However, while still significant, these risks are low with appropriate monitoring and clinical management. Hirsutizm Tedavisinde Flutamid ve Bikalutamid Kullanm. Stenger, P. J., Wagner, L., Egelhoff, J., & Rose, S. R. (2009). What the Primary Care Pediatrician Needs to Know About Gender Incongruence and Gender Dysphoria in Children and Adolescents. An official website of the United States government. The 7th patient was noted to have Tanner III breasts at her 2nd follow-up clinic visit 12.5 months after starting bicalutamide. Tomson, A., McLachlan, C., Wattrus, C., Adams, K., Addinall, R., Bothma, R., Jankelowitz, L., Kotze, E., Luvuno, Z., Madlala, N., Matyila, S., Padavatan, A., Pillay, M., Rakumakoe, M. D., Tomson-Myburgh, M., Venter, W., & de Vries, E. (2021). Hamidi, O., & Davidge-Pitts, C. J. In February 2023, Jamie Reed, a former case manager at the The Washington University Transgender Center at St. Louis Childrens Hospital in St. Louis, Missouri, published the op-ed I Thought I Was Saving Trans Kids. In addition, the absolute incidence of liver toxicity with bicalutamide is likely to be very low. At that time, the Wikipedia content for bicalutamide was greatly expanded, which made information about bicalutamide more accessible. However, there were some older patients who chose bicalutamide with the possible secondary feminizing effect in mind. However, our results must be considered extremely preliminary, and additional data are needed. 2022;95(5):405-414. doi: 10.1159/000524030. Unable to load your collection due to an error, Unable to load your delegates due to an error. It's either go off the spiro completely and use NO anti-androgens or find a guideline for adults. In a clinical study the mean concentration of R-bicalutamide in semen of men receiving 150 mg of bicalutamide was 4.9 g/mL. Fifteen patients who were started on bicalutamide alone have been seen in follow-up thus far. Gonadotropin-releasing hormone analogs (GnRHas) are considered the gold standard for halting pubertal development in these youth [1]. In Mann, R. D., & Andrews, E. B. Prominent researchers in transgender medicine have recently shown openness to bicalutamide for potential use in transfeminine people and have written positively about it. Combined oral contraception and bicalutamide in polycystic ovary syndrome and severe hirsutism: a double-blind randomized controlled trial. (2003). Bicalutamide has a much lower risk of liver toxicity than its analogue flutamide (Kolvenbag & Blackledge, 1996; Schellhammer et al., 1997; Thole et al., 2004; Manso et al., 2006; Table). B., Johnson, T. W., Karasic, D. H., Knudson, G. A., Leibowitz, S. F., Meyer-Bahlburg, H. F., Monstrey, S. J., Motmans, J., Nahata, L., & Arcelus, J. Treatment with bicalutamide should be started at the same time as treatment with an LHRH analog. Gurnurkar, S., DiLillo, E., & Carakushansky, M. (2021). 5 things to know about transgender depersonalization, The far-right law firm Alliance Defending Freedom offered a Florida anti-trans hate group $15,000 to refute the WPATH Standards of Care for use in litigation, Andres opinion: Florida Medicaid agency paid thousands to a hate group leader to help ghostwrite their anti-trans policy; he copied nearly all of his sources from the hate group, What we learned in April about the Florida AHCAs Medicaid transition care exclusion Rule 59G-1.050(7) and subsequent litigation in Dekker v. Weida: Summary, Round two: Gender Analysis calls on Florida Boards of Medicine to stop the trans youth care bans and investigate critical irregularities in the rulemaking process, Floridas newest Boards of Medicine appointees wrote an anti-trans letter calling for gender exploratory therapy, citing a report of a trans teenager being involuntarily hospitalized for nearly two years, Center of Excellence for Transgender Health. Missed Dose . Hembree, W. C., Cohen-Kettenis, P., Delemarre-Van De Waal, H. A., Gooren, L. J., Meyer III, W. J., Spack, N. P., Tangpricha, V., & Montori, V. M. (2009). A very small amount is made by the adrenal glands, which sit above the kidneys. Prostate cancer is an androgen-dependent disease, so antiandrogens are effective in treating it. I have seen others speak up on r/asktransgender about how their doctors are allowing them to use bicalutamide as an alternative to spironolactone and I need this information to hand off to my doctor. Disclaimer: I am not a doctor, and this is not medical advice. These instances are merely co-occurrences, and causality