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Friday, August 30, 2024

Blog

From Wikipedia, the free encyclopedia
https://en.wikipedia.org/wiki/Blog

The emergence and growth of blogs in the late 1990s coincided with the advent of web publishing tools that facilitated the posting of content by non-technical users who did not have much experience with HTML or computer programming. Previously, knowledge of such technologies as HTML and File Transfer Protocol had been required to publish content on the Web, and early Web users therefore tended to be hackers and computer enthusiasts. As of the 2010s, the majority are interactive Web 2.0 websites, allowing visitors to leave online comments, and it is this interactivity that distinguishes them from other static websites. In that sense, blogging can be seen as a form of social networking service. Indeed, bloggers not only produce content to post on their blogs but also often build social relations with their readers and other bloggers. Blog owners or authors often moderate and filter online comments to remove hate speech or other offensive content. There are also high-readership blogs which do not allow comments.

Many blogs provide commentary on a particular subject or topic, ranging from philosophy, religion, and arts to science, politics, and sports. Others function as more personal online diaries or online brand advertising of a particular individual or company. A typical blog combines text, digital images, and links to other blogs, web pages, and other media related to its topic. Most blogs are primarily textual, although some focus on art (art blogs), photographs (photoblogs), videos (video blogs or vlogs), music (MP3 blogs), and audio (podcasts). In education, blogs can be used as instructional resources; these are referred to as edublogs. Microblogging is another type of blogging, featuring very short posts.

Blog and blogging are now loosely used for content creation and sharing on social media, especially when the content is long-form and one creates and shares content on regular basis, so one could be maintaining a blog on Facebook or blogging on Instagram. A 2022 estimate suggested that there were over 600 million public blogs out of more than 1.9 billion websites.

History

An early example of a "diary" style blog consisting of text and images transmitted wirelessly in real-time from a wearable computer with head-up display, February 22, 1995

The term "weblog" was coined by Jorn Barger on December 17, 1997. The short form "blog" was coined by Peter Merholz, who jokingly broke the word weblog into the phrase we blog in the sidebar of his blog Peterme.com in May 1999. Shortly thereafter, Evan Williams at Pyra Labs used "blog" as both a noun and verb ("to blog", meaning "to edit one's weblog or to post to one's weblog") and devised the term "blogger" in connection with Pyra Labs' Blogger product, leading to the popularization of the terms.

Origins

Before blogging became popular, digital communities took many forms, including Usenet, commercial online services such as GEnie, Byte Information Exchange (BIX) and the early CompuServe, e-mail lists, and Bulletin Board Systems (BBS). In the 1990s, Internet forum software created running conversations with "threads". Threads are topical connections between messages on a virtual "corkboard".

Berners-Lee also created what is considered by Encyclopedia Britannica to be "the first 'blog'" in 1992 to discuss the progress made on creating the World Wide Web and software used for it.

From June 14, 1993, Mosaic Communications Corporation maintained their "What's New" list of new websites, updated daily and archived monthly. The page was accessible by a special "What's New" button in the Mosaic web browser.

In November 1993 Ranjit Bhatnagar started writing about interesting sites, pages and discussion groups he found on the internet, as well as some personal information, on his website Moonmilk, arranging them chronologically in a special section called Ranjit's HTTP Playground. Other early pioneers of blogging, such as Justin Hall, credit him with being an inspiration.

The earliest instance of a commercial blog was on the first business to consumer Web site created in 1995 by Ty, Inc., which featured a blog in a section called "Online Diary". The entries were maintained by featured Beanie Babies that were voted for monthly by Web site visitors.

The modern blog evolved from the online diary where people would keep a running account of the events in their personal lives. Most such writers called themselves diarists, journalists, or journalers. Justin Hall, who began personal blogging in 1994 while a student at Swarthmore College, is generally recognized as one of the earlier bloggers, as is Jerry Pournelle. Dave Winer's Scripting News is also credited with being one of the older and longer running weblogs. The Australian Netguide magazine maintained the Daily Net News on their web site from 1996. Daily Net News ran links and daily reviews of new websites, mostly in Australia.

Another early blog was Wearable Wireless Webcam, an online shared diary of a person's personal life combining text, digital video, and digital pictures transmitted live from a wearable computer and EyeTap device to a web site in 1994. This practice of semi-automated blogging with live video together with text was referred to as sousveillance, and such journals were also used as evidence in legal matters. Some early bloggers, such as The Misanthropic Bitch, who began in 1997, actually referred to their online presence as a zine, before the term blog entered common usage.

The first research paper about blogging was Torill Mortensen and Jill Walker Rettberg's paper "Blogging Thoughts", which analysed how blogs were being used to foster research communities and the exchange of ideas and scholarship, and how this new means of networking overturns traditional power structures.

Technology

Early blogs were simply manually updated components of common Websites. In 1995, the "Online Diary" on the Ty, Inc. Web site was produced and updated manually before any blogging programs were available. Posts were made to appear in reverse chronological order by manually updating text-based HTML code using FTP software in real time several times a day. To users, this offered the appearance of a live diary that contained multiple new entries per day. At the beginning of each new day, new diary entries were manually coded into a new HTML file, and at the start of each month, diary entries were archived into their own folder, which contained a separate HTML page for every day of the month. Then, menus that contained links to the most recent diary entry were updated manually throughout the site. This text-based method of organizing thousands of files served as a springboard to define future blogging styles that were captured by blogging software developed years later.

The evolution of electronic and software tools to facilitate the production and maintenance of Web articles posted in reverse chronological order made the publishing process feasible for a much larger and less technically-inclined population. Ultimately, this resulted in the distinct class of online publishing that produces blogs we recognize today. For instance, the use of some sort of browser-based software is now a typical aspect of "blogging". Blogs can be hosted by dedicated blog hosting services, on regular web hosting services, or run using blog software.

Rise in popularity

After a slow start, blogging rapidly gained in popularity. Blog usage spread during 1999 and the years following, being further popularized by the near-simultaneous arrival of the first hosted blog tools:

  • Bruce Ableson launched Open Diary in October 1998, which soon grew to thousands of online diaries. Open Diary innovated the reader comment, becoming the first blog community where readers could add comments to other writers' blog entries.
  • Brad Fitzpatrick started LiveJournal in March 1999.
  • Andrew Smales created Pitas.com in July 1999 as an easier alternative to maintaining a "news page" on a Web site, followed by DiaryLand in September 1999, focusing more on a personal diary community.
  • Blogger (blogspot.com) was launched in 1999

Political impact

On December 6, 2002, Josh Marshall's talkingpointsmemo.com blog called attention to U.S. Senator Lott's comments regarding Senator Thurmond. Senator Lott was eventually to resign his Senate leadership position over the matter.

