Gynecomastia https://greenmedinfo.com/taxonomy/term/6251/all en A case of prednisone-induced gynecomastia has been reported. https://greenmedinfo.com/article/case-prednisone-induced-gynecomastia-has-been-reported PMID:  Am J Med Sci. 2011 Aug 3. Epub 2011 Aug 3. PMID: 21817886 Abstract Title:  Breast Enlargement With Prednisone Treatment. Abstract:  A 17-year-old boy sought endocrine advice for an unusual gynecomastia that inexplicably recurred whenever he was treated with prednisone. This began at the age of 14, when the patient was diagnosed as having Addison&#039;s disease and was first treated with prednisone. An ensuing breast enlargement caused him to stop the medication and a regression of the gynecomastia was observed. Breast enlargement reappeared each time prednisone treatment resumed. Review of this problem led to the final diagnosis of congenital adrenal hyperplasia in a teenager who was genetically female but phenotypically male. https://greenmedinfo.com/article/case-prednisone-induced-gynecomastia-has-been-reported#comments Gynecomastia Prednisone Human: Case Report Sat, 13 Aug 2011 19:47:30 +0000 greenmedinfo 68089 at https://greenmedinfo.com A variety of drugs may contribute to gynecomastia. https://greenmedinfo.com/article/variety-drugs-may-contribute-gynecomastia PMID:  Can Fam Physician. 2010 Apr ;56(4):344-5. PMID: 20393092 Abstract Title:  Drug-induced gynecomastia in children and adolescents. Abstract:  QUESTION: I frequently see adolescent boys in my practice with transient gynecomastia. My management includes reassuring the boys and their families; however, I also understand that specific medication, alcohol, and drugs can cause gynecomastia. How common is this phenomenon, and what medications can induce gynecomastia? ANSWER: While gynecomastia is a physiologic phenomenon in most newborns and adolescents, it is important to consider pathologic conditions and medications that can cause breast enlargement. Antibiotics, antiulcer drugs, growth hormones, and chemotherapy have been reported to induce gynecomastia. Adolescents who use anabolic steroids, or who abuse alcohol, marijuana, heroin, or amphetamines, should be alerted to the fact that gynecomastia might develop. Treatment of drug-induced gynecomastia includes discontinuation of the offending drug. Very rarely is surgical intervention required. https://greenmedinfo.com/article/variety-drugs-may-contribute-gynecomastia#comments Cannabis Gynecomastia Acid Blockers Alcohol Consumption Amphetamine Antibiotics Chemotherapy Heroin Recombinant Bovine Growth Hormone (rBGH) Review Sat, 13 Aug 2011 19:50:50 +0000 greenmedinfo 68091 at https://greenmedinfo.com An epidemic of gynecomastia among haitian refugees was linked to phenothrin exposure. https://greenmedinfo.com/article/epidemic-gynecomastia-among-haitian-refugees-was-linked-phenothrin-exposure PMID:  Endocr Pract. 2003 Sep-Oct;9(5):370-5. PMID: 14583418 Abstract Title:  Epidemic of gynecomastia among haitian refugees: exposure to an environmental antiandrogen. Abstract:  OBJECTIVE: To investigate an observed epidemic of gynecomastia among Haitian refugees in US detention centers in 1981 and 1982.METHODS: All identifiable environmental exposures were investigated for estrogenic and antiandrogenic activity.RESULTS: A high incidence of gynecomastia was observed among Haitian refugees in five detention centers in the United States. Of 284 men screened, 20 (from 18 to 53 years old) demonstrated new-onset gynecomastia (Tanner stages 2 to 5) in June 1982. The mean onset of gynecomastia was 130 +/- 12 days after arrival in the United States. Other symptoms included loss of libido (in all 20 patients) and decreased beard growth (in 10). Plasma concentrations of luteinizing hormone, follicle-stimulating hormone, prolactin, testosterone, and estradiol were not significantly different from those in 20 age-matched control subjects. Environmental substances, including tap water and the delousing agents Kwell shampoo and R&amp;C Spray (applied to bedding and clothing), were tested for estrogenicity and androgenicity. None of these substances bound to cytosol estrogen receptors. The delousing agents were assayed for androgen binding by using genital skin fibroblasts. R&amp;C Spray competed equally with testosterone for androgen-binding sites. Phenothrin, the &quot;multi-cide&quot; component