in terms of bicalutamide and liver toxicity has not been established. Reddit, Inc. 2023. There have been concerns about rare instances of liver failure that have occurred with bicalutamide in men with prostate cancer (Wiki). In fact, transgender hormone therapy guidelines largely dont even mention it still. Effects of RU 23.903 (Anandron) on Lateralization and Spatial Ability in Male-to-Female-Transsexuals. Inclusion criteria included MTF transgender patients who were treated with bicalutamide. Of these, 3 were started on estrogen concurrently whereas 11 received bicalutamide alone, 7 of whom have returned for follow up thus far. Dahl, M., Feldman, J. L., Goldberg, J., & Jaberi, A. However, it could still be allowed as a second-line option when other antiandrogens are less feasible or not possible due to being for instance inadequately effective, poorly tolerated, contraindicated, or unavailable. Bicalutamide has also been studied in combination with anastrozole (Arimidex), an aromatase inhibitor, for the treatment of gonadotropin-independent precocious puberty in cisgender boys (Kreher et al., 2006; Lewis et al., 2009; Mitre & Lteif, 2009; Stenger et al., 2009; Lenz et al., 2010; Reiter et al., 2010; Tessaris et al., 2012; zcab et al., 2015; Kor, 2018; Arya & Davies, 2019; Nabhan & Eugster, 2019; Finkle et al., 2020; Gurnurkar, DiLillo, & Carakushansky, 2021; Wiki). Prolactin - pre-treatment and at 1, 2, and 3 years. (2006). Testosterone is also called an androgen. The adult center affiliated with Washington University will not use this medication for this reason. Moussa, A., Kazmi, A., Bokhari, L., & Sinclair, R. D. (2022). Graham Head, 66, who kidnapped and tried to rape two women, was caught after one victim remembered three digits of his car registration. Although rare, fulminant hepatotoxicity resulting in death has been described with bicalutamide (OBryant et al., 2008). By Aly | First published July 1, 2020 | Last modified April 17, 2023. Levy, A., Crown, A., & Reid, R. (2003). Unlike flutamide, bicalutamide is a selective anti-androgen and does not affect luteinizing hormone and testosterone levels. Administration of estrogen (via oral, sublingual, transdermal, intramuscular, or subcutaneous routes) lower serum testosterone levels, raises serum estradiol levels, and results in the development of typical female secondary . Bicalutamide as an Androgen Blocker with Secondary Effect of Promoting Feminization in Male to Female (MTF) Transgender Adolescents. and transmitted securely. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. 2009 Dec;22(12):1163-7. doi: 10.1515/jpem.2009.22.12.1163. Peripheral Precocious Puberty: Interventions to Improve Growth. (2002). Bicalutamide is given in combination with another medicine called a luteinizing (LOO-tee-in-ize-ing) hormone-releasing hormone, or LHRH. . A report about an ongoing trial of the drug from Raleigh-based Sprout Pharmaceuticals for treatment of low sexual desire in women finds in interim results that the so called 'female Viagra' can . Now Im Blowing the Whistle. On the other hand, other authors have not been as welcoming of bicalutamide for transfeminine people (e.g., Hamidi & Davidge-Pitts, 2019; Cocchetti et al., 2020). Rare liver toxicity is an acceptable risk in men with prostate cancer because the riskbenefit ratio of bicalutamide therapy is very favorable, with the benefit of treating prostate cancer vastly outweighing the harm of the very rare instances of liver problems. Bicalutamide and letrozole treatment of precocious puberty due to elevated levels of human chorionic gonadotropin (hCG). Gooren, L., Spinder, T., Spijkstra, J. J., Van Kessel, H., Smals, A., Rao, B. R., & Hoogslag, M. (1987). The employment of bicalutamide for transfeminine people was largely precluded for many years by the fact that bicalutamide had pharmaceutical patent protection and was very expensive. Of 104 patients with GD, 39 (37.5%) were MTF patients. In any case, the reported cases of serious liver toxicity with bicalutamide in transgender people have not been published nor properly confirmed. (2009). Six patients received estrogen concurrently. Bicalutamide is used together with a luteinizing hormone releasing hormone (LHRH) analog (eg, goserelin or leuprolide) to treat stage D2 metastatic prostate cancer (cancer that has spread) in men. Renal Dose Adjustments No adjustment recommended. About 0.5 to 1.5% of men taking 50 to 150 mg/day bicalutamide in the major clinical programmes of