An early milestone in the rise in importance of blogs came in 2002, when many bloggers focused on comments by U.S. Senate Majority Leader Trent Lott. Senator Lott, at a party honoring U.S. Senator Strom Thurmond, praised Senator Thurmond by suggesting that the United States would have been better off had Thurmond been elected president. Lott's critics saw these comments as tacit approval of racial segregation, a policy advocated by Thurmond's 1948 presidential campaign. This view was reinforced by documents and recorded interviews dug up by bloggers. (See Josh Marshall's Talking Points Memo.) Though Lott's comments were made at a public event attended by the media, no major media organizations reported on his controversial comments until after blogs broke the story. Blogging helped to create a political crisis that forced Lott to step down as majority leader.

Similarly, blogs were among the driving forces behind the "Rathergate" scandal. Television journalist Dan Rather presented documents on the CBS show 60 Minutes that conflicted with accepted accounts of President Bush's military service record. Bloggers declared the documents to be forgeries and presented evidence and arguments in support of that view. Consequently, CBS apologized for what it said were inadequate reporting techniques (see: Little Green Footballs). The impact of these stories gave greater credibility to blogs as a medium of news dissemination.

In Russia, some political bloggers have started to challenge the dominance of official, overwhelmingly pro-government media. Bloggers such as Rustem Adagamov and Alexei Navalny have many followers, and the latter's nickname for the ruling United Russia party as the "party of crooks and thieves" has been adopted by anti-regime protesters. This led to The Wall Street Journal calling Navalny "the man Vladimir Putin fears most" in March 2012.

Mainstream popularity

By 2004, the role of blogs became increasingly mainstream, as political consultants, news services, and candidates began using them as tools for outreach and opinion forming. Blogging was established by politicians and political candidates to express opinions on war and other issues and cemented blogs' role as a news source. (See Howard Dean and Wesley Clark.) Even politicians not actively campaigning, such as the UK's Labour Party's Member of Parliament (MP) Tom Watson, began to blog to bond with constituents. In January 2005, Fortune magazine listed eight bloggers whom business people "could not ignore": Peter Rojas, Xeni Jardin, Ben Trott, Mena Trott, Jonathan Schwartz, Jason Goldman, Robert Scoble, and Jason Calacanis.

Israel was among the first national governments to set up an official blog. Under David Saranga, the Israeli Ministry of Foreign Affairs became active in adopting Web 2.0 initiatives, including an official video blog and a political blog. The Foreign Ministry also held a microblogging press conference via Twitter about its war with Hamas, with Saranga answering questions from the public in common text-messaging abbreviations during a live worldwide press conference. The questions and answers were later posted on IsraelPolitik, the country's official political blog.

The impact of blogging on the mainstream media has also been acknowledged by governments. In 2009, the presence of the American journalism industry had declined to the point that several newspaper corporations were filing for bankruptcy, resulting in less direct competition between newspapers within the same circulation area. Discussion emerged as to whether the newspaper industry would benefit from a stimulus package by the federal government. U.S. President Barack Obama acknowledged the emerging influence of blogging upon society by saying, "if the direction of the news is all blogosphere, all opinions, with no serious fact-checking, no serious attempts to put stories in context, then what you will end up getting is people shouting at each other across the void, but not a lot of mutual understanding". Between 2009 and 2012, an Orwell Prize for blogging was awarded.

In the late 2000s, blogs were often used on business websites and for grassroots political activism.

Types

A screenshot from the BlogActive website

There are many different types of blogs, differing not only in the type of content, but also in the way that content is delivered or written.

Personal blogs
The personal blog is an ongoing online diary or commentary written by an individual, rather than a corporation or organization. While the vast majority of personal blogs attract very few readers, other than the blogger's immediate family and friends, a small number of personal blogs have become popular, to the point that they have attracted lucrative advertising sponsorship. A tiny number of personal bloggers have become famous, both in the online community and in the real world.
Collaborative blogs or group blogs
A type of weblog in which posts are written and published by more than one author. The majority of high-profile collaborative blogs are organised according to a single uniting theme, such as politics, technology or advocacy. In recent years, the blogosphere has seen the emergence and growing popularity of more collaborative efforts, often set up by already established bloggers wishing to pool time and resources, both to reduce the pressure of maintaining a popular website and to attract a larger readership.
Microblogging
Microblogging is the practice of posting small pieces of digital content—which could be text, pictures, links, short videos, or other media—on the internet. Microblogging offers a portable communication mode that feels organic and spontaneous to many users. It has captured the public imagination, in part because the short posts are easy to read on the go or when waiting. Friends use it to keep in touch, business associates use it to coordinate meetings or share useful resources, and celebrities and politicians (or their publicists) microblog about concert dates, lectures, book releases, or tour schedules. A wide and growing range of add-on tools enables sophisticated updates and interaction with other applications. The resulting profusion of functionality is helping to define new possibilities for this type of communication. Examples of these include Twitter, Facebook, Tumblr and, by far the largest, Weibo.
Corporate and organizational blogs
A blog can be private, as in most cases, or it can be for business or not-for-profit organization or government purposes. Blogs used internally and only available to employees via an Intranet are called corporate blogs. Companies use internal corporate blogs to enhance the communication, culture and employee engagement in a corporation. Internal corporate blogs can be used to communicate news about company policies or procedures, build employee esprit de corps and improve morale. Companies and other organizations also use external, publicly accessible blogs for marketing, branding, or public relations purposes. Some organizations have a blog authored by their executive; in practice, many of these executive blog posts are penned by a ghostwriter who makes posts in the style of the credited author. Similar blogs for clubs and societies are called club blogs, group blogs, or by similar names; typical use is to inform members and other interested parties of club and member activities.
Aggregated blogs
Individuals or organization may aggregate selected feeds on a specific topic, product or service and provide a combined view for its readers. This allows readers to concentrate on reading instead of searching for quality on-topic content and managing subscriptions. Many such aggregations called planets from name of Planet (software) that perform such aggregation, hosting sites usually have planet. subdomain in domain name (like http://planet.gnome.org/).
By genre
Some blogs focus on a particular subject, such as political blogs, journalism blogs, health blogs, travel blogs (also known as travelogs), gardening blogs, house blogs, Book Blogs, fashion blogs, beauty blogs, lifestyle blogs, party blogs, wedding blogs, photography blogs, project blogs, psychology blogs, sociology blogs, education blogs, niche blogs, classical music blogs, quizzing blogs, legal blogs (often referred to as a blawgs), or dreamlogs. How-to/Tutorial blogs are becoming increasing popular. Two common types of genre blogs are art blogs and music blogs. A blog featuring discussions, especially about home and family is not uncommonly called a mom blog. While not a legitimate type of blog, one used for the sole purpose of spamming is known as a splog.
By media type
A blog comprising videos is called a vlog, one comprising links is called a linklog, a site containing a portfolio of sketches is called a sketchblog or one comprising photos is called a photoblog. Blogs with shorter posts and mixed media types are called tumblelogs. Blogs that are written on typewriters and then scanned are called typecast or typecast blogs. A rare type of blog hosted on the Gopher Protocol is known as a phlog.
By device
A blog can also be defined by which type of device is used to compose it. A blog written by a mobile device like a mobile phone or PDA could be called a moblog. One early blog was Wearable Wireless Webcam, an online shared diary of a person's personal life combining text, video, and pictures transmitted live from a wearable computer and EyeTap device to a web site. This practice of semi-automated blogging with live video together with text was referred to as sousveillance. Such journals have been used as evidence in legal matters.
Reverse blog
A reverse blog is composed by its users rather than a single blogger. This system has the characteristics of a blog and the writing of several authors. These can be written by several contributing authors on a topic or opened up for anyone to write. There is typically some limit to the number of entries to keep it from operating like a web forum.