of R&amp;C Spray, reproduced this competitive binding result. When tested for antiandrogenic effects on prostate growth by using immature male rats treated with testosterone-filled Silastic capsules, phenothrin antagonized androgen action, as demonstrated by decreased prostate weights.CONCLUSION: The antiandrogenic activity of phenothrin may explain this unusual epidemic of gynecomastia. https://greenmedinfo.com/article/epidemic-gynecomastia-among-haitian-refugees-was-linked-phenothrin-exposure#comments Gynecomastia Anti-Androgen Anti-Androgenic Endocrine Disruptor Phenothrin Human Study Sun, 14 Aug 2011 13:26:39 +0000 greenmedinfo 68098 at https://greenmedinfo.com Dietary soy protein containing isoflavonoids does not adversely effect the reproductive tract in male macaques, nor does it cause gynecomastia. https://greenmedinfo.com/article/dietary-soy-protein-containing-isoflavonoids-does-not-adversely-effect-reprodu PMID:  J Nutr. 2007 Jun;137(6):1390-4. PMID: 17513396 Abstract Title:  Dietary soy protein containing isoflavonoids does not adversely affect the reproductive tract of male cynomolgus macaques (Macaca fascicularis). Abstract:  Short-term dietary studies of soy-protein-derived isoflavonoids, using rodent and nonhuman primate models, have documented variable effects on the reproductive tract. Long-term effects of dietary soy and/or isoflavonoids on the reproductive tract of nonhuman primates have not been determined. The objective of this study was to assess the effects of long-term consumption of dietary soy isoflavonoids on histomorphology of the mammary glands and prostate gland, testis, and sperm counts in adult male cynomolgus macaques. Ninety-one adult male cynomolgus macaques (Macaca fascicularis) were fed diets for 3 y differing only in protein source: 1) a soy-free, casein-lactalbumin-based diet or 2) a low-soy isoflavonoid diet ( approximately 6 mg . kg(-1) . d(-1)) or 3) a high-soy isoflavonoid diet ( approximately 12 mg . kg(-1) . d(-1)). Serum isoflavonoids were measured by liquid chromatographic-photodiode array electrospray MS. Mammary gland, prostate gland, and testes were obtained at postmortem and evaluated histopathologically and histomorphometrically. Epididymal and testicular sperm counts were performed. Serum isoflavonoid concentrations at 4 h postfeeding differed among all groups (P &lt; 0.001) and were (means +/- SEM) 67 +/- 23 (soy-free diet), 799 +/- 44 (low-soy isoflavonoid diet), and 1458 +/- 80 nmol . L(-1) (high-soy isoflavonoid diet). Diet did not alter serum estradiol and testosterone concentrations or epididymal and testicular sperm counts. Organ weights and histologic indices did not differ among treatment groups. Mammary gland histopathologic and histomorphometric analysis revealed no abnormalities and no indication of gynecomastia. We found no evidence of an adverse effect of soy isoflavonoids at physiologically relevant doses within the reproductive organs of adult male macaques. https://greenmedinfo.com/article/dietary-soy-protein-containing-isoflavonoids-does-not-adversely-effect-reprodu#comments Gynecomastia Male Hormone Imbalances Soy: Positive Data Animal Study Fri, 24 Jul 2009 00:56:17 +0000 greenmedinfo 45920 at https://greenmedinfo.com Gluten exorphin B5 enhances prolactin secretion in male rats. https://greenmedinfo.com/article/gluten-exorphin-b5-enhances-prolactin-secretion-male-rats PMID:  Life Sci. 2005 Feb 25;76(15):1713-9. Epub 2004 Dec 20. PMID: 15698850 Abstract Title:  Gluten exorphin B5 stimulates prolactin secretion through opioid receptors located outside the blood-brain barrier. Abstract:  Gluten exorphin B5 (GE-B5) is a food-derived opioid peptide identified in digests of wheat gluten. We have recently shown that GE-B5 stimulates prolactin (PRL) secretion in rats; this effect is abolished by preadministration of the opioid receptor antagonist naloxone. However, since the structure of naloxone allows it to cross the blood-brain barrier (BBB) and antagonize opioid effects centrally as well as peripherally, it could not established, on the basis of those data, if GE-B5-induced PRL release is exerted through sites located inside or outside the BBB. In this study, we sought to determine the site of action of GE-B5 on PRL secretion, by pretreating male rats with naloxone methobromide (NMB), an opioid antagonist that