Bioidentical progesterone replacement therapy is commonly used by perimenopausal and postmenopausal women whose shifting hormone levels severely affect their well-being, causing symptoms such as irritability, hot flashes, difficulty concentrating, loss of libido, and more. However, women of reproductive age may also choose to take bioidentical ...Jul 10, 2020 · Bioidentical progesterone replacement therapy is commonly used by perimenopausal and postmenopausal women whose shifting hormone levels severely affect their well-being, causing symptoms such as irritability, hot flashes, difficulty concentrating, loss of libido, and more. However, women of reproductive age may also choose to take bioidentical ... Custom hormone treatments, called compounded bioidentical hormone therapies (cBHTs), are often promoted by celebrities as natural or safer than FDA-approved therapies.A wide variety of FDA-approved bioidentical hormones are currently available. New transdermal biodentical estradiol gels have been approved by the FDA for menopausal symptoms. In the future, new ... The FDA’s Pharmacy Compounding Advisory Committee (PCAC) should review select hormones for the Difficult to Compound list, including estradiol, estrone, estradiol, progesterone, estriol, testosterone, and the pellet dosage form. The federal government and State Boards of Pharmacy should expand and improve oversight of 503A “traditional ...The following lists some basic information about the FDA-approved hormone medicines for menopause. Use this information to help you talk to your healthcare provider about whether hormone... The first will examine the clinical utility of treating patients with compounded bioidentical hormone replacement therapy (BHRT) products. ... are used at times instead of FDA-approved drug ... Mar 11, 2021 · Bioidentical hormones are available as FDA-approved hormone formulations. Nonapproved custom-compounded preparations are marketed as bioidentical, but content is uncertain. The widespread use of compounded bioidentical hormone therapy despite the lack of evidence to support its safety and efficacy is concerning. Most of these hormones, except progesterone, are not approved by the FDA for use in women. Purchasing FDA-approved progesterone requires a medical prescription. Scientists report that FDA-approved progesterone BHRT products also adopt the name “body-identical” to avoid confusion with compounded bioidentical hormones (cBHRT). They are ...These types are approved and regulated by the FDA, and they are made by drug companies. Some bioidentical hormones are available in a compounding pharmacy. Compounded bioidentical hormones may be put into a capsule, a skin cream or gel, a tablet to dissolve under your tongue, a suppository, or a nose spray.Nov 8, 2022 · Bioidentical hormone therapy used to treat menopausal symptoms typically contains estradiol which is, in fact, identical to the estradiol used in traditional hormone therapy. Thus, the term bioidentical hormone therapy can be confusing; there are bioidentical hormones approved by the FDA, but there are also compounded bioidentical hormone ... Prescribers Should Restrict the Use of Non-FDA-Approved Compounded Bioidentical Hormones, Except for Specific Medical Circumstances. The National Academies of Sciences Engineering Medicine ...May 27, 2022 · There are FDA-approved bioidentical hormone products available, including estradiol ... Aug 11, 2020 · FDA Approved Bioidentical Hormones Preparations: All the hormones used in compounded preparations have been FDA approved and are used OFF-Label in compounded preparations. Here is a partial list of FDA approved hormone preparations for Estradiol, Progesterone and Testosterone: Hormone Product Year of FDA Approval Manufacturer These days, there are FDA-approved versions of bioidentical hormones, and there are alternative, custom-prepared varieties — like the one Foster uses — made in specialized "compounding ...The FDA has approved several bioidentical hormones. Somers' books, however, describes custom-compounded bioidentical hormones, meaning they are produced by a pharmacy mixing ingredients of various ...Mar 10, 2021 · Source: goodtoknow.co.uk. On the other hand, many of these points may be directly treated with bioidentical hormone alternative therapy. Hormone preparations specially tailor made for patients by compounding pharmacies, often known as bioidentical hormones, are extensively touted as being safer and more natural than Food and Drug Administration (FDA) approved variations of hormones. The U.S. Food and Drug Administration (FDA) has approved some forms of manufactured bioidentical hormones, including bioidentical estriol (a weak form of estrogen) and progesterone.Bioidentical hormones are broadly categorized, as either tested and reviewed by the FDA or not. Products approved by the FDA have undergone extensive testing and quality control.In October 2005 Wyeth Pharmaceuticals, a manufacturer of both FDA-approved bioidentical and non-bioidentical HRT preparations, filed a citizen petition with the FDA asking for enforcement action against compounding pharmacies that dispensed BHT and to investigate labelling and advertising guidelines. Soon after, the FDA took a number of ...Jul 13, 2021 · Group Tells the FDA to Restrict the Use of Compounded Hormones. That is the message this group is using to convince the FDA to make prescribing compounded products a very restricted field. The use of compounded bioidentical hormone therapies (cBHTs) — an increasingly popular approach to relieve symptoms of menopause and male hypogonadism ... 