • Like any medical intervention, feminizing hormone therapy carries potential risks, including blood clot formation, cardiovascular issues, and other side effects. Regular medical check-ups are crucial to monitor for potential complications.
  3. Fertility:
    • Feminizing hormones may impact fertility. Individuals considering hormone therapy should discuss family planning options with their healthcare providers.

Feminizing hormone therapy is a significant aspect of gender-affirming care and can contribute to the overall well-being and satisfaction of transgender women. It is crucial for individuals to undergo hormone therapy under the guidance of qualified healthcare professionals who can monitor their health and make adjustments to the treatment plan as needed.

Gender dysphoria

Gender dysphoria is a psychological term used to describe the distress or discomfort that may arise when an individual’s assigned gender at birth does not align with their deeply-felt sense of their own gender identity. It is important to note that gender dysphoria is not a mental illness; rather, it is the distress that can accompany incongruence between one’s gender identity and assigned gender.

Key Concepts:

  1. Gender Identity:
    • Gender dysphoria is closely tied to an individual’s gender identity, which is their internal and deeply-felt sense of being male, female, or another gender. When there is a misalignment between gender identity and assigned gender, gender dysphoria may occur.
  2. Manifestation:
    • Gender dysphoria can manifest in various ways, including emotional distress, anxiety, depression, or dissatisfaction with one’s body or social role.
  3. Onset:
    • Gender dysphoria can become apparent at different stages of life, often emerging during childhood, adolescence, or adulthood. It is not a universal experience, and its intensity varies among individuals.
  4. Diagnosis:
    • In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), gender dysphoria is a diagnostic category used by mental health professionals. It reflects the distress associated with the incongruence between assigned gender and gender identity.
  5. Social Dysphoria:
    • Social dysphoria refers to the distress caused by incongruence between one’s gender identity and how they are perceived and treated by others. This can include issues related to name, pronouns, clothing, and gender roles.
  6. Physical Dysphoria:
    • Physical dysphoria involves distress related to the incongruence between one’s gender identity and their physical characteristics. For example, a transgender woman may experience physical dysphoria related to facial hair or the absence of certain feminine features.
  7. Treatment Options:
    • Gender dysphoria can be alleviated or managed through various gender-affirming interventions. These may include social transition, hormone therapy, gender-affirming surgeries, and mental health support.
  8. Transgender Health Care:
    • Gender-affirming care, provided by knowledgeable and supportive healthcare professionals, plays a crucial role in addressing gender dysphoria. This may include access to hormone therapy, counseling, and, in some cases, gender affirmation surgeries.
  9. Legal Recognition:
    • Legal recognition of one’s gender identity, including name and gender marker changes on identification documents, is an important aspect of addressing social dysphoria.
  • Support Systems:
    • Having supportive friends, family, and community can significantly impact an individual’s experience of gender dysphoria. Creating a safe and affirming environment is crucial for mental well-being.

Ethical Considerations:

  • Mental health professionals aim to provide affirming and supportive care for individuals experiencing gender dysphoria. Affirmative and culturally competent practices involve respecting individuals’ gender identities, using correct names and pronouns, and understanding the unique challenges they may face.

It is essential to approach discussions about gender dysphoria with sensitivity and respect for individuals’ experiences. Access to gender-affirming care and support networks contributes to improved mental health outcomes for transgender individuals experiencing gender dysphoria.

Estradiol

Estradiol is a type of estrogen, which is a group of sex hormones that play a crucial role in the development and maintenance of female reproductive tissues. Among the various forms of estrogen, estradiol is the most potent and predominant form during the reproductive years. It is produced primarily by the ovaries in females, but smaller amounts are also produced by the adrenal glands.

Key Concepts:

  1. Role in Female Reproductive System:
    • Estradiol is a key hormone involved in the development and functioning of the female reproductive system. It is particularly important during the menstrual cycle and pregnancy.
  1. Menstrual Cycle:
    • During the menstrual cycle, estradiol levels fluctuate. Elevated levels of estradiol contribute to the growth and thickening of the uterine lining (endometrium) during the follicular phase of the menstrual cycle.
  1. Secondary Sex Characteristics:
    • Estradiol plays a crucial role in the development of secondary sex characteristics during puberty. This includes breast development, widening of the hips, and changes in body fat distribution.
  1. Bone Health:
    • Estradiol is associated with maintaining bone density. Its decline during menopause is linked to an increased risk of osteoporosis, a condition characterized by reduced bone density and an increased risk of fractures.
  1. Vaginal Health:
    • Estradiol contributes to the health of the vaginal epithelium and the maintenance of normal vaginal lubrication. Low levels of estradiol, especially during menopause, can lead to vaginal dryness and discomfort.
  1. Cardiovascular Health:
    • Estrogen, including estradiol, has been associated with cardiovascular health. It is believed to have protective effects on blood vessels and may influence cholesterol levels.
  1. Hormone Replacement Therapy (HRT):
    • Estradiol is commonly used in hormone replacement therapy (HRT) for postmenopausal women to alleviate symptoms such as hot flashes, vaginal dryness, and mood swings.
  1. Transgender Hormone Therapy:
    • In transgender hormone therapy, estradiol is used as part of feminizing hormone therapy for individuals assigned male at birth who wish to develop physical characteristics that align with a female gender identity.
  1. Administration:
    • Estradiol can be administered through various methods, including oral pills, patches, injections, and topical gels or creams. The chosen method depends on individual preferences, health considerations, and treatment goals.
  1. Monitoring:
    • Regular monitoring of hormone levels is essential during hormone therapy to ensure that estradiol levels are within a safe and effective range. Dosages may be adjusted based on individual responses and health considerations.

Risks and Considerations:

  • While estradiol is generally safe when used as prescribed, hormone therapy comes with potential risks, including an increased risk of blood clots, cardiovascular issues, and certain cancers. It is crucial for individuals undergoing hormone therapy to be monitored regularly by healthcare professionals.