does not cross the BBB. Four groups of rats were given the following treatments: 1) intravenous vehicle; 2) intravenous GE-B5 (3 mg kg(-1) body weight); 3) intraperitoneal NMB (5 mg kg(-1) body weight), followed by vehicle; 4) NMB, followed by GE-B5. Blood samples for PRL were taken at intervals for 40 minutes after vehicle or GE-B5 administration. GE-B5 stimulated PRL secretion; the effect was statistically significant at time 20. NMB preadministration completely abolished PRL response. Our experiment indicates that GE-B5 stimulates PRL secretion through opioid receptors located outside the BBB. Since opioid peptides do not exert their effect on PRL secretion directly, but via a reduced dopaminergic tone, our data suggest that GE-B5 can modify brain neurotransmitter release without crossing the BBB. https://greenmedinfo.com/article/gluten-exorphin-b5-enhances-prolactin-secretion-male-rats#comments Gynecomastia Prolactin Hypersecretion Syndrome Gluten Exorphin B5 Animal Study Sat, 19 Jun 2010 18:44:48 +0000 greenmedinfo 55461 at https://greenmedinfo.com Gynecomastia may be associated with atorvastatin therapy. https://greenmedinfo.com/article/gynecomastia-may-be-associated-atorvastatin-therapy PMID:  Pharmacotherapy. 2006 Aug ;26(8):1165-8. PMID: 16863492 Abstract Title:  Golf-inhibiting gynecomastia associated with atorvastatin therapy. Abstract:  Gynecomastia can have a significant emotional and social impact on men. Although numerous drug therapies may cause this condition, we found no documented cases of gynecomastia associated with atorvastatin. We describe the development of breast enlargement and tenderness in a 52-year-old Caucasian man 6 months after his simvastatin therapy had been switched to atorvastatin. His symptoms ultimately interfered with his ability to play golf and participate in other activities. These problems resolved after atorvastatin discontinuation and did not recur despite resumption of simvastatin therapy. The gynecomastia in this patient represented a possible adverse effect of atorvastatin according to the Naranjo adverse drug reaction probability scale. The mechanism may be atorvastatin&#039;s theoretical suppression of adrenal or gonadal steroid production through effects on cholesterol synthesis. Based on this and other case reports, 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) should be considered as a potential cause when evaluating otherwise unexplainable cases of gynecomastia in patients taking these drugs. https://greenmedinfo.com/article/gynecomastia-may-be-associated-atorvastatin-therapy#comments Gynecomastia Statin-Induced Pathologies Anticholesteremic Agents Atorvastatin Statin Drugs Human: Case Report Mon, 24 Oct 2011 21:41:47 +0000 greenmedinfo 69250 at https://greenmedinfo.com Higher estradiol levels are associated with gynecomastia. https://greenmedinfo.com/article/higher-estradiol-levels-are-associated-gynecomastia PMID:  Dtsch Med Wochenschr. 1984 Nov 2 ;109(44):1678-82. PMID: 6489180 Abstract Title:  [Testosterone and estradiol levels in male gynecomastia. Clinical and endocrine findings during treatment with tamoxifen]. Abstract:  Oestradiol-(E2) levels in serum were significantly higher in a group of 91 males with gynaecomastia than in a control group. The levels were highest in patients with testicular tumour, hyperprolactinaemia and idiopathic gynaecomastia. In gynaecomastia of puberty and primary or secondary hypogonadism, the E2 level was within normal limits, but the testosterone/oestradiol ratio was significantly reduced. Tamoxifen, at a daily dose of 20 mg, was administered over 2-4 months to 16 patients with gynaecomastia. Of twelve patients with painful gynaecomastia ten became painfree. Gynaecomastia regressed partially or completely in 14 patients, in only 2 was it unchanged. There was no recurrence of gynaecomastia after discontinuing tamoxifen. Side-effects did not occur. It is concluded that tamoxifen is a promising alternative to the surgical treatment of gynaecomastia. https://greenmedinfo.com/article/higher-estradiol-levels-are-associated-gynecomastia#comments Estrogen Dominance Gynecomastia 17beta-estradiol Diseases that are Linked Drug: Tamoxifen Human Study Sat, 13 Aug 2011 19:04:34 +0000 greenmedinfo 68088 at https://greenmedinfo.com Ipriflavone accelerates clearance of estradiol (E2) through enhancing the