14 uses of U.S. Food and Drug Administration (FDA) approved hormone therapies include 15 replacement during menopause, oncology therapies, and for endocrine or genetic disorders. 16 Although oral contraceptives are a common use of hormones, their primary use for the prevention The FDA requires manufacturers of FDA-approved products that contain estrogen and progestin to include a black box warning that reflects the findings of the Women’s Health Initiative. However, compounded products (including “bio-identical hormones”) are not approved by the FDA and have been exempt from having to provide patient package They have names such as Estrace, Alora, Climara, Estring and Vagifem. A woman who still has her uterus and who goes on hormone therapy for menopause symptoms should also take progesterone to reduce her risk for uterine cancer. FDA-approved bioidentical progesterone products, such as Prometrium, are available as well.The FDA’s Pharmacy Compounding Advisory Committee (PCAC) should review select hormones for the Difficult to Compound list, including estradiol, estrone, estradiol, progesterone, estriol, testosterone, and the pellet dosage form. The federal government and State Boards of Pharmacy should expand and improve oversight of 503A “traditional ...The following lists some basic information about the FDA-approved hormone medicines for menopause. Use this information to help you talk to your healthcare provider about whether hormone... May 31, 2019 · The FDA has approved bioidentical formulations of both estrogen and progesterone. Products include (FDA) oral, transdermal, and vaginal 17β-estradiol and oral progesterone. These products are carefully controlled and regulated, allowing for improved safety and known risks. If women are interested in using bioidentical hormone therapy, consider The FDA requires manufacturers of FDA-approved products that contain estrogen and progestin to include a black box warning that reflects the findings of the Women’s Health Initiative. However, compounded products (including “bio-identical hormones”) are not approved by the FDA and have been exempt from having to provide patient package“The [widely available] FDA-approved bioidentical hormones produced in monitored facilities demonstrate a high quality of safety and efficiency in trials; therefore, there is no rationale for the routine prescribing of unregulated, untested, and potentially harmful custom-compounded bioidentical HTs.” The FDA has latched onto this false conclusion from a report it commissioned, and it is another direct threat compounded bioidentical hormones’ future. The FDA’s announcement regarding bioidentical hormones came just hours after the National Academy of Sciences, Engineering, and Medicine (NASEM) released their report reviewing the ...The FDA has approved several bioidentical hormones. Somers' books, however, describes custom-compounded bioidentical hormones, meaning they are produced by a pharmacy mixing ingredients of various ...Jul 1, 2020 · The U.S. Food and Drug Administration (FDA) has approved dozens of hormone therapy products for men and women, including estrogen, progesterone, testosterone, and related compounds. These products have been reviewed for safety and efficacy and are indicated for treatment of symptoms resulting from hormonal changes associated with menopause or ... Sep 12, 2012 · A long list of FDA-approved hormone products contain 17-beta estradiol and, therefore, are bioidentical. Examples include oral esterase, estradiol transdermal patches (Climara®, Vivelle®) and the vaginal ring (Estring®). Prometrium® is an oral FDA-approved bioidentical progesterone product. The next misconception is that progesterone ... Custom hormone treatments, called compounded bioidentical hormone therapies (cBHTs), are often promoted by celebrities as natural or safer than FDA-approved therapies.There are FDA-approved bioidentical hormone products available, including estradiol (Estrace, Climara, Vivelle) and progesterone (Prometrium). Many compounded hormones are also considered to be bioidentical. These are hormones made just for you. But they aren’t FDA-approved and can vary in quality. Table of contents About bioidentical hormones UsesSep 29, 2021 · Doses should be as low as possible to help ease the symptoms, and then taken for the shortest amount of time. For some women, this may be for a few months, for others, years. If you are taking HRT for serious