Identify the incorrect answer:

Case Histories 7: 70 YO retired engineer with c/o ED otherwise very healthy, thin, muscular, SHBG 107 nmol/l!

Lab tests: Testosterone 900 ng/dl, E2 – 40 pg/ml, SHBG 107 nmol/l (uln 60)!, CFTI – est 85 nmol/l (borderline low).

Identify the incorrect answer:

Case Histories 7: 70 YO retired engineer with c/o ED otherwise very healthy, thin, muscular, SHBG 107 nmol/l!

Lab tests: Testosterone 900 ng/dl, E2 – 40 pg/ml, SHBG 107 nmol/l (uln 60)!, CFTI – est 85 nmol/l (borderline low).

Case 7 was treated with Danazol 20 mg SR capsule 1 daily.

Identify the incorrect answer: Danazol…

Case Histories 8: 65 YO retired postal worker with typical low androgen symptoms – fatigue, mild depression, low libido, loss of muscle strength and mass.

All labs A+ except: Testosterone 220 ng/dl; SHBG 45 nmol/l – CFTI – 40 pg/ml; E2 <20 pg/ml; FSH 28/LH 15; DHEA-S – 45 ng/dl.

What is the correct answer?

Case Histories 8: 65 YO retired postal worker with typical low androgen symptoms – fatigue, mild depression, low libido, loss of muscle strength and mass.

All labs A+ except: Testosterone 220 ng/dl; SHBG 45 nmol/l – CFTI – 40 pg/ml; E2 <20 pg/ml; FSH 28/LH 15; DHEA-S – 45 ng/dl.

This patient needs:

Case Histories 9: 16 YO with sluggishness, shy personality, obesity, gynecomastia.

Lab: Testosterone – 200 ng/dl, E2 – 35 pg/ml, E2 – 35 pg/ml, FSH – 35, LH – 25, prolactin – 18.

What is the incorrect answer?

Case Histories 10: 20 YO college student, early pattern baldness, but otherwise a typical healthy, sexually active, athletic individual. He took Propecia for the hair loss for 6 weeks and noticed significant fatigue, loss of libido, and changes in erectile fullness and diminished ejaculate. Symptoms persisted after Propecia was stopped.

Testing: Testosterone – 350 ng/dl, E2 – 48 pg/ml, prolactin – 20 ng/dl, FSH/LH <2.

What is the incorrect answer?

Case Histories 11: 28 YO insulin-dependent diabetic, very obese (>250 lbs) extreme fatigue, sweating, wash out spells in the afternoon where he could not function, remarkable gynecomastia.

Lab: Testosterone – 220 ng/dl, E2 – 45 pg/ml, IGF-1 – 60 ng/dl, SHBG – 25 umol/L, prolactin – 16, cortisol 25 mg/dl, DHEA-S 350 mg/dl, TSH – 1.2, Free T4 1.1, Free T3 – 2.4. Poor variable response to Androgel – Test never > 350 ng/dl.

Started on Arimidex 1 mg twice weekly with some variable responses – could feel it wearing off after 2–3 days. Testosterone increased to 450 ng/dl, E2 – 35 pg/ml. Dose of Arimidex increased to 1 md 3x weekly with some further improvement, but could still feel it wearing off and still having fatigue spells. Switched to stronger aromatase inhibitor, Femara 2.5 mg ½ tablet weekly with much improved energy and no wear-off spells. Testosterone 650 ng/dl, E2 – 22 pg/ml, IGF-1 – 70. Scheduled for IV GH stim test at a university locally.

True or false: Patient was given an excessive original dose of Androgel.

Case Histories 11: 28 YO insulin-dependent diabetic, very obese (>250 lbs) extreme fatigue, sweating, wash out spells in the afternoon where he could not function, remarkable gynecomastia.

Lab: Testosterone – 220 ng/dl, E2 – 45 pg/ml, IGF-1 – 60 ng/dl, SHBG – 25 umol/L, prolactin – 16, cortisol 25 mg/dl, DHEA-S 350 mg/dl, TSH – 1.2, Free T4 1.1, Free T3 – 2.4. Poor variable response to Androgel – Test never > 350 ng/dl.

Started on Arimidex 1 mg twice weekly with some variable responses – could feel it wearing off after 2–3 days. Testosterone increased to 450 ng/dl, E2 – 35 pg/ml. Dose of Arimidex increased to 1 md 3x weekly with some further improvement, but could still feel it wearing off and still having fatigue spells. Switched to stronger aromatase inhibitor, Femara 2.5 mg ½ tablet weekly with much improved energy and no wear-off spells. Testosterone 650 ng/dl, E2 – 22 pg/ml, IGF-1 – 70. Scheduled for IV GH stim test at a university locally.

True or false: Patient was given an excessive original dose of Arimidex.

Case Histories 11: 28 YO insulin-dependent diabetic, very obese (>250 lbs) extreme fatigue, sweating, wash out spells in the afternoon where he could not function, remarkable gynecomastia.

Lab: Testosterone – 220 ng/dl, E2 – 45 pg/ml, IGF-1 – 60 ng/dl, SHBG – 25 umol/L, prolactin – 16, cortisol 25 mg/dl, DHEA-S 350 mg/dl, TSH – 1.2, Free T4 1.1, Free T3 – 2.4. Poor variable response to Androgel – Test never > 350 ng/dl.

Started on Arimidex 1 mg twice weekly with some variable responses – could feel it wearing off after 2–3 days. Testosterone increased to 450 ng/dl, E2 – 35 pg/ml. Dose of Arimidex increased to 1 md 3x weekly with some further improvement, but could still feel it wearing off and still having fatigue spells. Switched to stronger aromatase inhibitor, Femara 2.5 mg ½ tablet weekly with much improved energy and no wear-off spells. Testosterone 650 ng/dl, E2 – 22 pg/ml, IGF-1 – 70. Scheduled for IV GH stim test at a university locally.

True or false: Patient was given Femara as a stronger aromatase inhibitor, more relevant for an obese male.

Case Histories 11: 28 YO insulin-dependent diabetic, very obese (>250 lbs) extreme fatigue, sweating, wash out spells in the afternoon where he could not function, remarkable gynecomastia.

Lab: Testosterone – 220 ng/dl, E2 – 45 pg/ml, IGF-1 – 60 ng/dl, SHBG – 25 umol/L, prolactin – 16, cortisol 25 mg/dl, DHEA-S 350 mg/dl, TSH – 1.2, Free T4 1.1, Free T3 – 2.4. Poor variable response to Androgel – Test never > 350 ng/dl.

Started on Arimidex 1 mg twice weekly with some variable responses – could feel it wearing off after 2–3 days. Testosterone increased to 450 ng/dl, E2 – 35 pg/ml. Dose of Arimidex increased to 1 md 3x weekly with some further improvement, but could still feel it wearing off and still having fatigue spells. Switched to stronger aromatase inhibitor, Femara 2.5 mg ½ tablet weekly with much improved energy and no wear-off spells. Testosterone 650 ng/dl, E2 – 22 pg/ml, IGF-1 – 70. Scheduled for IV GH stim test at a university locally.

What is incorrect concerning Re Letrozole (Femara)?