activity of the enzyme estradiol 3-glucuronide. https://greenmedinfo.com/article/ipriflavone-accelerates-clearance-estradiol-e2-through-enhancing-activity-enzy PMID:  Biol Pharm Bull. 2004 Nov;27(11):1844-9. PMID: 15516735 Abstract Title:  Studies on the interactions between drugs and estrogen. III. Inhibitory effects of 29 drugs reported to induce gynecomastia on the glucuronidation of estradiol. Abstract:  To determine the inhibition effects of drugs on the glucuronidation of estradiol (E2), 29 drugs that have been reported to induce gynecomastia were examined in the presence of UDP-glucuronic acid using human hepatic microsomes (pooled) as the enzyme source. The percentage inhibition of the E2 glucuronidation was determined at drug concentrations of 1 microM (approximate therapeutic concentration) and 100 microM (non-clinical overdose concentration) based on the rate constants for the 3- and 17-glucuronidation of E2 (11.2 and 2.52 pmol/min/mg protein, respectively). The only drug that exhibited 50% or higher inhibition of the 3-glucuronidation at a concentration of 1 microM was manidipine (54.4%). When the concentration was 100 microM, manidipine exhibited 100% inhibition of the 3-glucuronidation, and other drugs that exhibited 50% or higher inhibition of the 3-glucuronidation were nicardipine (92%), nisoldipine (90%), nifedipine (84%), domperidone (81%), tacrolimus (80%), nitrendipine (77%) and ketoconazole (69%). Conversely, ipriflavone accelerated the formation of estradiol 3-glucuronide in the activity of 165% at the concentration of 100 microM. On the 17-glucuronidation, all of the drugs showed less than 50% inhibition at the concentration of 1 microM, but at the concentration of 100 microM, drugs that exhibited 50% or higher inhibition consisted of manidipine (79%), chlormadinone acetate (74%), nisoldipine (66%), nitrendipine (60%) and ketoconazole (55%). Although IC(50) values of these drugs were all lower than the K(m) value (285 microM) for the 3-glucuronidation of E2, they were higher than the K(m) value for the 17-glucuronidation (18.8 microM). Thus, the effect of the drugs on the E2 glucuronidation should be greater for hydroxy group at the C-3 than that at the C-17 of E2 molecule. On the other hand, metabolic clearances (V(max)/K(m)) of the 3- and 17-glucuronidation were about 1/14th and 1/18th of that of the 2-hydroxylation of E2, respectively. The result implies that, when the contribution of the glucuronidation to enterohepatic circulation is taken into consideration, the effect of this metabolic inhibition in the estrogen pool cannot be ignored. https://greenmedinfo.com/article/ipriflavone-accelerates-clearance-estradiol-e2-through-enhancing-activity-enzy#comments Estrogen Dominance Gynecomastia Ipriflavone Estradiol 3-glucuronide enhancer In Vitro Study Mon, 05 Apr 2010 15:51:27 +0000 greenmedinfo 53637 at https://greenmedinfo.com Men treated for metastatic prostate cancer with anti-androgen therapy commonly experience andropause symptoms. https://greenmedinfo.com/article/men-treated-metastatic-prostate-cancer-anti-androgen-therapy-commonly-experien PMID:  Cancer Nurs. 2011 May 9. Epub 2011 May 9. PMID: 21558849 Abstract Title:  Andropause Syndrome in Men Treated for Metastatic Prostate Cancer: A Qualitative Study of the Impact of Symptoms. Abstract:  BACKGROUND:: Androgen deprivation therapy (ADT) has become the cornerstone of treatment for men with metastatic prostate cancer. However, treatments are associated with a number of adverse effects that collectively are referred to as andropause syndrome, or the male menopause. OBJECTIVE:: This study explored the experience and impact of andropause symptoms, particularly hot flashes, among men undergoing ADT for metastatic prostate cancer. METHODS:: Twenty-one men receiving ADT for metastatic prostate cancer underwent a qualitative interview focusing on the adverse effects of ADT and the impact of these symptoms on daily living and coping strategies. RESULTS:: The most frequently mentioned adverse effects were hot flashes and night sweats, gynecomastia, cognitive decline, and changes in sexual function. Hot flashes did impact on everyday functioning, and night sweats regularly disturbed sleep patterns and led to participants feeling tired and irritable. Participants reported a lack of control over their hot flashes and night