menopause symptoms, you may be reluctant to stop taking HRT, for fear the symptoms will return. May 27, 2022 · There are FDA-approved bioidentical hormone products available, including estradiol ... May 31, 2019 · The FDA has approved bioidentical formulations of both estrogen and progesterone. Products include (FDA) oral, transdermal, and vaginal 17β-estradiol and oral progesterone. These products are carefully controlled and regulated, allowing for improved safety and known risks. If women are interested in using bioidentical hormone therapy, consider Compounded hormone products (e.g., pellets), including but not limited to compounded testosterone, estrogen, and progesterone pellets are not proven or medically necessary for any indication. Compounded drugs, including compounded testosterone, estrogen, or progesterone pellets are not FDA approved. 3. Applicable CodesFDA-approved. FDA does not have evidence that compounded “bioidentical hormones” are safe and effective, or safer or more effective than FDA-approved hormone therapy. FDA has approved drugs ...FDA-approved. FDA does not have evidence that compounded “bioidentical hormones” are safe and effective, or safer or more effective than FDA-approved hormone therapy. FDA has approved drugs ...The Food and Drug Administration (“FDA”) is currently considering placing eleven hormones used in Compounded Bioidentical Hormone Therapy (“cBHT”) on a The Food and Drug Administration (“FDA”) is currently considering placing eleven hormones used in Compounded Bioidentical Hormone Therapy (“cBHT”) on a “difficult to compound list”[1],effectively banning the compounding of ...Aug 11, 2020 · FDA Approved Bioidentical Hormones Preparations: All the hormones used in compounded preparations have been FDA approved and are used OFF-Label in compounded preparations. Here is a partial list of FDA approved hormone preparations for Estradiol, Progesterone and Testosterone: Hormone Product Year of FDA Approval Manufacturer Feb 22, 2022 · October 17, 2019 | Filed under: Health, Menopause. I’m so thrilled to have Dr. Barbie Taylor a.k.a. “Menopause Taylor” with us today! She’s a retired OB/GYN who’s dedicated her 2nd half to educating women about menopause! If you’re a woman (of any age), this is a must watch video! I was a typical aging woman who had NO …. The term "bioidentical hormone therapy" is used to describe hormones that are identical or nearly identical to the molecular structure of hormones produced naturally by your body. Technically, your body cannot tell bioidentical hormones from the ones your ovaries produce. Bioidentical hormones come from plants like soy or yams, but still need ...The FDA has approved several bioidentical hormones. Somers' books, however, describes custom-compounded bioidentical hormones, meaning they are produced by a pharmacy mixing ingredients of various ...They have names such as Estrace, Alora, Climara, Estring and Vagifem. A woman who still has her uterus and who goes on hormone therapy for menopause symptoms should also take progesterone to reduce her risk for uterine cancer. FDA-approved bioidentical progesterone products, such as Prometrium, are available as well.Pellet therapy is one of the many ways you can receive hormone replacement therapy and is a popular treatment plan for patients in wellness, anti-aging, and hormone clinics. The pellets can be FDA-approved drugs (Testopel), or they can be custom made (not FDA-approved) in a compounding pharmacy (e.g., BioTE and many others).Indeed, the appeal of bioidentical hormone therapy has not been lost on the public or the medical community: nearly one-third of women who now use hormone therapy do so with bioidentical hormones (Gass 2015). Many FDA-approved commercial preparations now utilize bioidentical hormones, which is helping spread acceptance of bioidentical HRT among ...Compounded drugs have long been part of the medical armamentarium. Through drug compounding, compounders may offer therapeutic alternatives for patients with unique medical needs that cannot be met by U.S. Food and Drug Administration (FDA)-approved drug products (FDA, 2017a). The Federal Food, Drug, and Cosmetic Act (FDCA) of 1938 is the primary source of FDA's authority over prescription ...Jul 13, 2021 · Group Tells the FDA to Restrict the Use of Compounded Hormones. That is the message this group is using to convince the FDA to make prescribing compounded products a very restricted field. The use of compounded bioidentical hormone therapies (cBHTs) — an increasingly popular approach to relieve symptoms of menopause and male hypogonadism ... (See Table for a list of FDA-approved bioi-dentical HT products.) Another hormone, testosterone (shown to improve sexual desire), is not currently available as an FDA-approved bioidentical product. Confusion and unsubstantiated claims surround the custom-compounded bioidentical hormone therapy products used to treat Bioidentical testosterone is currently not FDA approved or commercially available for women. Through compounding pharmacy technology, the product can be formulated for off-label use, but again, will not be covered by insurance. Two gels are approved in the U.S. for men only: AndroGel and Testim (1%). There are no FDA approved products for cis ...FDA approved bioidentical hormones are intended for standard doses that are mass-produced by manufacturers. If you need a dose that is higher or lower than what a manufacturer makes, then you must have it compounded to your individual needs. There are 3 types of bioidentical estrogens. The stronger and more active estrogen against menopausal ...compounded drugs, and then it reviews key regulatory issues related to the U.S. compounded drug market. 