bicalutamide for prostate cancer developed liver changes sufficiently marked that they required discontinuation (Blackledge, 1996; See et al., 2002; Wiki). Hormonal therapies are drugs that change the way hormones are made or how they work in the body. There is additionally an unpublished case anecdote of death in a young transfeminine person associated with bicalutamide thats been making its rounds through the transgender medical community. Results: In noncomparative trials, the decline in PSA value associated with daily doses of 200 mg bicalutamide was greater than that observed with . (2012). Finkle, A., Zavertnik, S., Myers, S., Cormier, D., Heithaus, J., & Augustyn, M. (2020). Keywords: ChildrenUse and dose must be determined by your doctor. In addition to her op-ed, Reed provided a sworn affidavit to the office of Republican Missouri attorney general Andrew Bailey, who proceeded to launch an investigation of the clinic (Missouri Government, 2023a). As touched on in the present article, it is likely that more studies of bicalutamide in transfeminine people will be needed before bicalutamide could become endorsed by major transgender care guidelines. starting/low dose topical formulations, i.e. Bicalutamide plus anastrozole for the treatment of gonadotropin-independent precocious puberty in boys with testotoxicosis: a phase II, open-label pilot study (BATT). The transgender medical community isnt there at this time though. In an electronic message to the center, her mother said that they were lucky her family was not the type to sue. 2020 Nov;83(5):1478-1479. doi: 10.1016/j.jaad.2020.03.034. Blackledge, G. R. P. (1996). The .gov means its official. Gooren is a major longtime researcher in the field of transgender medicine and is one of the coauthors of the Endocrine Societys transgender hormone therapy guidelines (Hembree et al., 2009; Hembree et al., 2017). Bicalutamide may be an alternative to gonadotropin-releasing hormone analogs in transgender male-to-female youth who are also ready to undergo physical transition. Sign up for free and stay up to date on research advancements, health tips, current health topics, and expertise on managing health. There are no clinical studies for using this drug for gender transitions, and there are no established standards of care for using this drug. I Thought I Was Saving Trans Kids. Tomson A, McLachlan C, Wattrus C, Adams K, Addinall R, Bothma R, Jankelowitz L, Kotze E, Luvuno Z, Madlala N, Matyila S, Padavatan A, Pillay M, Rakumakoe MD, Tomson-Myburgh M, Venter WDF, de Vries E. South Afr J HIV Med. J Pediatr Endocrinol Metab. van Kemenade, J. F., Cohen-Kettenis, P. T., Cohen, L., & Gooren, L. J. Schellhammer, P. F., Sharifi, R., Block, N. L., Soloway, M. S., Venner, P. M., Patterson, A. L., Sarosdy, M. F., Vogelzang, N. J., Schellenger, J. J., Kolvenbag, G. J., & Casodex Combination Study Group. Results: Reiter, E. O., Mauras, N., McCormick, K., Kulshreshtha, B., Amrhein, J., De Luca, F., OBrien, S., Armstrong, J., & Melezinkova, H. (2010). This medicine should come with a patient information leaflet. Disclaimer. See, W. A., Wirth, M. P., McLeod, D. G., Iversen, P., Klimberg, I., Gleason, D., Chodak, G., Montie, J., Tyrrell, C., Wallace, D. M., Delaere, K. P., Vaage, S., Tammela, T. L., Lukkarinen, O., Persson, B. E., Carroll, K., Kolvenbag, G. J., & Casodex Early Prostate Cancer Trialist Group. In addition to halting pubertal progression, embarking on physical transition that is aligned with gender identity is frequently expressed by patients as a goal when starting endocrine treatment [2]. Guy TSjoen: collaborating to improve transgender wellbeing. Bicalutamide is used to treat prostate cancer that has spread to other parts of the body (metastatic). Additionally, bicalutamide was found to be effective on women presenting with other features of hyperandrogenism such as seborrhea, acne, and hirsutism with mild and well-tolerated adverse effects. Accessibility (2010). Testotoxicosis: Report of Two Cases, One with a Novel Mutation in LHCGR Gene. LHRH helps prevent the testicles from producing testosterone. The https:// ensures that you are connecting to the Arya, V. B., & Davies, J. H. (2019). Prostate cancer needs the male hormone testosterone to grow. Another case of liver failure and death in a transgender person over 60 years of age who was treated with bicalutamide has also been informally reported (QueerDoc). We have found that bicalutamide appears to be effective in decreasing androgen exposure