sweats. There was reluctance among our sample to disclose the type of symptoms experienced to others. CONCLUSION:: The occurrence of andropause symptoms, including hot flashes and night sweats, was common among this sample. Participants reported a range of cognitive and behavioral responses to these symptoms. There was some reluctance about discussing a prostate cancer diagnosis or the occurrence of symptoms with others. IMPLICATIONS FOR PRACTICE:: The findings have implications for a range of individual and couple interventions to manage the impact of this constellation of symptoms. https://greenmedinfo.com/article/men-treated-metastatic-prostate-cancer-anti-androgen-therapy-commonly-experien#comments Andropause Syndrome Gynecomastia Hot Flash Night Sweats Antiandrogen Endocrine Disruptor Human Study Sun, 26 Jun 2011 17:51:50 +0000 greenmedinfo 64923 at https://greenmedinfo.com Phthalate exposure may contribute to the development of pubertal gynecomastia. https://greenmedinfo.com/article/phthalate-exposure-may-contribute-development-pubertal-gynecomastia PMID:  Pediatrics. 2010 Jan;125(1):e122-9. Epub 2009 Dec 14. PMID: 20008419 Abstract Title:  Plasma phthalate levels in pubertal gynecomastia. Abstract:  OBJECTIVE: Several untoward health effects of phthalates, which are a group of industrial chemicals with many commercial uses including personal-care products and plastic materials, have been defined. The most commonly used, di-(2-ethylhexyl)-phthalate (DEHP), is known to have antiandrogenic or estrogenic effects or both. Mono-(2-ethylhexyl)-phthalate (MEHP) is the main metabolite of DEHP. In this study, we aimed to determine the plasma DEHP and MEHP levels in pubertal gynecomastia cases. PATIENTS AND METHODS: The study group comprised 40 newly diagnosed pubertal gynecomastia cases who were admitted to Hacettepe University Ihsan Doğramaci Children&#039;s Hospital. The control group comprised 21 age-matched children without gynecomastia or other endocrinologic disorder. Plasma DEHP and MEHP levels were measured by using high-performance liquid chromatography. Serum hormone levels were determined in some pubertal gynecomastia casesaccording to the physician&#039;s evaluation. RESULTS: Plasma DEHP and MEHP levels were found to be statistically significantly higher in the pubertal gynecomastia group compared with the control group (P https://greenmedinfo.com/article/phthalate-exposure-may-contribute-development-pubertal-gynecomastia#comments Childhood Chemical Exposures Gynecomastia Phthalates Human Study Mon, 05 Apr 2010 15:58:08 +0000 greenmedinfo 53638 at https://greenmedinfo.com Phthalates adversely affect reproductive outcomes and children's health. https://greenmedinfo.com/article/phthalates-adversely-affect-reproductive-outcomes-and-childrens-health PMID:  Int J Occup Med Environ Health. 2011 Jun ;24(2):115-41. Epub 2011 May 19. PMID: 21594692 Abstract Title:  Exposure to phthalates: reproductive outcome and children health. A review of epidemiological studies. Abstract:  Phthalates are a family of industrial chemicals that have been used for a variety of purposes. As the potential consequences of human exposure to phthalates have raised concerns in the general population, they have been studied in susceptible subjects such as pregnant women, infants and children. This article aims at evaluating the impact of exposure to phthalates on reproductive outcomes and children health by reviewing most recent published literature. Epidemiological studies focusing on exposure to phthalates and pregnancy outcome, genital development, semen quality, precocious puberty, thyroid function, respiratory symptoms and neurodevelopment in children for the last ten years were identified by a search of the PubMed, Medline, Ebsco, Agricola and Toxnet literature bases. The results from the presented studies suggest that there are strong and rather consistent indications that phthalates increase the risk of allergy and asthma and have an adverse impact on children&#039;s neurodevelopment reflected by quality of alertness among girls, decreased (less masculine) composite score in boys and attention deficit hyperactivity disorder. Results of few studies demonstrate negative associations between phthalate levels commonly experienced by the public and impaired sperm quality (concentration, morphology, motility). Phthalates