2 FDA-APPROVED DRUG PRODUCTS. FDA approves a new drug for public use only after careful review of data from preclinical studies in animals and human clinical trials that determine whether the benefits of the drug outweigh its known and potential risks.Compounded hormone products (e.g., pellets), including but not limited to compounded testosterone, estrogen, and progesterone pellets are not proven or medically necessary for any indication. Compounded drugs, including compounded testosterone, estrogen, or progesterone pellets are not FDA approved. 3. Applicable CodesBioidentical or body-identical hormones are estradiol and progesterone that are molecularly identical to human hormones. Most (not all) modern menopause hormone therapy is bioidentical. Keep reading for a list of brands. The difference between “bioidentical” and “body-identical” is that body-identical is the preferred conventional term ...Compounding pharmacies should be aware of recent developments in the law surrounding bioidentical hormone therapy (cBHT). In the field of pharmacy, compounding (performed in compounding pharmacies) is preparation of a custom formulation of a medication to fit the unique need of a patient which cannot be met with commercially available products. Compounded drugs are not FDA-approved. The Food ...In contrast to FDA-approved drug products, compounded bioidentical hormone therapy (cBHT) preparations lack standardized production methods, potentially leading to state-by-state and even pharmacy-by-pharmacy variability in the medications dispensed to patients.Pellet therapy is one of the many ways you can receive hormone replacement therapy and is a popular treatment plan for patients in wellness, anti-aging, and hormone clinics. The pellets can be FDA-approved drugs (Testopel), or they can be custom made (not FDA-approved) in a compounding pharmacy (e.g., BioTE and many others).The first will examine the clinical utility of treating patients with compounded bioidentical hormone replacement therapy (BHRT) products. ... are used at times instead of FDA-approved drug ... Bioidentical Hormone Therapy. The change in hormonal milieu associated with perimenopause and menopause can lead to a variety of symptoms that can affect a woman's quality of life. Postmenopausal hormone therapy (HT) is an effective, well-tolerated treatment for these symptoms. However, combined HT consisting of conjugated equine estrogen and ...These types are approved and regulated by the FDA, and they are made by drug companies. Some bioidentical hormones are available in a compounding pharmacy. Compounded bioidentical hormones may be put into a capsule, a skin cream or gel, a tablet to dissolve under your tongue, a suppository, or a nose spray.Sep 27, 2021 · The FDA wants to restrict compounded hormones to patients who are allergic to manufactured products or who need an unavailable specific dosage. People other than estrogen-deficient women use ... Sep 27, 2021 · The FDA wants to restrict compounded hormones to patients who are allergic to manufactured products or who need an unavailable specific dosage. People other than estrogen-deficient women use ... Feb 22, 2022 · October 17, 2019 | Filed under: Health, Menopause. I’m so thrilled to have Dr. Barbie Taylor a.k.a. “Menopause Taylor” with us today! She’s a retired OB/GYN who’s dedicated her 2nd half to educating women about menopause! If you’re a woman (of any age), this is a must watch video! I was a typical aging woman who had NO …. Bioidentical progesterone replacement therapy is commonly used by perimenopausal and postmenopausal women whose shifting hormone levels severely affect their well-being, causing symptoms such as irritability, hot flashes, difficulty concentrating, loss of libido, and more. However, women of reproductive age may also choose to take bioidentical ...A long list of FDA-approved hormone products contain 17-beta estradiol and, therefore, are bioidentical. Examples include oral esterase, estradiol transdermal patches (Climara®, Vivelle®) and the vaginal ring (Estring®). Prometrium® is an oral FDA-approved bioidentical progesterone product. The next misconception is that progesterone ...Group Tells the FDA to Restrict the Use of Compounded Hormones. That is the message this group is using to convince the FDA to make prescribing compounded