It would be wonderful if life could always be fair. We could plan our future, confident we would always get our just deserts. Unfortunately, the world can be uncaring, if not actually cruel. No matter how carefully we plan for the best outcomes, there’s always a chance for things to go wrong. Worse, even if everything goes right, we can end up the victims of jealousy or even hate for our success. Whether it’s at school or in the workplace, people can seize on the smallest things as justifications for treating us badly. It should not be this way, but even the way our body works can end up a trap. We can grow too tall or put on too much weight. We can be too pretty or have a physical disability.

One of the most common excuses for wanton cruelty is acne. As the hormones kick in, the majority of children and young adults find themselves the victims of abuse. Twenty or thirty years ago, this was mostly a problem for teens. Now it’s affecting younger children and lasting longer. That this is unfair could not be clearer. Everyone has the same bacteria growing on their skins and so has the same chance of suffering acne. Yet, no matter who shows the first signs, the others are always waiting to sniff the air to detect body odor and hint at the unwillingness to wash or make even more unkind suggestions for the cause of the emerging spots. At a time when most people lack self-confidence, these personal attacks are extremely hurtful and many suffer psychological damage.

It would be good if acne was a one-time event. We could put the trauma behind us and get on with our lives. But several million women are now discovering acne can return as they pass through the menopause. It should not be unexpected because the same hormonal changes that cause acne during puberty are repeating themselves. As it stands, the medical profession has been slow to respond and so the cosmetics industry has been making excessive profits with products to clean the skin and cover up the spots. For better or worse, our society has placed a burden on women to appear perfect, no matter what their age. So what action should the older woman take? It starts with the use of exfoliates. During and after menopause, skin erosion grows more uneven and so it’s always better to gently remove the epidermis or outer layer of skin to produce a more even appearance and clean out the pores. In turn, this helps control the acne. But only use the most gentle products to avoid drying out the skin. If this is not effective, you can move up to a retinoid cream. Should the menopause continue, using an oral contraceptive will usually calm down the hormone production.

Should all these simple steps fail, Accutane remains as the ultimate cure. Always remember pregnancy must be avoided at all costs so, if you are still sexually active and able to conceive, you must take comprehensive steps to prevent conception. As an older woman, you are in a high risk category for babies with birth defects. Use Accutane and birth defects become a certainty. Take advice before using this drug.

When life was more simple, we had two biological sexes. Men and women got together when they were old enough and produced the next generation. Thanks to their efforts, we’ve managed to grow the population to an amazing level. So long as our culture was based on the biology of making children and the legal questions of how to pass on our wealth to them, gender roles were easy to define. Men and women got married. Their legitimate children inherited the wealth. End of story. But there’s been a slow revolution as the definition of gender has grown more flexible. We’ve now begun to accept people for who and what they are. So when sexual attraction does not match the biological imperative, we’re prepared to tolerate same sex relationships. We’ve got enough people on the planet for now. Similarly, if women want to act more like men and vice versa, transgender behavior is increasingly acceptable. Once we get over our prejudices, we can all end up more equal.

Gender roles are set while we’re growing up. Everyone contributes: parents, teachers and other authority figures, all those we meet, and all those we read about and see. From good and bad experiences, we work out what’s socially acceptable. While young, parents have the most influence. Suppose they act protectively and expect their children to run to them every time they feel pain. The children learn to see pain as a way of attracting attention. Parents make a fuss of them to distract them. In the majority of families, this affects girls more than boys. It’s expected boys will fall off bicycles. They are expected to get back on again. But girls are often encouraged to watch out for signs of illness and to act immediately if there’s any pain.

All the statistics collected by the federal and state governments show women use the healthcare services significantly more often than men. They routinely report pain to their doctors. They receive more prescriptions for painkillers than men. When it comes to planning for the future of our healthcare services, this suggests diverting an increasing proportion of resources to the preventative treatment of women, i.e. focussing on diagnosing problems early and preventing them from developing into threats to health. Men deny illness and injury until the pain becomes unbearable, i.e. they need urgent treatment for more serious conditions. This gender divide has real significance when it comes to deciding where to build new hospitals and clinics, and how to train the next generation of doctors and nurses.

Fortunately, brain chemistry is the same in all shades of gender, so Tramadol will always be an effective painkiller. However, one major change should be made. At present, women are given far too many painkillers. This means many build up tolerance for these drugs, i.e. the drugs slowly become less effective. Tramadol is the preferred drug for moderate to severe pain but, if it’s given too often to people with only moderate pain, it will lose its power to control more severe pain unless prescribed at higher dosages. If people take this drug for too long at higher dosages, there’s a risk of dependence. So, people with lower levels of pain should use less powerful drugs or use only very low dosages of more powerful drugs.