with the welcome side effect in these adolescents of promoting feminization. Gooren, L. J. Conflicts of interest: The authors have no conflicts of interest to disclose. (2017). Ther Adv Endocrinol Metab. If we combine this information with your protected The limitations of this study are its small size, minimal laboratory testing, and retrospective nature. (2018). All but one were Caucasian. Feminizing hormonal treatment for transgender women or gender non-binary people . In addition, certain transfeminine people, noting its advantages over existing options and its excellent potential for use in transfeminine hormone therapy, began advocating for use of bicalutamide in transfeminine people in online circles. Here, we report the novel use of bicalutamide as a puberty blocker in MTF patients with GD in whom it also results in feminization by causing breast development. Ask your doctor if you have questions. Batch CBD Full-Spectrum Gummies. Contraindicated for use in pregnant women because it can cause fetal harm; not indicated for use in females; there are no human data on use in pregnant women; in animal reproduction studies, oral administration of bicalutamide to pregnant rats during organogenesis caused abnormal development of reproductive organs in male fetuses at exposures approximately 0.7 to 2 times the human . (2017). It competitively binds to the androgen receptor to block the binding of androgens. Clinical and laboratory characteristics of patients treated with bicalutamide are summarized in Table 1. SEEN Identity and Sexual Differentiation Group (GIDSEEN). Per certain very credible people in the field of transgender medicine (e.g., Asa Radix and Zil Goldstein), she is said to have been a 20-year-old transgender girl in Texas taking bicalutamide with rapid-onset liver failure and no warning signs. Moreno-Prez, ., De Antonio, I. E., & Grupo de Identidad y Diferenciacin Sexual de la SEEN (GIDSEEN. (As well as 240 cases of interstitial lung disease associated with bicalutamide notablyrelative to only 14 published case reports; Table.) Kolvenbag, G. J., & Blackledge, G. R. (1996). Of 104 patients with gender dysphoria, 23 male-to-female adolescents received bicalutamide 50 mg daily as a second-line puberty blocker after insurance company denial of a gonadotropin-releasing hormone analog. We're Zinnia Jones and Heather McNamara, and we're the Gender Analysis team! FOIA Its a sense of unreality, estrangement from your own feelings, and separation from the real world and its a common symptom of gender dysphoria. Careers. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. Given that bicalutamide has not been adequately studied in trans feminine populations, we do not recommend its routine use. Bookshelf In Deutsch, M. B. John Randolph, a researcher at the University of Michigan, has also written positively about bicalutamide (Randolph, 2018), though he may have since changed his mind on it (Michigan Medicine, 2020). (Eds.). White matter microstructure in female to male transsexuals before cross-sex hormonal treatment. 2023 Mar 30;14:20420188231160405. doi: 10.1177/20420188231160405. The small risks of bicalutamide with appropriate monitoring may prove to be acceptable to the transgender medical community. . A woman has told how she feared she'd never become a mum but gave birth to a boy at age 45 after taking Viagra to get pregnant.. Carin Rockind, 48, welcomed a "miracle" baby after trying to have a . Testotoxicosis with an episodic course: an unusual case within a series. The following information includes only the average doses of this medicine. (2019). A phase 2 clinical trial was completed and a New Drug Application (NDA) was submitted in the United States for treatment of the condition with bicalutamide and anastrozole, but the application was not approved due to inadequate evidence of effectiveness on the primary efficacy endpoint of limiting height (AstraZeneca, 2008). Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Unauthorized use of these marks is strictly prohibited. Bicalutamide plus anastrozole for the treatment of gonadotropin-independent precocious puberty in boys with testotoxicosis: A phase II, open-label pilot study (BATT). The earliest clear mention of bicalutamide in the literature in the context of transfeminine hormone therapy was by Louis Gooren in 2011 (Gooren, 2011). While they did not recommend bicalutamide as a first-line agent due to its limited characterization in transfeminine people and its known small risk of liver toxicity, they were cautiously permissive of its use in transfeminine hormone therapy: Bicalutamide can be used for [gender-affirming hormone therapy], but there are very few studies examining its use and the relative risk/benefit for this purpose. 