Community and cataloging

An artist's depiction of the interconnections between blogs and blog authors in the "blogosphere" in 2007
Blogosphere
The collective community of all blogs and blog authors, particularly notable and widely read blogs, is known as the blogosphere. Since all blogs are on the internet by definition, they may be seen as interconnected and socially networked, through blogrolls, comments, linkbacks (refbacks, trackbacks or pingbacks), and backlinks. Discussions "in the blogosphere" were occasionally used by the media as a gauge of public opinion on various issues. Because new, untapped communities of bloggers and their readers can emerge in the space of a few years, Internet marketers pay close attention to "trends in the blogosphere".
Blog search engines
Several blog search engines have been used to search blog contents, such as Bloglines (defunct), BlogScope (defunct), and Technorati (defunct).
Blogging communities and directories
Several online communities exist that connect people to blogs and bloggers to other bloggers. Interest-specific blogging platforms are also available. For instance, Blogster has a sizable community of political bloggers among its members. Global Voices aggregates international bloggers, "with emphasis on voices that are not ordinarily heard in international mainstream media."
Blogging and advertising
It is common for blogs to feature banner advertisements or promotional content, either to financially benefit the blogger, support website hosting costs, or to promote the blogger's favourite causes or products. The popularity of blogs has also given rise to "fake blogs" in which a company will create a fictional blog as a marketing tool to promote a product.

As the popularity of blogging continued to rise (as of 2006), the commercialisation of blogging is rapidly increasing. Many corporations and companies collaborate with bloggers to increase advertising and engage online communities with their products. In the book Fans, Bloggers, and Gamers, Henry Jenkins stated that "Bloggers take knowledge into their own hands, enabling successful navigation within and between these emerging knowledge cultures. One can see such behaviour as co-optation into commodity culture insofar as it sometimes collaborates with corporate interests, but one can also see it as increasing the diversity of media culture, providing opportunities for greater inclusiveness, and making more responsive to consumers."

Early popularity

  • Before 2006: The blogdex project was launched by researchers in the MIT Media Lab to crawl the Web and gather data from thousands of blogs to investigate their social properties. Information was gathered by the tool for over four years, during which it autonomously tracked the most contagious information spreading in the blog community, ranking it by recency and popularity. It can, therefore, be considered the first instantiation of a memetracker. The project was replaced by tailrank.com, which in turn has been replaced by spinn3r.com.
  • 2006: Blogs are given rankings by Alexa Internet (web hits of Alexa Toolbar users), and formerly by blog search engine Technorati based on the number of incoming links (Technorati stopped doing this in 2014). In August 2006, Technorati found that the most linked-to blog on the internet was that of Chinese actress Xu Jinglei. Chinese media Xinhua reported that this blog received more than 50 million page views, claiming it to be the most popular blog in the world at the time. Technorati rated Boing Boing to be the most-read group-written blog.
  • 2008: As of 2008, blogging had become such a mania that a new blog was created every second of every minute of every hour of every day. Researchers have actively analyzed the dynamics of how blogs become popular. There are essentially two measures of this: popularity through citations, as well as popularity through affiliation (i.e., blogroll). The basic conclusion from studies of the structure of blogs is that while it takes time for a blog to become popular through blogrolls, permalinks can boost popularity more quickly and are perhaps more indicative of popularity and authority than blogrolls since they denote that people are actually reading the blog's content and deem it valuable or noteworthy in specific cases.

Blurring with the mass media

Many bloggers, particularly those engaged in participatory journalism, are amateur journalists, and thus they differentiate themselves from the professional reporters and editors who work in mainstream media organizations. Other bloggers are media professionals who are publishing online, rather than via a TV station or newspaper, either as an add-on to a traditional media presence (e.g., hosting a radio show or writing a column in a paper newspaper), or as their sole journalistic output. Some institutions and organizations see blogging as a means of "getting around the filter" of media "gatekeepers" and pushing their messages directly to the public. Many mainstream journalists, meanwhile, write their own blogs—well over 300, according to CyberJournalist.net's J-blog list. The first known use of a blog on a news site was in August 1998, when Jonathan Dube of The Charlotte Observer published one chronicling Hurricane Bonnie.

Some bloggers have moved over to other media. The following bloggers (and others) have appeared on radio and television: Duncan Black (known widely by his pseudonym, Atrios), Glenn Reynolds (Instapundit), Markos Moulitsas Zúniga (Daily Kos), Alex Steffen (Worldchanging), Ana Marie Cox (Wonkette), Nate Silver (FiveThirtyEight.com), and Ezra Klein (Ezra Klein blog in The American Prospect, now in The Washington Post''). In counterpoint, Hugh Hewitt exemplifies a mass media personality who has moved in the other direction, adding to his reach in "old media" by being an influential blogger. Similarly, it was Emergency Preparedness and Safety Tips On Air and Online blog articles that captured Surgeon General of the United States Richard Carmona's attention and earned his kudos for the associated broadcasts by talk show host Lisa Tolliver and Westchester Emergency Volunteer Reserves-Medical Reserve Corps Director Marianne Partridge.

Blogs have also had an influence on minority languages, bringing together scattered speakers and learners; this is particularly so with blogs in Gaelic languages. Minority language publishing (which may lack economic feasibility) can find its audience through inexpensive blogging. There are examples of bloggers who have published books based on their blogs, e.g., Salam Pax, Ellen Simonetti, Jessica Cutler, and ScrappleFace. Blog-based books have been given the name blook. A prize for the best blog-based book was initiated in 2005, the Lulu Blooker Prize. However, success has been elusive offline, with many of these books not selling as well as their blogs. The book based on Julie Powell's blog "The Julie/Julia Project" was made into the film Julie & Julia, apparently the first to do so.