negatively impact also on gestational age and head circumference; however, the results of the studies were not consistent. In all the reviewed studies, exposure to phthalates adversely affected the level of reproductive hormones (luteinizing hormone, free testosterone, sex hormone-binding globulin), anogenital distance and thyroid function. The urinary levels of phthalates were significantly higher in the pubertal gynecomastia group, in serum in girls with premature thelarche and in girls with precocious puberty. Epidemiological studies, in spite of their limitations, suggest that phthalates may affect reproductive outcome and children health. Considering the suggested health effects, more epidemiologic data is urgently needed and, in the meantime, precautionary policies must be implemented. https://greenmedinfo.com/article/phthalates-adversely-affect-reproductive-outcomes-and-childrens-health#comments Gynecomastia Premature Puberty Premature Thelarche Endocrine Disruptor Phthalates Review Sat, 13 Aug 2011 19:58:24 +0000 greenmedinfo 68094 at https://greenmedinfo.com Possible gynecomastia induced by rosuvastatin has been reported. https://greenmedinfo.com/article/possible-gynecomastia-induced-rosuvastatin-has-been-reported PMID:  Pharmacotherapy. 2008 Apr ;28(4):549-51. PMID: 18363539 Abstract Title:  Gynecomastia possibly induced by rosuvastatin. Abstract:  Gynecomastia is characterized by benign progressive enlargement of the male breast. A pharmacologic origin is identified in 10-20% of cases. Several case reports have associated this condition to the use of statins. However, to our knowledge, no case of rosuvastatin-induced gynecomastia has been reported in the literature. We describe a 57-year-old man who developed bilateral gynecomastia after 2 months of rosuvastatin therapy. After switching to a different statin, atorvastatin, his symptoms resolved within 1 month. Use of the Naranjo adverse drug reaction probability scale indicated a possible relationship between the patient&#039;s development of gynecomastia and rosuvastatin therapy. The relatively strong effect of rosuvastatin on inhibiting steroidogenesis might have explained why our patient&#039;s gynecomastia occurred only with this agent. Clinicians should be aware of the possibility of adverse endocrine reactions when statins are prescribed, including newer agents such as rosuvastatin. https://greenmedinfo.com/article/possible-gynecomastia-induced-rosuvastatin-has-been-reported#comments Gynecomastia Statin-Induced Pathologies Endocrine Disruptor Rosuvastatin Statin Drugs Human: Case Report Mon, 24 Oct 2011 21:06:01 +0000 greenmedinfo 69249 at https://greenmedinfo.com The rates of gynecomastia with leuprorelin have been found to range from 3 to 16% https://greenmedinfo.com/article/rates-gynecomastia-leuprorelin-have-been-found-range-3-16 PMID:  Lancet Oncol. 2005 Dec ;6(12):972-9. PMID: 16321765 Abstract Title:  Management of gynaecomastia in patients with prostate cancer: a systematic review. Abstract:  Patients with prostate cancer are increasingly being offered treatment with non-steroidal antiandrogen monotherapy, which offers potential quality-of-life benefits compared with other treatment. Non-steroidal antiandrogens directly antagonise androgen action in breast tissue, and indirectly increase the oestrogen concentration. Thus, the most troublesome side-effects of monotherapy with these drugs are gynaecomastia and breast pain. Patients younger than 60 years of age, who might not have symptoms of prostate cancer, are probably more concerned about their body image and the development of enlarged breasts than are those older than 60 years. Clinicians who seek a treatment for prostate cancer need information on simple and well-tolerated options for the management of gynaecomastia and breast pain. In this review, management options for gynaecomastia caused by hormonal manipulation in patients with prostate cancer are discussed. <p><a href="https://greenmedinfo.com/article/rates-gynecomastia-leuprorelin-have-been-found-range-3-16" target="_blank">read more</a></p> https://greenmedinfo.com/article/rates-gynecomastia-leuprorelin-have-been-found-range-3-16#comments Gynecomastia Prostate Cancer Anti-Androgenic Leuprorelin (Lupron) Human Study Sat, 29 Dec 2018 15:07:19 +0000 greenmedinfo 176638 at https://greenmedinfo.com