Facts on File Encyclopedia of Health and Medicine

fat, and sometimes diminished energy and LIBIDO
(sex drive). Some men experience clinical DEPRES-
SION, loss of BONEmass,ERECTILE DYSFUNCTION, and
other symptoms as a consequence of lower testos-
terone levels. Some researchers believe the decline
in testosterone levels contributes to the increased
risk for HEART ATTACKas a man gets older.
Doctors may recommend prescription hormone
supplementation with ANDROGENS(testosterone or
testosterone precursors) for men who have unac-
ceptable symptoms. However, the long-term ther-
apeutic value and possible risks of such treatment
remain uncertain. Some men take the over-the-
counter product DEHYDROEPIANDROSTERONE (DHEA),
available in the United States as a dietary supple-
ment, as an androgen precursor (a substance the
body converts to testosterone during its METABO-
LISM). There are few clinical studies to provide
clear evidence of whether this is effective or safe.
Some doctors believe as long as the DHEA does
not push testosterone levels beyond the normal
range, the risk for adverse health effects is mini-
mal. However, other doctors worry that sustained
increases in blood testosterone levels in men over
age 50 may increase the risk for PROSTATE CANCER
and CARDIOVASCULAR DISEASE(CVD).
See also ADRENAL INSUFFICIENCY; AGING, REPRODUC-
TIVE AND SEXUAL CHANGES THAT OCCUR WITH; ANABOLIC
STEROIDS AND STEROID PRECURSORS; HORMONE-DRIVEN
CANCERS; MENOPAUSE.

Apgar score A standardized measure of an
infant’s health status, typically assessed one

minute and five minutes after birth. Anesthesiolo-

gist Virginia Apgar (1909–1974) developed the

scoring system that bears her name in 1953,

assigning a point value of 0, 1, or 2 to each of five

categories of vital function (BREATHING, HEART RATE,

REFLEXresponse, MUSCLEtone, and SKINcolor) and

reporting their sum as the overall Apgar score.

Today the Apgar score is an international standard

to assess whether a newborn needs resuscitation

(lifesaving measures) and to evaluate the success

of resuscitative efforts. The highest score possible

is 10; doctors consider a score between 7 and 10 to

reflect good health in the infant. A score between

4 and 7 bears monitoring and perhaps supportive

care such as suctioning of the airways or supple-

mental oxygen. A score of 3 or lower indicates a

life-threatening or critical circumstance for the

infant.

See also CHILDBIRTH; PREMATURE BIRTH.

assisted reproductive technology (ART) Medical

interventions to produce PREGNANCY. The US Cen-

ters for Disease Control and Prevention (CDC),

which has a mandate under federal law to report

the success rates of ART at FERTILITYclinics in the

United States each year, defines ART as any

method that involves manipulation of both SPERM

and OVA(eggs). Other methods to aid fertility may

use interventions such as HORMONE therapies to

stimulate OVULATION (the release of ova) in the

woman or techniques such as intrauterine artifi-

cial insemination (placement of sperm within the

UTERUS) to improve sperm viability. ART typically

assisted reproductive technology (ART) 245

APGAR SCORES

Apgar Score 0 1 2
BREATHING not breathing slow or irregular breathing 20 to 50 breaths per minute, regular rhythm

HEART RATE no heart rate < 100 beats per minute 100 to 104 beats per minute

REFLEXresponse no response to facial grimace with nasal stimulation sneeze or cough with nasal stimulation
nasal stimulation

MUSCLEtone flaccid some flexing of the arms and legs active movement

SKINcolor cyanotic (bluish gray) cyanotic limbs pink