ADHD Expert

Dr Renata Schoeman has been in full-time private practice as a general psychiatrist (child, adolescent and adult psychiatry) since 2008, currently based in Oude Westhof (Bellville). Renata also holds appointments as senior lecturer in Leadership (USB) and as a virtual faculty member of USB Executive Development’s Neuroleadership programme. She serves on the advisory boards of various pharmaceutical companies, as a director of the Psychiatric Management Group (PsychMG) and is the co-convenor of the South African Society of Psychiatrist (SASOP) special interest group for adult ADHD, and co-founder of the Goldilocks and The Bear Foundation (www.gb4adhd.co.za) She is passionate about corporate mental health awareness and uses her neuroscience background to assist leaders in equipping them to become balanced, healthy and dynamic leaders that take their own and their team’s emotional, intellectual, social health and physical needs into account. Renata is academically active and enjoys research and collaborative work, has published in many peer-reviewed journals, and has presented at local and international congresses. She is regularly invited to present at conferences and to engage with the media. During her post-graduate studies, she trained at Harvard, Boston in neurocognition and neuroimaging. Her awards include, amongst others, the Young Minds in Psychiatry award from the American Psychiatric Association, the Discovery Foundation Fellowship award, a Thuthuka award from the NRF, and a MRC Fellowship. She also received the Top MBA student award and the Director’s award from USB for 2015. She was a finalist for the Businesswomen’s Association of South Africa’s Businesswoman of the Year Award for 2016, and received the Excellence in Media Work award from SASOP during 2016.

Doctors have to make special appeals for vital treatments such as hip operations and cataract surgery.

Women and girls born in Somalia make up more than a third of those identified, but 112 were UK-born.

Caster Semenya has been under scrutiny since her astounding performance at the African Championships in 2009, prompting the International Association of Athletics Federations (IAAF) to ask Athletics South Africa to carry out a gender test on the athlete.

Over the years this South African athlete has won many medals for the country, but it seems the controversy over her abnormally high levels of testosterone just won’t quieten down. 

A new study, funded by the IAAF, found that women runners born with high testosterone levels enjoy a “significant competitive advantage” on the field. This could reignite debate on the future participation of athletes such as Semenya whose gender was questioned.

In 2015, the Court of Arbitration for Sport (CAS) suspended the IAAF regulations in a challenge brought on behalf of India’s Chand, a sprinter, an athlete facing similar challenges to Semenya. 

It said there was not sufficient scientific evidence that natural testosterone boosts performance in hyperandrogenic women, and gave the agency two years to submit expert reports to the contrary.

The study, jointly sponsored by the sporting agency seeking to ban athletes with hyperandrogenism, comes three weeks before the  IAAF must present expert evidence on “the actual degree” of advantage women could gain. The deadline of July 27 is looming.

Hyperandrogenism is a condition that causes high natural levels of the male hormone, testosterone, in women.

Regulatory ban

Without proof, IAAF regulations excluding women with hyperandrogenism from competition are set to lapse. Track stars such as South Africa’s Caster Semenya and India’s Dutee Chand both endured banishment for failing so-called “gender tests”.

The new study, published in the British Journal of Sports Medicine, was funded by the IAAF and the World Anti-Doping Agency (WADA).

One of the authors, Stephane Bermon, is an IAAF consultant and a member of its working group on hyperandrogenic athletes.

The other, Pierre-Yves Garnier, is director of the IAAF’s health and science department. He returned to work in January after a three-month suspension in a probe linked to Russian athletics doping.

Their research relied on blood data from male and female athletes who competed in the World Championships in 2011 and 2013 – more than 2 100 samples in all.

Natural performance enhancer

It found that women with high natural testosterone levels performed better in the 400m sprint, 400m hurdles, and 800m middle-distance events than women with low levels.

They also outperformed them at pole-vaulting and hammer throw.

Depending on the event, performance improved by between 1.8 and 4.5%, the paper said.

This link, concluded the authors, “should be taken into account when the eligibility of women with hyperandrogenism to compete in the female category of competition is discussed”.

The study is an observational study that cannot determine conclusively that higher testosterone is what causes the performance boost, merely that an increase in one is associated with an increase in the other.

‘Hyperandrogenism regulations’

Testosterone, which can also be injected as a performance-enhancer, increases muscle mass and boosts physical strength

The issue of hyperandrogenism is controversial because it has pitted principles of fair competition against the rights of women born with a condition they have no control over.

In 2011, the IAAF introduced so-called “hyperandrogenism regulations” after a highly-emotive and public battle with South Africa’s Semenya.

The regulations allowed hyperandrogenic athletes to take medication to lower their testosterone levels to below 10 nanomoles per litre – considered a low level in men.

The natural range for women is about 10 times lower.

Semenya won gold in the 800m at the 2009 World Championships in Berlin, but was subsequently barred from competing for nearly a year while undergoing gender tests.

Discriminatory gender testing

Competitors say hyperandrogenic athletes enjoy an unfair physical advantage, but critics say gender testing is arbitrary, discriminatory and psychologically harmful.

“Our starting position is to defend, protect and promote fair female competition,” an IAAF statement quoted Bermon as saying.

“This study is one part of the evidence the IAAF will be submitting to the CAS,” he added.

There would be no impact on the World Championships in London in August, as the regulations remain suspended “pending the resolution of the CAS proceeding”, the association said.

Read more:

Victory boosts testosterone levels

FDA approves new testosterone drug

12 facts on women and testosterone

Round-the-clock fire warden patrols are also under way at 19 “highest risk” NHS trusts.