Consumer-generated advertising

Consumer-generated advertising is a relatively new and controversial development, and it has created a new model of marketing communication from businesses to consumers. Among the various forms of advertising on blog, the most controversial are the sponsored posts. These are blog entries or posts and may be in the form of feedback, reviews, opinion, videos, etc. and usually contain a link back to the desired site using a keyword or several keywords. Blogs have led to some disintermediation and a breakdown of the traditional advertising model, where companies can skip over the advertising agencies (previously the only interface with the customer) and contact the customers directly via social media websites. On the other hand, new companies specialised in blog advertising have been established to take advantage of this new development as well. However, there are many people who look negatively on this new development. Some believe that any form of commercial activity on blogs will destroy the blogosphere's credibility.

Blogging can result in a range of legal liabilities and other unforeseen consequences.

Defamation or liability

Several cases have been brought before the national courts against bloggers concerning issues of defamation or liability. U.S. payouts related to blogging totalled $17.4 million by 2009; in some cases these have been covered by umbrella insurance. The courts have returned with mixed verdicts. Internet Service Providers (ISPs), in general, are immune from liability for information that originates with third parties (U.S. Communications Decency Act and the EU Directive 2000/31/EC). In Doe v. Cahill, the Delaware Supreme Court held that stringent standards had to be met to unmask the anonymous bloggers and also took the unusual step of dismissing the libel case itself (as unfounded under American libel law) rather than referring it back to the trial court for reconsideration. In a bizarre twist, the Cahills were able to obtain the identity of John Doe, who turned out to be the person they suspected: the town's mayor, Councilman Cahill's political rival. The Cahills amended their original complaint, and the mayor settled the case rather than going to trial.

In January 2007, two prominent Malaysian political bloggers, Jeff Ooi and Ahirudin Attan, were sued by a pro-government newspaper, The New Straits Times Press (Malaysia) Berhad, Kalimullah bin Masheerul Hassan, Hishamuddin bin Aun and Brenden John a/l John Pereira over alleged defamation. The plaintiff was supported by the Malaysian government. Following the suit, the Malaysian government proposed to "register" all bloggers in Malaysia to better control parties against their interests. This is the first such legal case against bloggers in the country. In the United States, blogger Aaron Wall was sued by Traffic Power for defamation and publication of trade secrets in 2005. According to Wired magazine, Traffic Power had been "banned from Google for allegedly rigging search engine results." Wall and other "white hat" search engine optimization consultants had exposed Traffic Power in what they claim was an effort to protect the public. The case was dismissed for lack of personal jurisdiction, and Traffic Power failed to appeal within the allowed time.

In 2009, NDTV issued a legal notice to Indian blogger Kunte for a blog post criticizing their coverage of the Mumbai attacks. The blogger unconditionally withdrew his post, which resulted in several Indian bloggers criticizing NDTV for trying to silence critics.

Employment

Employees who blog about elements of their place of employment can begin to affect the reputation of their employer, either in a positive way, if the employee is praising the employer and its workplaces, or in a negative way, if the blogger is making negative comments about the company or its practices.

In general, attempts by employee bloggers to protect themselves by maintaining anonymity have proved ineffective. In 2009, a controversial and landmark decision by The Hon. Mr Justice Eady refused to grant an order to protect the anonymity of Richard Horton. Horton was a police officer in the United Kingdom who blogged about his job under the name "NightJack".

Delta Air Lines fired flight attendant Ellen Simonetti because she posted photographs of herself in uniform on an aeroplane and because of comments posted on her blog "Queen of Sky: Diary of a Flight Attendant" which the employer deemed inappropriate. This case highlighted the issue of personal blogging and freedom of expression versus employer rights and responsibilities, and so it received wide media attention. Simonetti took legal action against the airline for "wrongful termination, defamation of character and lost future wages". The suit was postponed while Delta was in bankruptcy proceedings.

In early 2006, Erik Ringmar, a senior lecturer at the London School of Economics, was ordered by the convenor of his department to "take down and destroy" his blog in which he discussed the quality of education at the school.

Mark Jen was terminated in 2005 after 10 days of employment as an assistant product manager at Google for discussing corporate secrets on his personal blog, then called 99zeros and hosted on the Google-owned Blogger service. He blogged about unreleased products and company finances a week before the company's earnings announcement. He was fired two days after he complied with his employer's request to remove the sensitive material from his blog.

In India, blogger Gaurav Sabnis resigned from IBM after his posts questioned the claims made by a management school. Jessica Cutler, aka "The Washingtonienne", blogged about her sex life while employed as a congressional assistant. After the blog was discovered and she was fired, she wrote a novel based on her experiences and blog: The Washingtonienne: A Novel. As of 2006, Cutler is being sued by one of her former lovers in a case that could establish the extent to which bloggers are obligated to protect the privacy of their real life associates.

Catherine Sanderson, a.k.a. Petite Anglaise, lost her job in Paris at a British accountancy firm because of blogging. Although given in the blog in a fairly anonymous manner, some of the descriptions of the firm and some of its people were less than flattering. Sanderson later won a compensation claim case against the British firm, however.

On the other hand, Penelope Trunk wrote an upbeat article in The Boston Globe in 2006, entitled "Blogs 'essential' to a good career". She was one of the first journalists to point out that a large portion of bloggers are professionals and that a well-written blog can help attract employers.

Business owners

Business owners who blog about their business can also run into legal consequences. Mark Cuban, owner of the Dallas Mavericks, was fined during the 2006 NBA playoffs for criticizing NBA officials on the court and in his blog.

Political dangers

Blogging can sometimes have unforeseen consequences in politically sensitive areas. In some countries, Internet police or secret police may monitor blogs and arrest blog authors or commentators. Blogs can be much harder to control than broadcast or print media because a person can create a blog whose authorship is hard to trace by using anonymity technology such as Tor. As a result, totalitarian and authoritarian regimes often seek to suppress blogs and punish those who maintain them.

In Singapore, two ethnic Chinese individuals were imprisoned under the country's anti-sedition law for posting anti-Muslim remarks in their blogs. Egyptian blogger Kareem Amer was charged with insulting the Egyptian president Hosni Mubarak and an Islamic institution through his blog. It is the first time in the history of Egypt that a blogger was prosecuted. After a brief trial session that took place in Alexandria, the blogger was found guilty and sentenced to prison terms of three years for insulting Islam and inciting sedition and one year for insulting Mubarak. Egyptian blogger Abdel Monem Mahmoud was arrested in April 2007 for anti-government writings in his blog. Monem is a member of the then banned Muslim Brotherhood. After the 2011 Egyptian revolution, the Egyptian blogger Maikel Nabil Sanad was charged with insulting the military for an article he wrote on his personal blog and sentenced to three years.

After expressing opinions in his personal blog about the state of the Sudanese armed forces, Jan Pronk, United Nations Special Representative for Sudan, was given three days notice to leave Sudan. The Sudanese army had demanded his deportation. In Myanmar, Nay Phone Latt, a blogger, was sentenced to 20 years in jail for posting a cartoon critical of head of state Than Shwe.