products a very restricted field. The use of compounded bioidentical hormone therapies (cBHTs) — an increasingly popular approach to relieve symptoms of menopause and male hypogonadism ...A wide variety of FDA-approved bioidentical hormones are currently available. New transdermal biodentical estradiol gels have been approved by the FDA for menopausal symptoms. In the future, new ... The FDA has not approved these compounded hormones, and it does not regulate them. As a result, they may pose safety risks. There is little evidence supporting bioidentical hormones, particularly ...Oct 10, 2022 · Bioidentical or body-identical hormones are estradiol and progesterone that are molecularly identical to human hormones. Most (not all) modern menopause hormone therapy is bioidentical. Keep reading for a list of brands. The difference between “bioidentical” and “body-identical” is that body-identical is the preferred conventional term ... The Food and Drug Administration (“FDA”) is currently considering placing eleven hormones used in Compounded Bioidentical Hormone Therapy (“cBHT”) on a The Food and Drug Administration (“FDA”) is currently considering placing eleven hormones used in Compounded Bioidentical Hormone Therapy (“cBHT”) on a “difficult to compound list”[1],effectively banning the compounding of ...Dec 7, 2020 · Compounding pharmacies should be aware of recent developments in the law surrounding bioidentical hormone therapy (cBHT). In the field of pharmacy, compounding (performed in compounding pharmacies) is preparation of a custom formulation of a medication to fit the unique need of a patient which cannot be met with commercially available products. Compounded drugs are not FDA-approved. The Food ... Jul 7, 2010 · "It is important that women understand what bioidentical hormones are and the differences between those that are FDA-approved and those that are compounded or "mixed" at the pharmacy level," said ... Compounded bioidentical hormone replacement therapy (BHRT) products such as progesterone and testosterone, are used at times instead of FDA-approved drugs for hormone replacement therapy.The author falsely claims that bioidentical hormones have not been proven safe and effective as required for FDA approval process. Take a look at the list of bioidentical prescription hormones above. These are all FDA approved and proven safe and effective.The author falsely claims that bioidentical hormones have not been proven safe and effective as required for FDA approval process. Take a look at the list of bioidentical prescription hormones above. These are all FDA approved and proven safe and effective.Context: Since 2002, when the US Food and Drug Administration (FDA) placed a black box warning on women's hormone replacement products, women and their providers have been struggling with whether to proceed with hormone replacement therapy. Out of the controversy has grown a popular movement promoting the use of bioidentical hormones. In addition to this, these drugs used estriol, a weaker form of estrogen which does not have FDA approval. The Benefits and Risks of Bioidentical Hormone Therapy. As with any health treatment, bioidentical hormones come with benefits and risks. The benefits of FDA-approved bioidentical hormone therapy stem from the nature of their creation.Bioidentical hormones are broadly categorized, as either tested and reviewed by the FDA or not. Products approved by the FDA have undergone extensive testing and quality control.Sep 29, 2021 · Doses should be as low as possible to help ease the symptoms, and then taken for the shortest amount of time. For some women, this may be for a few months, for others, years. If you are taking HRT for serious menopause symptoms, you may be reluctant to stop taking HRT, for fear the symptoms will return. Jul 10, 2020 · Bioidentical progesterone replacement therapy is commonly used by perimenopausal and postmenopausal women whose shifting hormone levels severely affect their well-being, causing symptoms such as irritability, hot flashes, difficulty concentrating, loss of libido, and more. However, women of reproductive age may also choose to take bioidentical ... The FDA wants to restrict compounded hormones to patients who are allergic to manufactured products or who need an unavailable specific dosage. People other than estrogen-deficient women use ...compounded drugs, and then it reviews key regulatory issues related to the U.S. compounded drug market. 2 FDA-APPROVED DRUG PRODUCTS. FDA approves a new drug for public use only after careful review of data from preclinical studies in animals and human clinical trials that determine whether the benefits of the drug outweigh its known and potential risks.
Sep 27, 2021 · The FDA wants to restrict compounded hormones to patients who are allergic to manufactured products or who need an unavailable specific dosage. People other than estrogen-deficient women use ... . Fons porterpercent27s love of quilting patterns