Popular hormone-based drugs for treating an enlarged prostate could increase men’s risk of type 2 diabetes, heart disease or stroke, a new study suggests.

A group of German men taking the drug Avodart (dutasteride) for three years wound up with higher blood sugar and cholesterol levels than men taking another class of prostate medication that does not affect male hormones, the researchers reported.

According to a Health24 article, the basis of most treatments for enlarged prostates is depriving the prostate of testosterone, a hormone that is needed for prostate cancer to develop and grow.

The current study was published online in the journal Hormone Molecular Biology and Clinical Investigation.

Honest discussion with patients

“Our small study suggests there are really adverse effects on metabolic function from these drugs that have not been reported previously,” said lead researcher Abdulmaged Traish. He is a professor of urology with the Boston University School of Medicine.

But Dr Ashutosh Tewari, chair of urology for the Icahn School of Medicine at Mount Sinai in New York City, said the new findings run counter to prior clinical trials of the drug, and do not warrant any change in use at this time.

Still, Traish believes urologists should talk about these new results with patients before prescribing either Avodart or another hormone-based prostate drug called Proscar (finasteride). Both are in the class of drugs known as 5-alpha-reductase inhibitors.

Better urination

The prostate is a walnut-sized gland surrounding the urethra where it connects to the bladder. The prostate produces fluid that goes into semen, and is essential for male fertility. But as men age, their prostates tend to enlarge, pinching the urethra and making urination more difficult.

Avodart reduces production of dihydrotestosterone (DHT), a hormone linked to enlargement of the prostate gland. Treatment with Avodart can cause a man’s prostate to shrink by roughly 18 to 20%, Traish noted.

“The men urinate a little bit better,” Traish said. “They don’t have to stand an hour and a half in the bathroom at the airport.”

However, DHT also plays an important role in the function of other organs, particularly the liver, Traish said. He and his colleagues are concerned that reducing DHT could have other unknown health effects.

To examine the issue, Traish’s team reviewed records of 460 men treated at a single urologist’s office in Germany for enlarged prostate.

Rise in blood sugar levels

Half of the men had been prescribed Avodart to treat their problem, and the other half had been prescribed Flomax (tamsulosin). Flomax, in the class of drugs known as alpha-blockers, does not affect hormones, but works by causing the smooth muscle tissue of the prostate to relax, Traish said.

The researchers tracked all of the men for 36 to 42 months, performing blood tests and assessing prostate size and function.

Avodart was linked to an ongoing rise in blood sugar levels among men who received the drug, while men taking Flomax did not experience any such increase, the study authors said.

Based on his findings, Traish said he would lean toward prescribing Flomax first rather than a hormone-based prostate drug.

Reliance on past data

“I would rather have my patient try something safer, and if it works for him, keep him on that,” Traish said.

Tewari noted that the clinical trials that found Avodart effective in treating enlarged prostate did not show any of these other metabolic problems.

Those clinical trials relied on men being randomly assigned Avodart, Tewari said. The men in this new study were not assigned medication randomly, but were allowed to choose their treatment following discussion with a doctor.

The new study also did not compare men taking Avodart to a control group taking a placebo, and relied on past data rather than an entirely new experiment, Tewari continued.

“This is interesting, yet needs to be verified in a controlled setting with a larger pool of patients,” Tewari explained. “At this time, I’m not too impressed with any clinical significance of this study.”

Read more:

Prevalence of enlarged prostate

Prevalence of enlarged prostate

Botox for enlarged prostate

In type 1 diabetes, the immune system attacks the cells in the pancreas that produce insulin, the hormone that helps usher sugar to cells to be used as fuel. 

A recent Swedish study found that almost half of people with type 1 diabetes are still producing some insulin more than a decade after being diagnosed with the disease.

This challenges previous assumptions that people with type 1 diabetes lose their ability to produce any insulin over time.

Researchers at Sweden’s Uppsala University, led by post-doctoral researcher Daniel Espes, reached their conclusions after studying more than 100 patients with type 1 diabetes.

The study appears in the June issue of Diabetes Care.

High levels of protein

The investigators found that people who still produced insulin despite their long-standing type 1 diabetes had higher levels of a protein called interleukin-35. This protein appears to play an important role in the immune system.

Past research had shown that both newly diagnosed people with type 1 diabetes and those who’ve had the disease for some time had lower average levels of interleukin-35 compared to healthy people.

Type 1 diabetes is an autoimmune disease that causes the body’s immune system to mistakenly attack healthy cells in the pancreas that make insulin, causing insufficient insulin production and uncontrolled blood glucose levels in the cardiovascular system leading to various health complications.

Prevalence of diabetes

According to Health24, three-and-a-half million South Africans – about 6% of the population – suffer from diabetes – with he highest prevalence among the Indian population (11–13%), as this group has a strong genetic predisposition for diabetes, followed by 8–10% in the coloured community, 5–8% among blacks and 4% among whites.

This leaves people without enough insulin to meet the body’s daily needs. To survive, people with type 1 diabetes must replace that lost insulin through multiple daily injections or through a tiny tube inserted under the skin every few days and then attached to an insulin pump.

The Uppsala researchers have launched a new study to see if they may be able to boost insulin production in those people with type 1 diabetes who are still making insulin.

Read more:

Transplant of insulin-producing cells – new hope for diabetics

Artificial Pancreas Helps Type 1 Diabetics During Sleep

Type 1 diabetes linked to gut