Personal safety

One consequence of blogging is the possibility of online or in-person attacks or threats against the blogger, sometimes without apparent reason. In some cases, bloggers have faced cyberbullying. Kathy Sierra, author of the blog "Creating Passionate Users", was the target of threats and misogynistic insults to the point that she cancelled her keynote speech at a technology conference in San Diego, fearing for her safety. While a blogger's anonymity is often tenuous, Internet trolls who would attack a blogger with threats or insults can be emboldened by the anonymity of the online environment, where some users are known only by a pseudonymous "username" (e.g., "Hacker1984"). Sierra and supporters initiated an online discussion aimed at countering abusive online behaviour and developed a Blogger's Code of Conduct, which set out a rules for behaviour in the online space.

Proteinopathy

From Wikipedia, the free encyclopedia
 
Proteinopathy
Micrograph of a section of the cerebral cortex from a person with Alzheimer's disease, immunostained with an antibody to amyloid beta (brown), a protein fragment that accumulates in amyloid plaques and cerebral amyloid angiopathy. 10X microscope objective.

In medicine, proteinopathy ([pref. protein]; -pathy [suff. disease]; proteinopathies pl.; proteinopathic adj), or proteopathy, protein conformational disorder, or protein misfolding disease, is a class of diseases in which certain proteins become structurally abnormal, and thereby disrupt the function of cells, tissues and organs of the body. Often the proteins fail to fold into their normal configuration; in this misfolded state, the proteins can become toxic in some way (a toxic gain-of-function) or they can lose their normal function. The proteinopathies include such diseases as Creutzfeldt–Jakob disease (and a variant associated with mad cow disease) and other prion diseases, Alzheimer's disease, Parkinson's disease, amyloidosis, multiple system atrophy, and a wide range of other disorders. The term proteopathy was first proposed in 2000 by Lary Walker and Harry LeVine.

The concept of proteopathy can trace its origins to the mid-19th century, when, in 1854, Rudolf Virchow coined the term amyloid ("starch-like") to describe a substance in cerebral corpora amylacea that exhibited a chemical reaction resembling that of cellulose. In 1859, Friedreich and Kekulé demonstrated that, rather than consisting of cellulose, "amyloid" actually is rich in protein.[9] Subsequent research has shown that many different proteins can form amyloid, and that all amyloids show birefringence in cross-polarized light after staining with the dye Congo red, as well as a fibrillar ultrastructure when viewed with an electron microscope. However, some proteinaceous lesions lack birefringence and contain few or no classical amyloid fibrils, such as the diffuse deposits of amyloid beta (Aβ) protein in the brains of people with Alzheimer's. Furthermore, evidence has emerged that small, non-fibrillar protein aggregates known as oligomers are toxic to the cells of an affected organ, and that amyloidogenic proteins in their fibrillar form may be relatively benign.

Micrograph of amyloid in a section of liver that has been stained with the dye Congo red and viewed with crossed polarizing filters, yielding a typical orange-greenish birefringence. 20X microscope objective; the scale bar is 100 microns (0.1mm).

Pathophysiology

In most, if not all proteinopathies, a change in the 3-dimensional folding conformation increases the tendency of a specific protein to bind to itself. In this aggregated form, the protein is resistant to clearance and can interfere with the normal capacity of the affected organs. In some cases, misfolding of the protein results in a loss of its usual function. For example, cystic fibrosis is caused by a defective cystic fibrosis transmembrane conductance regulator (CFTR) protein, and in amyotrophic lateral sclerosis / frontotemporal lobar degeneration (FTLD), certain gene-regulating proteins inappropriately aggregate in the cytoplasm, and thus are unable to perform their normal tasks within the nucleus. Because proteins share a common structural feature known as the polypeptide backbone, all proteins have the potential to misfold under some circumstances. However, only a relatively small number of proteins are linked to proteopathic disorders, possibly due to structural idiosyncrasies of the vulnerable proteins. For example, proteins that are normally unfolded or relatively unstable as monomers (that is, as single, unbound protein molecules) are more likely to misfold into an abnormal conformation. In nearly all instances, the disease-causing molecular configuration involves an increase in beta-sheet secondary structure of the protein. The abnormal proteins in some proteopathies have been shown to fold into multiple 3-dimensional shapes; these variant, proteinaceous structures are defined by their different pathogenic, biochemical, and conformational properties. They have been most thoroughly studied with regard to prion disease, and are referred to as protein strains.

Micrograph of immunostained α-synuclein (brown) in Lewy bodies (large clumps) and Lewy neurites (thread-like structures) in the cerebral cortex of a patient with Lewy body disease, a synucleinopathy. 40X microscope objective.

The likelihood that proteinopathy will develop is increased by certain risk factors that promote the self-assembly of a protein. These include destabilizing changes in the primary amino acid sequence of the protein, post-translational modifications (such as hyperphosphorylation), changes in temperature or pH, an increase in production of a protein, or a decrease in its clearance. Advancing age is a strong risk factor, as is traumatic brain injury. In the aging brain, multiple proteopathies can overlap. For example, in addition to tauopathy and Aβ-amyloidosis (which coexist as key pathologic features of Alzheimer's disease), many Alzheimer patients have concomitant synucleinopathy (Lewy bodies) in the brain.

It is hypothesized that chaperones and co-chaperones (proteins that assist protein folding) may antagonize proteotoxicity during aging and in protein misfolding-diseases to maintain proteostasis.

Seeded induction

Some proteins can be induced to form abnormal assemblies by exposure to the same (or similar) protein that has folded into a disease-causing conformation, a process called 'seeding' or 'permissive templating'. In this way, the disease state can be brought about in a susceptible host by the introduction of diseased tissue extract from an affected donor. The best known forms of inducible proteopathy are prion diseases, which can be transmitted by exposure of a host organism to purified prion protein in a disease-causing conformation. There is now evidence that other proteinopathies can be induced by a similar mechanism, including amyloidosis, amyloid A (AA) amyloidosis, and apolipoprotein AII amyloidosis,tauopathy, synucleinopathy, and the aggregation of superoxide dismutase-1 (SOD1), polyglutamine, and TAR DNA-binding protein-43 (TDP-43).

In all of these instances, an aberrant form of the protein itself appears to be the pathogenic agent. In some cases, the deposition of one type of protein can be experimentally induced by aggregated assemblies of other proteins that are rich in β-sheet structure, possibly because of structural complementarity of the protein molecules. For example, AA amyloidosis can be stimulated in mice by such diverse macromolecules as silk, the yeast amyloid Sup35, and curli fibrils from the bacterium Escherichia coli. AII amyloid can be induced in mice by a variety of β-sheet rich amyloid fibrils, and cerebral tauopathy can be induced by brain extracts that are rich in aggregated Aβ. There is also experimental evidence for cross-seeding between prion protein and Aβ. In general, such heterologous seeding is less efficient than is seeding by a corrupted form of the same protein.