For example, one study found that only 1 of 10 compounding pharmacies provided progesterone vaginal suppositories that were all within the potency range required of similar FDA-approved products. 2. This article will focus on compounded bioidentical hormone preparations aimed at menopausal and perimenopausal women.Estrogen, progesterone and testosterone are the most commonly used bioidentical hormones. Some prescription forms of bioidentical hormones are premade by drug companies. The U.S. Food and Drug Administration (FDA) has approved certain types of bioidentical hormones. The first will examine the clinical utility of treating patients with compounded bioidentical hormone replacement therapy (BHRT) products. ... instead of FDA-approved drug products for hormone ...The FDA requires manufacturers of FDA-approved products that contain estrogen and progestin to include a black box warning that reflects the findings of the Women’s Health Initiative. However, compounded products (including “bio-identical hormones”) are not approved by the FDA and have been exempt from having to provide patient packageAug 12, 2020 · Patented synthetic hormones require extensive testing and funding, which helps keep the FDA in business. When looking at the safety of bioidentical hormones, several things stand out. As mentioned above, the risk of breast cancer is reduced using bioidentical hormones. Oct 24, 2017 · See Table 1 for a list of FDA-approved bioidentical hormone preparations. Moreover, supplementation with scientifically studied herbs such as Dong quai ( Angelica sinensis ) and licorice ( Glycyrrhiza glabra ) root can further promote healthy metabolism of female hormones and complement the actions of bioidentical HRT. The quick answer is yes, bioidentical hormones are FDA approved but hold on, this is a very controversial and somewhat complex topic that requires more explanation. Some bioidentical hormones are manufactured by drug companies, are approved by the FDA, and sold in standard doses. On the other hand some bioidentical hormone preparations are made ...FDA Approved Drugs. The following database contains a listing of drugs approved by the Food and Drug Administration (FDA) for sale in the United States. Drug information typically includes the drug name, approval status, indication of use, and clinical trial results. A.A wide variety of FDA-approved bioidentical hormones are currently available. New transdermal biodentical estradiol gels have been approved by the FDA for menopausal symptoms. In the future, new ... In recent decades there has been a significant increase in both the supply and demand for compounded bioidentical hormone therapy (cBHT) products, raising the need for a better understanding of their safety and effectiveness. cBHT use has alarmed many providers as custom-compounded hormones are not Food and Drug Administration (FDA) approved and do not have labeling that details product risks ...Aug 12, 2020 · Patented synthetic hormones require extensive testing and funding, which helps keep the FDA in business. When looking at the safety of bioidentical hormones, several things stand out. As mentioned above, the risk of breast cancer is reduced using bioidentical hormones. “The [widely available] FDA-approved bioidentical hormones produced in monitored facilities demonstrate a high quality of safety and efficiency in trials; therefore, there is no rationale for the routine prescribing of unregulated, untested, and potentially harmful custom-compounded bioidentical HTs.” A wide variety of FDA-approved bioidentical hormones are currently available. New transdermal biodentical estradiol gels have been approved by the FDA for menopausal symptoms. In the future, new ... To learn more, review the BIJUVA Patient Information and talk about BIJUVA with your healthcare provider or pharmacist. The FDA-approved product labeling, including Patient Information, can be found here. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch or call 1-800-FDA-1088.May 13, 2016 · The author, an AP medical writer, might be horrified to know that these non-FDA approved bioidentical hormones, (estradiol, progesterone, estriol and testosterone), are floating around in her blood stream right now, and have been since she was born. So, please, don’t do anything impulsive or crazy, like trying to remove these non-FDA approved ... Background In recent years, compounded bioidentical hormone therapy (CBHT) has emerged as a popular alternative to manufactured, FDA approved hormone therapy (HT)—despite concerns within the medical community and the availability of new FDA approved “bioidentical” products. This study aims to characterize the motivations for using CBHT in a U.S. sample of ordinary midlife women. Methods ...Bioidentical hormones have the exact same chemical and molecular structure as hormones that are produced in the human body. Bioidentical hormones are available as FDA-approved hormone formulations. Nonapproved custom-compounded preparations are marketed as bioidentical, but content is uncertain. .