2019 Nov;39(11):6373-6378. doi: 10.21873/anticanres.13850. Before Spontaneous ReportingUSA. A Case of Familial Male-limited Precocious Puberty with a Novel Mutation. government site. To provide you with the most relevant and helpful information, and understand which At present, the use of bicalutamide in transfeminine people is mostly limited to a number of more flexible clinicians and to people in the transgender do-it-yourself (DIY) hormone therapy community. A., & Bouman, F. G. (1987). Anderson, J. For this reason, bicalutamide may be an option for trans women who cant tolerate the side effects of other anti-androgens, and past publications on hormonal treatment have listed bicalutamide as having a potential role in HRT. Of 13 patients treated exclusively with bicalutamide seen in follow-up, 84.6% had breast development within 6 months, the majority being Tanner stage III. (2006). eHealthMeStart your phase IV clinical trial Toggle navigationeHealthMe Start A Clinical Trial Tools 2021 Sep 28;22(1):1299. doi: 10.4102/sajhivmed.v22i1.1299. (2022). Spontaneous reporting of hepatotoxicity associated with antiandrogens: data from the Spanish pharmacovigilance system. Bicalutamide 25 mg/day in the treatment of hirsutism. [World Professional Association for Transgender Health (WPATH)] Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. Liver Dose Adjustments Mild hepatic impairment: No adjustment recommended. He and his colleagues at the Center of Expertise on Gender Dysphoria of the Vrije Universiteit Medical Center (VUMC) in Amsterdam, Netherlands had conducted studies on nilutamide (Anandron, Nilandron) as an antiandrogen for transfeminine people in the late 1980s and early 1990s (de Voogt et al., 1987a; de Voogt et al., 1987b; Gooren et al., 1987; Johannes et al., 1987; Rao et al., 1988; Asscheman, Gooren, & Peereboom-Wynia, 1989; van Kemenade et al., 1989; Wiki). These guidelines briefly discussed bicalutamide including in the following two instances: Bicalutamide is an antiandrogen that has been used in the treatment of prostate cancer. Thompson, J., Hopwood, R. A., deNormand, S., & Cavanaugh, T. (2021). Bethesda, MD 20894, Web Policies pain in your back, pelvis, or stomach; swelling in your arms, ankles, legs, or feet; increased night-time urination; weakness, dizziness; or. This is below that required to induce changes in offspring of laboratory animals. Mderris, . ., & ner, G. (2009). (1997). Bicalutamide works by directly blocking the action of androgens at the androgen receptor. GraphPad Prism, version 7.03, (GraphPad Software) was used for statistical analyses of sample data. If you miss a dose of this medicine, skip the missed dose and go back to your regular dosing schedule. As an example, there are around 50 published case reports of meningioma with cyproterone acetate (Table), but a recent large study by the French government found that there were more than 500 operated instances of meningioma in association with high-dose cyproterone acetate over an 8-year period in France alone (Aly, 2020). Combined treatment with bicalutamide and anastrozole in a young boy with peripheral precocious puberty due to McCune-Albright Syndrome. It is recommended that bicalutamide be taken at the same time each day. Bicalutamide is a prescription medicine belonging to a class of medicines called non-steroidal androgen receptor inhibitors. Bicalutamide(Casodex) is a nonsteroidal antiandrogenand selectiveantagonistof the androgen receptorwhich was originally introduced for the treatment of prostate cancerin cisgender men in 1995. All she can find is guidelines for use in trans teens. Bicalutamide (150 mg) versus placebo as immediate therapy alone or as adjuvant to therapy with curative intent for early nonmetastatic prostate cancer: 5.3-year median followup from the Scandinavian Prostate Cancer Group Study Number 6. The role of antiandrogen monotherapy in the treatment of prostate cancer. Effects of the pure antiandrogen RU 23.903 (anandron) on sexuality, aggression, and mood in male-to-female transsexuals. Bicalutamide acts as a highly selective competitive silent antagonist of the AR ( IC50 = 159-243 nM), the major biological target of the androgen sex hormones testosterone and DHT, and