Case Histories 1: A 40 YO ex-weight lifter and past steroid user (off steroids for several years).

What statement would be UNTRUE of this patient?

Case Histories 1: A 40 YO ex-weight lifter and past steroid user (off steroids for several years).

What would NOT be true if he was given 25 mg Clomiphene h.s. x 1 week?

Case Histories 1: A 40 YO ex-weight lifter and past steroid user (off steroids for several years).

What would be INCORRECT if he was prescribed hCG 250 IUs given Mon, Wed, and Fri?

Case Histories 1: A 40 YO ex-weight lifter and past steroid user (off steroids for several years).

What would NOT be correct if he was prescribed hCG 200 IUs given Mon, Wed, and Fri?

Case Histories 1: A 40 YO ex-weight lifter and past steroid user (off steroids for several years).

What would NOT be correct if he was given the aromatase inhibitor, chrysin?

Clomiphene Stimulation Test. Case Histories 2: 54 YO lawyer, centrally obese, hypertensive: 160/94, FBS -120 mg/dl, Insulin: 24 umol, Chol:140, trig: 550, HDL 35 type B, Vitamin D: 15 ng/ml, ED for the last 2 years (when started statin, b-blocker, diuretic).

ED for the last 2 years (when started statin, b-blocker, diuretic), fatigue, poor concentration, no initiative.

Meds: B-blocker, diuretic, statin, SSRI, Rozerem. Habits: 2 drinks/night+/-, no daily exercise, snores.

What would be UNTRUE if he was given Clomiphene 25 mg hs for 7 nights?

Clomiphene Stimulation Test. Case Histories 2: 54 YO lawyer, centrally obese, hypertensive: 160/94, FBS -120 mg/dl, Insulin: 24 umol, Chol:140, trig: 550, HDL 35 type B, Vitamin D: 15 ng/ml, ED for the last 2 years (when started statin, b-blocker, diuretic).

ED for the last 2 years (when started statin, b-blocker, diuretic), fatigue, poor concentration, no initiative.

Meds: B-blocker, diuretic, statin, SSRI, Rozerem. Habits: 2 drinks/night+/-, no daily exercise, snores.

What would NOT be a recommended treatment for him?

Case Histories 3: 50 YO elite athlete with decline in performance, decreased energy after workouts, feeling depressed and burned out at times over the last 6 months. Never an unhealthy day in past.

All Lab A+ except testosterone total 455 ng/dl, SHBG 56 nmol/l, CFTI – 60 pg/ml, E2 28 pg/ml, cortisol 8 mg/dl, DHEA-S 95 mg/dl.

Clomiphene stim test: Testosterone 1100 mg/dl, CFTI – 190 pg/ml, FSH 12 , LH 9, E2 47 pg/ml, E2 rose to 47.

Clinically: Immediate boosted to high levels of energy.

This patient has improved through treatment. Should his testosterone CFTI and E2 be increased?

Rx after stim test for case 3 patient: Clomiphene 15mg SR capsules 1 hs M, W, F, DHEA 25 mg/gm, pregnenolone 25 mg/gm, selegiline 1 mg/gm – 1 gm cream daily in the AM, Zinc 50 mg daily and DHEA 25 mg SR capsule hs nightly.

Clinical response: Back to normal+, feeling better than in years, mood, libido, function, performance all improved.

Lab: Testosterone 750 ng/dl, CFTI 120 pg/ml, E2 38 pg/ml; cortisol 15.5 mg/dl, DHEA-S 450 mg/dl.

He has continued to improve. Should he have been treated with higher levels of testosterone CFTI and E2 midway between previous and most recent test?

Case Histories 4: 48 YO mesomorphic athlete. Head injury 10 years before. Post concussion syndrome, ADD-type residual cognitive changes. Persistent fatigue, lack of response to physical training, no ED but decreased libido from past levels.

Test: Clomiphene SR 25 mg M/W/Fri hs.

True or false: He is also a good candidate for selegiline 3 mg/cc/preg 10 mg/cc/DHEA 10mg/cc alcoholic gel combined Rx because of neural regeneration, ADD, mood and depression.

Case Histories 4: 48 YO mesomorphic athlete. Head injury 10 years before. Post concussion syndrome, ADD-type residual cognitive changes. Persistent fatigue, lack of response to physical training, no ED but decreased libido from past levels.

Test: Clomiphene SR 25 mg M/W/Fri hs.

True or false: He may be a good candidate for Sinemet/L-arginine or l-dopa stim test for growth hormone.

Case Histories 4: 48 YO mesomorphic athlete. Head injury 10 years before. Post concussion syndrome, ADD-type residual cognitive changes. Persistent fatigue, lack of response to physical training, no ED but decreased libido from past levels.

Test: Clomiphene SR 25 mg M/W/Fri hs.

Results of his Clomiphene stim test:

What would be UNTRUE?

Case Histories 5: 52 YO healthy athletic male, typical low testosterone symptoms for the last several years. Testosterone 350 ng/dl, E2 <20 pg/ml.

What would be TRUE for this patient?

Case Histories 5: 52 YO healthy athletic male, typical low testosterone symptoms for the last several years. Testosterone 350 ng/dl, E2 <20 pg/ml.

He had a poor response to Clomid stimulation test… it didn’t work.

He was then given the hCG stimulation test: hCG 500 IU sq given M/W/F for 2 weeks.

Clinical response: Improved libido, AM erections and energy.

What would now be TRUE for this patient?

Prolactinoma. Case Histories 6: 48 YO obese male, Extreme fatigue, Fibromyalgia, Low testosterone, Elevated prolactin 785 ng/dl.

Not relieved by testosterone patch from another doctor.

MRI positive for prolactinoma.

True or false: Testosterone can make prolactinomas grow through conversion to estrogen.

Prolactinoma. Case Histories 6: 48 YO obese male, Extreme fatigue, Fibromyalgia, Low testosterone, Elevated prolactin 785 ng/dl.

Not relieved by testosterone patch from another doctor.

MRI positive for prolactinoma.

If you are going to replenish testosterone, you should also treat with (choose the correct answer):