Bilirubin is a breakdown product of hemoglobin. Red blood cells contain hemoglobin, which is broken down into the components "heme" and "globin." Heme is converted into bilirubin. Albumin carries bilirubin to the liver, where most of it is conjugated with a glucuronide before it is excreted in the bile. Conjugated bilirubin is called "direct bilirubin;" unconjugated bilirubin is called "indirect bilirubin." Total bilirubin equals direct bilirubin plus indirect bilirubin.
Testosterone, like many anabolic steroids, was classified as a controlled substance in 1991. Testosterone is administered parenterally in normal and delayed-release (depot) forms. In September 1995, the FDA approved testosterone transdermal patches (Androderm), and many transdermal forms and brands are now available including implants, gels, and topical solutions. A testosterone buccal system, Striant, was FDA-approved in July 2003; Striant is a mucoadhesive product that adheres to the buccal mucosa and provides a controlled and sustained release of testosterone. In May 2014, the FDA approved an intranasal gel formulation of testosterone (Natesto). A transdermal patch (Intrinsa) for hormone replacement in women is under investigation; the daily dosages used in women are much lower than for products used in males. The FDA refused approval for Intrinsa in 2004 stating that more data regarding safety, especially in relation to cardiovascular and breast health, were required.
Intersex is the development of genitalia somewhere between typical male and female genitalia. Once the child is born, the parents are faced with decisions that are often difficult to make, such as whether or not to modify the genitalia, assign the child as male or female , or leave the genitalia as is. Some parents allow their doctors to choose. If they do decide to modify the genitalia, they have approximately a 50% chance of getting genitalia that will match the child's gender identity . If they pick the wrong one, their child may begin to show symptoms of transsexualism , which can lead them to a life of discomfort until they are able to remedy the issue.