hence is an antiandrogen . Treatment of familial male-limited precocious puberty with bicalutamide and anastrozole. Do not stop taking these medicines without checking with your doctor first. Hence, the true numbers may be much greater. The side effects of bicalutamide, a nonsteroidal antiandrogen (NSAA), including its frequent and rare side effects, have been well-studied and characterized. Storage (2011). Given that GnRH analogue puberty blockers can cost thousands of dollars and may not be covered by insurance, this lesser-known anti-androgen may be an economical option for adolescent trans girls. The most common side effects of bicalutamide monotherapy in men include breast tenderness, breast growth, feminization, demasculinization, and hot flashes.Less common side effects of bicalutamide monotherapy in men include sexual . Overview of feminizing hormone therapy Primary Author (s): Madeline B. Deutsch, MD, MPH Publication Date: June 17, 2016 Introduction The goal of feminizing hormone therapy is the development of female secondary sex characteristics, and suppression/minimization of male secondary sex characteristics. Sex steroids and pulsatile luteinizing hormone release in men. Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children, Indianapolis, Indiana, The publisher's final edited version of this article is available at, Bicalutamide, Transgender care, Gender dysphoria, Puberty blocker. However, use of bicalutamide as an antiandrogen in transfeminine hormone therapy is very recent. Variables evaluated comprised age, ethnicity, duration of follow-up, timing of estrogen initiation, laboratory studies, and change in breast Tanner stage during treatment. the contents by NLM or the National Institutes of Health. Bicalutamide is used to treat prostate cancer. Moreover, there were no cases of serious liver toxicity or liver failure with bicalutamide in the initial clinical development programme of bicalutamide for advanced prostate cancer, in which almost 4,000 men were treated with bicalutamide (Blackledge, 1996; Kolvenbag & Blackledge, 1996; McLeod, 1997; Anderson, 2003; Iversen et al., 2004; Wiki). Its not exactly great data by any means, but its a study at least. In September 2021, the Southern African HIV Clinicians Society (SAHCS) published clinical guidelines for transgender care for the first time: Surprisingly, these guidelines not only included bicalutamide but recommended it as the preferred antiandrogen over spironolactone and cyproterone acetate. Considering these apparent oversights and others, these guideliness recommendations should probably be interpreted with caution. 8600 Rockville Pike Oral bicalutamide for female pattern hair loss: A pilot study. This study reports on the use of bicalutamide in male-to-female youth, in whom it also causes significant feminization. Ballentine, S., & Hollingsworth, H. (2023 April 13). Anecdotally, all patients were extremely positive regarding the breast development they experienced on bicalutamide therapy. She believes the world is a better place when you educate women and give them the tools to manage their unique healthcare needs, this has inspire her work in women's health After working . Adults50 milligrams (mg) once a day, in the morning or in the evening. If your dose is different, do not change it unless your doctor tells you to do so. Iwamoto, S. J., Defreyne, J., Rothman, M. S., Van Schuylenbergh, J., Van de Bruaene, L., Motmans, J., & TSjoen, G. (2019). health information, we will treat all of that information as protected health While limited in its findings, Neyman, Fuqua, and Eugster (2019) helped to generate significant interest among clinicians and researchers in bicalutamide for use in transfeminine hormone therapy. If you are not a patient, this subreddit is the best forum to ask me questions in English or Spanish. The reason stated for this was less risk of neurosteroid depletion (does not cross blood-brain-barrier readily). However, this supposed effect isnt a known concern with antiandrogens besides 5-reductase inhibitors, and bicalutamide actually does appear to be centrally permeable in humans (Wiki). Peripheral precocious puberty with a Novel Mutation in LHCGR Gene drugs that change the way hormones are made how! J. H. ( 2023 bicalutamide dose mtf female viagra 13 ), O., & Jaberi,.... 2020 | Last modified April 17, 2023 youth [ 1 ] medicine skip... ( 5 ):1478-1479. doi: 10.1159/000524030 & Cavanaugh, T. 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