Psychoorganic syndrome

From Wikipedia, the free encyclopedia
https://en.wikipedia.org/wiki/Psychoorganic_syndrome

Psychoorganic syndrome (POS), also known as organic psychosyndrome, is a progressive disease comparable to presenile dementia. It consists of psychopathological complex of symptoms that are caused by organic brain disorders that involve a reduction in memory and intellect. Psychoorganic syndrome is often accompanied by asthenia.

Psychoorganic syndrome occurs during atrophy of the brain, most commonly during presenile and senile age (e.g. Alzheimer's disease, senile dementia). There are many causes, including cerebrovascular diseases, CNS damages to traumatic brain injury, intoxication, exposure to organic solvents such as toluene, chronic metabolic disorders, tumors and abscesses of the brain, encephalitis, and can also be found in cases of diseases accompanied by convulsive seizures. Psychoorganic syndrome may occur at any age but is most pronounced in elderly and senile age.

Depending on the nosological entity, the main symptoms of psychoorganic syndrome are expressed differently. For example, in atrophic cases such as Alzheimer's disease, the symptoms are more geared towards a memory disorder, while in Pick's disease, mental disorders are more commonly expressed.

Symptoms

Patients with psychoorganic syndrome often complain about headaches, dizziness, unsteadiness when walking, poor tolerance to the heat, stuffiness, atmospheric pressure changes, loud sounds, neurological symptoms.

The common reported psychological symptoms include:

  • loss of memory and concentration
  • emotional lability
  • Clinical fatigue
  • long term major depression
  • severe anxiety
  • reduced intellectual ability

The cognitive and behavioral symptoms are chronic and have little response to treatment.

Depending on lesion location, some patients may experience visual complications.

Cause

Psycho-organic syndrome is typically diagnosed in individuals following 5–10 years of consistent exposure to chemicals like xylene, toluene, and styrene, which are generally found in paint, plastic and degreasing products.

Patients work and environmental history must be evaluated for exposure to organic chemicals. A traumatic brain injury may also lead to POS.

Although the cause varies in each individual case, localization of the atrophy in the brain can occur due to aging and without external causes.

Prevention includes proper and regular use of Preventive Personal Equipment (PPE) in work environments that involve organic chemicals and limiting alcohol and drug substance intake.

Mechanism

Psychoorganic syndrome is a combination of various symptoms that are caused by organic changes in the brain. The exact component of the solvents that causes the neurological disorder is difficult to isolate due to worker generally being exposed to mixtures of various grades, compositions, and purity of solvents.

At the initial stage, asthenia is prevalent and the progress of the disorder is slow. Acute onset can be diagnosed when a large amount of psychological symptoms surface. The final stage of the disorder is made up of numerous disorders, including dementia, Korsakov's syndrome, and includes severe personality change such as depression, anxiety, memory loss, and drastic change in intellect. Level of kindness, happiness, and insight are greatly affect in the final stage.

The disorder stems from a defect in brain tissue, usually atrophy from another neurological disorder.

"In pathological findings, focal or diffuse signs of atrophy without inflammation or severe vascular insufficiency are present. Basic clinical picture depends on the localization of atrophy in brain."

Although the exact mechanism that solvents have on the nervous system are not fully understood, the metabolism of the solvents in the body that turn them into toxic intermediates are important. Some evidence shows that genetic polymorphisms affect the activity of metabolic enzymes that metabolize foreign chemicals.

Diagnosis

Along with occupational and environmental evaluation, a neurological exam, ECHO, EEG, CT-San, and X-ray of the brain may be conducted to determine disorder. Neuroimaging that detects cerebral atrophy or cardiovascular subcortical alterations can help point to psychoorganic syndrome. Strong CNS lesions are detected in POS patients. However, this is found to be difficult as many psychiatric disorders, like dementia, have common diagnosis.

Diagnosing POS is an ongoing and developing in the medical and psychiatric industry. Exact diagnosis is difficult due to many symptoms mirroring other psychological disorders in the older aged patients.

Various symptom diagnosis

CT scan or MRI can confirm dementia via observation of ventricular dilation and cortical substance degeneration.

Pick's disease can be confirmed via CT scan or MRI with atrophy of frontal and temporal lobe roots.

Alzheimer's is a disease confirmed by atrophy of the parietal and temporal lobe ganglia along with changes in the cortical ganglia found in a CT scan or MRI.

Treatment

In a confirmed medical diagnosis, therapy is used to isolate and begin treating the cause of the disorder. Thereafter, psychiatric medication is used a secondary step in treatment. Medications include antipsychotic, antidepressant, or sedation-inducing, varying on the patients severity.

Treatment of psychoorganic syndrome is directed at the main disease. Nootropics like piracetam, have had positive effects on patients. Vitamin therapy, antioxidants, neurotropic, and cerebroprotective have also found to be effective when put on a repeat course.

History

 POS was suggested to be associated with long term and high level solvent exposure in early studies conducted in Scandinavia. These studies found neurological deficits such as personality changes and memory loss were tied to these exposures. However, these studies were highly criticized and found biased, causing doubt in the existence of the syndrome.

Furthermore, various health organizations had difficulty coming to an agreement on the definition of the syndrome. In 1985, the syndrome was defined and provided clear criteria that could be used by patients and medical professionals to help identify the syndrome and isolate ways of prevention.

Recent research

In a 2007 clinical study conducted in Sweden on 128 subjects who had constant high exposure to solvents in their work environments, a definite link to POS was unable to be determined. However, the subject who had diagnosis of POS showed increased neurological symptoms with increased brain atrophy in as little as 3 years of exposure.

Gender-affirming hormone therapy

Gender-affirming hormone therapy (GAHT), also called hormone replacement therapy (HRT) or transgender hormone therapy, is a form of hormone therapy in which sex hormones and other hormonal medications are administered to transgender or gender nonconforming individuals for the purpose of more closely aligning their secondary sexual characteristics with their gender identity. This form of hormone therapy is given as one of two types, based on whether the goal of treatment is masculinization or feminization:

Eligibility for GAHT may require an assessment for gender dysphoria or persistent gender incongruence; or many medical institutions now use an informed consent model, which ensures patients are informed of the procedure process, including possible benefits and risks, while removing many of the historical barriers needed to start hormone therapy. Treatment guidelines for therapy have been developed by several medical associations.

Non-binary people may also engage in hormone therapy in order to achieve a desired balance of sex hormones or to help align their bodies with their gender identities. Many transgender people obtain hormone therapy from a licensed health care provider and others obtain and self-administer hormones.

History

Requirements

The formal requirements to begin gender-affirming hormone therapy vary widely depending on geographic location and specific institution. Gender-affirming hormones can be prescribed by a wide range of medical providers including, but not limited to, primary care physicians, endocrinologists, and gynecologists. Requirements generally include a minimum age; according to the Endocrine Society, there has been little research on taking cross-sex hormones before the age of about 14.

Historically, many health centers required a psychiatric evaluation and/or a letter from a therapist before beginning therapy. Many centers now use an informed consent model that does not require any routine formal psychiatric evaluation but instead focuses on reducing barriers to care by ensuring a person can understand the risks, benefits, alternatives, unknowns, limitations, and risks of no treatment. Some LGBT health organizations (notably Chicago's Howard Brown Health Center and Planned Parenthood) advocate for this type of informed consent model.

The World Professional Association for Transgender Health (WPATH) Standards of Care, 7th edition, note that both of these approaches to care are appropriate.

Gender dysphoria

Many international guidelines and institutions require persistent, well-documented gender dysphoria as a pre-requisite to starting gender-affirmation therapy. Gender dysphoria refers to the psychological discomfort or distress that an individual can experience if their sex assigned at birth is incongruent with that person's gender identity. Signs of gender dysphoria can include comorbid mental health stressors such as depression, anxiety, low self-esteem, and social isolation. Not all gender nonconforming individuals experience gender dysphoria, and measuring a person's gender dysphoria is critical when considering medical intervention for gender nonconformity.

Treatment options

Guidelines

For transgender youth, the Dutch protocol existed as among the earlier guidelines for hormone therapy by delaying puberty until age 16. The World Professional Association for Transgender Health (WPATH) and the Endocrine Society later formulated guidelines that created a foundation for health care providers to care for transgender patients. UCSF guidelines are also sometimes used. There is no generally agreed-upon set of guidelines, however.

Delaying puberty in adolescents

Tanner Stages for Female Sexual Characteristics
Tanner Stages for Male Sexual Characteristics

Adolescents experiencing gender dysphoria may opt to undergo puberty-suppressing hormone therapy at the onset of puberty. The Standards of Care set forth by WPATH recommend individuals pursuing puberty-suppressing hormone therapy wait until at least experiencing Tanner Stage 2 pubertal development. Tanner Stage 2 is defined by the appearance of scant pubic hair, breast bud development, and/or slight testicular growth. WPATH classifies puberty-suppressing hormone therapy as a "fully reversible" intervention. Delaying puberty allows individuals more time to explore their gender identity before deciding on more permanent interventions and prevents the physical changes associated with puberty.

The preferred puberty-suppressing agent for both individuals assigned male at birth and individuals assigned female at birth is a GnRH Analogue. This approach temporarily shuts down the Hypothalamic-Pituitary-Gonadal (HPG) Axis, which is responsible for the production of hormones (estrogen, testosterone) that cause the development of secondary sexual characteristics in puberty.

Feminizing hormone therapy

Feminizing hormone therapy is typically used by transgender women, who desire the development of feminine secondary sex characteristics. Individuals who identify as non-binary may also opt-in for feminizing hormone treatment to better align their body with their desired gender expression. Feminizing hormone therapy usually includes medication to suppress testosterone production and induce feminization. Types of medications include estrogens, antiandrogens (testosterone blockers), and progestogens. Most commonly, an estrogen is combined with an antiandrogen to suppress and block testosterone. This allows for demasculinization and promotion of feminization and breast development. Estrogens are administered in various modalities including injection, transdermal patch, and oral tablets.

The desired effects of feminizing hormone therapy focus on the development of feminine secondary sex characteristics. These desired effects include: breast tissue development, redistribution of body fat, decreased body hair, reduction of muscle mass, and more. The table below summarizes some of the effects of feminizing hormone therapy in transgender women:

Effects of feminizing hormone therapy
Effect Time to expected
onset of effect
Time to expected
maximum effect
Permanency if hormone
therapy is stopped
Breast development and nipple/areolar enlargement 2–6 months 1–5 years Permanent
Thinning/slowed growth of facial/body hair 4–12 months >3 years Reversible
Cessation/reversal of male-pattern scalp hair loss 1–3 months 1–2 years Reversible
Softening of skin/decreased oiliness and acne 3–6 months Unknown Reversible
Redistribution of body fat in a feminine pattern 3–6 months 2–5 years Reversible
Decreased muscle mass/strength 3–6 months 1–2 years Reversible
Widening and rounding of the pelvis Unspecified Unspecified Permanent
Changes in mood, emotionality, and behavior Unspecified Unspecified Reversible
Decreased sex drive 1–3 months Temporary Reversible
Decreased spontaneous/morning erections 1–3 months 3–6 months Reversible
Erectile dysfunction and decreased ejaculate volume 1–3 months Variable Reversible
Decreased sperm production/fertility Unknown >3 years Reversible or permanent
Decreased testicle size 3–6 months 2–3 years Unknown
Decreased penis size None Not applicable Not applicable
Decreased prostate gland size Unspecified Unspecified Unspecified
Voice changes None Not applicable Not applicable

Footnotes:

  • Estimates represent published and unpublished clinical observations.

  • Time at which further changes are unlikely at maximum maintained dose. Maximum effects vary widely depending on genetics, body habitus, age, and status of gonad removal. Generally, older individuals with intact gonads may have less feminization overall.

  • Complete removal of male facial and body hair requires electrolysis, laser hair removal, or both. Temporary hair removal can be achieved with shaving, epilating, waxing, and other methods.

  • Familial scalp hair loss may occur if estrogens are stopped.

  • Varies significantly depending on the amount of physical exercise.

  • Occurs only in individuals of pubertal age who have not yet completed epiphyseal closure.

  • Additional research is needed to determine permanency, but a permanent impact of estrogen therapy on sperm quality is likely and sperm preservation options should be counseled on and considered before initiation of therapy.

  • Conflicting reports, with none reported observed in transgender women but significant albeit minor reduction of penis size reported in men with prostate cancer on androgen deprivation therapy.

    1. Treatment by speech pathologists for voice training is effective.
    Sources: Guidelines: Reviews/book chapters: Studies:

    Masculinizing hormone therapy

    Masculinizing hormone therapy is typically used by transgender men, who desire the development of masculine secondary sex characteristics. Masculinizing hormone therapy usually includes testosterone to produce masculinization and suppress the production of estrogen. Treatment options include oral, subcutaneous injections or implant, and transdermal (patches, gels). Dosing is patient-specific, depending on the patient's rate of metabolism, and is discussed with the physician. The most commonly prescribed methods are intramuscular and subcutaneous injections. This dosing can be daily, weekly or biweekly depending on the route of administration and the individual patient.

    Unlike feminizing hormone therapy, individuals undergoing masculinizing hormone therapy do not usually require additional hormone suppression such as estrogen suppression. Therapeutic doses of testosterone are usually sufficient to inhibit the production of estrogen to desired physiologic levels.

    The desired effects of masculinizing hormone therapy focus on the development of masculine secondary sex characteristics. These desired effects include: increased muscle mass, development of facial hair, voice deepening, increase and thickening of body hair, and more.

    Effects of masculinizing hormone therapy
    Reversible Changes Irreversible Changes
    Increased libido Deepening of voice
    Redistribution of body fat Growth of facial/body hair
    Cessation of ovulation/menstruation Male-pattern baldness
    Increased muscle mass Enlargement of clitoris
    Increased perspiration Growth spurt/closure of growth plates
    Acne Breast atrophy
    Increased red blood cell count

    Safety

    Hormone therapy for transgender individuals has been shown in medical literature to be generally safe, when supervised by a qualified medical professional. There are potential risks with hormone treatment that will be monitored through screenings and lab tests such as blood count (hemoglobin), kidney and liver function, blood sugar, potassium, and cholesterol. Taking more medication than directed may lead to health problems such as increased risk of cancer, heart attack from thickening of the blood, blood clots, and elevated cholesterol.

    Feminizing hormone therapy

    The Standards of Care published by the World Professional Association for Transgender Health (WPATH) summarize many of the risks associated with feminizing hormone therapy (outlined below). For more in-depth information on the safety profile of estrogen-based feminizing hormone therapy visit the feminizing hormone therapy page.

    Summary of Risks of Estrogen Therapy
    Likely Increased Risk Possible Increased Risk Inconclusive/No Increased Risk
    Venous thromboembolic disease Type 2 diabetes Breast cancer
    Cardiovascular disease Hypertension Prostate cancer
    Hypertriglyceridemia Hyperprolactinaemia
    Gallstones Osteoporosis
    Hyperkalemia

    Cerebrovascular disease

    Polyuria (or dehydration)

    Meningioma


  • Only present in individuals taking spironolactone

    1. Only present in individuals taking cyproterone

    Masculinizing hormone therapy

    The Standards of Care published by the World Professional Association for Transgender Health (WPATH) summarize many of the risks associated with masculinizing hormone therapy (outlined below). For more in-depth information on the safety profile of testosterone-based masculinizing hormone therapy visit the masculinizing hormone therapy page.

    Summary of Risks of Testosterone Therapy
    Likely Increased Risk Possible Increased Risk Inconclusive/No Increased Risk
    Polycythemia Type 2 diabetes Osteoporosis
    Weight gain
    Breast cancer
    Acne
    Ovarian cancer
    Pattern hair loss
    Uterine cancer
    Hypertension
    Cervical cancer
    Sleep apnea

    Decreased HDL cholesterol

    Decreased LDL cholesterol

    Cardiovascular disease

    Hypertriglyceridemia

    Fertility consideration

    GAHT may limit fertility potential. Should a transgender individual choose to undergo gender-affirming surgery, their fertility potential is lost completely. Before starting any treatment, individuals may consider fertility issues and fertility preservation. Options include semen cryopreservation, oocyte cryopreservation, and ovarian tissue cryopreservation.

    A study presented at ENDO 2019 (the Endocrine Society's conference) shows that even after one year of treatment with testosterone, a transgender man can preserve his fertility potential.

    Fake products

    Some online scammers have been targeting trans consumers with products that do not contain any hormones or contain ones that are opposite of what is advertised. This can happen when legislations outlaw or restrict access to treatments by legitimate medical professionals.

    Treatment eligibility

    Many providers use informed consent, whereby someone seeking hormone therapy can sign a statement of informed consent and begin treatment without much gatekeeping. For other providers, eligibility is determined using major diagnostic tools such as ICD-11 or the Diagnostic and Statistical Manual of Mental Disorders (DSM) to classify a patient with gender dysphoria. The Endocrine Society requires physicians that diagnose gender dysphoria and gender incongruence to be trained in psychiatric disorders with competency in ICD-11 and DSM-5. The healthcare provider should also obtain a thorough assessment of the patient's mental health and identify potential psychosocial factors that can affect therapy.

    WPATH Standards of Care

    The WPATH Standards of Care, most recently published in 2022, outlines a series of guidelines which should be met before a patient should be allowed gender-affirming hormone therapy:

    • Gender incongruence is marked and sustained
    • Patient meets diagnostic criteria for gender incongruence prior to gender-affirming hormone treatment in regions where a diagnosis is necessary to access health care
    • Patient has capacity to consent to hormone therapy treatment
    • Other possible causes of apparent gender incongruence have been identified and excluded
    • Mental health and physical conditions that could negatively impact the outcome of treatment have been assessed
    • Understands the effect of gender-affirming hormone treatment on reproduction and they have explored reproductive options

    The WPATH standards of care distinguish between gender-affirming hormone therapy, and hormone replacement therapy, with the latter referring to the replacement of endogenous hormones after a gonadectomy to prevent cardiovascular and musculoskeletal issues.

    Readiness

    Some organizations – but fewer than in the past – require that patients spend a certain period of time living in their desired gender role before starting hormone therapy. This period is sometimes called real-life experience (RLE).

    In Sweden, for instance, patients seeking to access gender affirming healthcare must first undergo extended evaluations with psychiatric professionals, during which they must - without any form of medical transition - successfully live for one full year as their desired gender in all professional, social, and personal matters. Gender clinics are recommended to provide patients with wigs and breast prostheses for the endeavor. The evaluation additionally involves, if possible, meetings with family members and/or other individuals close to the patient. Patients may be denied care for any number of "psychosocial dimensions", including their choice of job or their marital status.

    Transgender and gender non-conforming activists, such as Kate Bornstein, have asserted that RLE is psychologically harmful and is a form of "gatekeeping", effectively barring individuals from transitioning for as long as possible, if not permanently.

    In September 2022, the World Professional Association for Transgender Health (WPATH) Standards of Care for the Health of Transgender and Gender Diverse People (SOC) Version 8 were released and removed the requirement of RLE for all gender-affirming treatments, including gender-affirming surgery.

    Accessibility

    Some transgender people choose to self-administer hormone replacement medications, often because doctors have too little experience in this area, or because no doctor is available. Others self-administer because their doctor will not prescribe hormones without an approval letter from a psychotherapist. Many therapists require extended periods of continuous psychotherapy and/or real-life experience before they will write such a letter. Because many individuals must pay for evaluation and care out-of-pocket, costs can be prohibitive.

    Access to medication can be poor even where health care is provided free. In a patient survey conducted by the United Kingdom's National Health Service in 2008, 5% of respondents acknowledged resorting to self-medication, and 46% were dissatisfied with the amount of time it took to receive hormone therapy. The report concluded in part: "The NHS must provide a service that is easy to access so that vulnerable patients do not feel forced to turn to DIY remedies such as buying drugs online with all the risks that entails. Patients must be able to access professional help and advice so that they can make informed decisions about their care, whether they wish to take the NHS or private route without putting their health and indeed their lives in danger." Self-administration of cross-gender hormones without medical supervision may have untoward health effects and risks.

    A number of private companies have attempted to increase accessibility for hormone replacement medications and help transgender people navigate the complexities of access to treatment.

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