Andropause Mastery

Evaluation and treatment of testosterone deficiency Part 1

9 Topics | 9 Quizzes

Hypogonadism: The Basics

Quiz 1: Hypogonadism: The Basics

PADAM – Partial Androgen deficiency in the Adult Male: Dx & Causes

Quiz 2: PADAM – Partial Androgen Deficiency in the Adult Male: Dx & Causes

Prescription medications that affect the endocrine system

Quiz 3: Prescription medications that affect the endocrine system

Evaluations: Initial Medical History for Men

Quiz 4: Evaluations: Initial Medical History for Men

Evaluations: Lab Testing

Quiz 5: Evaluations: Lab Testing

Treatments: Clomiphene, hCG, and ways to lower elevated prolactin

Quiz 6: Treatments: Clomiphene, hCG, and ways to lower elevated prolactin

Attention to Estrogen Levels in Males

Quiz 7: Attention to Estrogen Levels in Males

Paying Attention to SHBG

Quiz 8: Paying Attention to SHBG

Testosterone Replenishment Options

Quiz 9: Testosterone Replenishment Options

Evaluation and treatment of testosterone deficiency Part 2

3 Topics | 3 Quizzes

Case Histories Part 1: Clomiphene & hCG Stim testing, and prolactinoma

Quiz 10: Case Histories Part 1: Clomiphene & hCG Stim Testing, and Prolactinoma

Case Histories Part 2: Elevated SHBG, Aromatase Inhibitors, and Hormone Rx for the obese

Quiz 11: Case Histories Part 2: Elevated SHBG, Aromatase Inhibitors, and Hormone Rx for the obese

Sexual dysfunction: Libido, ED and Orgasmic Response

Quiz 12: Sexual dysfunction: Libido, ED and Orgasmic Response

Evaluation and treatment of testosterone deficiency Part 3

4 Topics | 4 Quizzes

Testosterone Nomogram, Working High and Low SHBG, and Danazol

Quiz 13: Testosterone Nomogram, Working High and Low SHBG, and Danazol

Human Chorionic Gonadotropin (hCG)

Quiz 14: Human Chorionic Gonadotropin (hCG)

Introduction to Estrogen and Aromatase Inhibitors

Quiz 15: Introduction to Estrogen and Aromatase Inhibitors

More on Aromatase Inhibitors. Boosting HPT Axis: Clomiphene. Prolactin.

Quiz 16: More on Aromatase Inhibitors. Boosting HPT Axis: Clomiphene, Prolactin

PDE-5 Inhibitors

5 Topics | 5 Quizzes

The Major Anti-aging Breakthroughs of the PDE-5 Inhibitors: Overview

Quiz 17: The Major Anti-aging Breakthroughs of the PDE-5 Inhibitors: Overview

PDE-5 Inhibitors: Benefit for Treatment of Diabetes and Cardiovascular Disease

Quiz 18: PDE-5 Inhibitors: Benefit for Treatment of Diabetes and Cardiovascular Disease

PDE-5 Inhibitors: Benefit for Treatment of Cancer

Quiz 19: PDE-5 Inhibitors: Benefit for Treatment of Cancer

PDE-5 Inhibitors: Benefit for Treatment CNS and Alzheimer’s Disease

Quiz 20: PDE-5 Inhibitors: Benefit for Treatment CNS and Alzheimer’s Disease

PDE-5 Inhibitors: Additional Observations & Summary of Benefits

Quiz 21: PDE-5 Inhibitors: Additional Observations & Summary of Benefits

Monday Morning Medicine: Part 1

4 Topics | 4 Quizzes

Monday Morning Medicine: Overview of testing and treating men: Basic Workup

Quiz 22: Monday Morning Medicine: Overview of testing and treating men: Basic Workup

Monday Morning Medicine: Stimulation testing

Quiz 23: Monday Morning Medicine: Stimulation testing

Monday Morning Medicine: Injectable Testosterone

Quiz 24: Monday Morning Medicine: Injectable Testosterone

Monday Morning Medicine: Topical Testosterone

Quiz 25: Monday Morning Medicine: Topical Testosterone

Monday Morning Medicine: Part 2

1 Topic | 1 Quiz

Monday Morning Medicine: PDE-5 Inhibitors

Quiz 26: Monday Morning Medicine: PDE-5 Inhibitors

Monday Morning Medicine: Part 3

3 Topics | 3 Quizzes

Monday Morning Medicine: Therapeutics Synergistic with PDE-5 Inhibitors

Quiz 27: Monday Morning Medicine: Therapeutics Synergistic with PDE-5 Inhibitors

Monday Morning Medicine: The estrogen issue in men

Quiz 28: Monday Morning Medicine: The estrogen issue in men

Practical applications: Use of Danazol for elevated SHBG

Quiz 29: Practical applications: Use of Danazol for elevated SHBG

2 Topics | 2 Quizzes

Thyroid basics and practical applications

Quiz 30: Thyroid basics and practical applications

Thyroid continued: Selenium, Iodine, and a pearl re T3 low dose to stop hair loss

Quiz 31: Thyroid continued: Selenium, Iodine, and a pearl re T3 low dose to stop hair loss

Cardiovascular and other results of Testosterone Rx

3 Topics | 3 Quizzes

Testosterone and Risk for Cardiovascular Diseases

Quiz 32: Testosterone and Risk for Cardiovascular Diseases

Additional factors related to Hormones and Cardiovascular Diseases

Quiz 33: Additional Factors Related to Hormones and Cardiovascular Diseases

So what are the objective results of treatment with testosterone?

Quiz 34: So what are the objective results of treatment with testosterone?

Quiz 12: Sexual dysfunction: Libido, ED and Orgasmic Response

Andropause Mastery Evaluation and treatment of testosterone deficiency Part 2 Sexual dysfunction: Libido, ED and Orgasmic Response Quiz 12: Sexual dysfunction: Libido, ED and Orgasmic Response

Note: Read each question carefully and choose the best answer among the choices.

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Question 1 of 12

1. Question
Impotence: Testosterone deficiency does NOT result in:
- Increased prolactin
- Decreased NO in pelvic arteries – decreased blood flow
- Atrophy of levator ani group – bulbo-cavernosus and ischio-cavernosus muscles
- Decreased nerve end plate receptors
- Decreased production of GMP
- Decreased penile-brachial index
- Decreased libido
Correct

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Question 2 of 12

2. Question
Low libido is NOT likely to be related to:
- Low testosterone
- Excess E2
- Low DHEA
- Excess prolactin
- Insufficient prolactin
- Drugs
- Environmental chemicals
- Depression
- Poor relationships
- Hypothalamic aging or damage
Correct

Incorrect
Question 3 of 12

3. Question
Some herbal remedies may help, but should be “cycled”. The list is long but excludes:
- Ginseng (various types)
- Ashwagandha
- Maca
- Calendula
- Yohimbine
- Horny goat weed
- Green oats
- Muira puama
- Damiana
- Elk velvet antler
- Fertile egg extract
- Various Chinese herbs
Correct

Incorrect
Question 4 of 12

4. Question
Impotence: Phosphodiesterase type 5 inhibitors (choose incorrect answer):
- Inhibit cyclic GMP metabolism
- Are primarily arterial vasodilators
- Are primarily venous vasodilators
- Require adequate NO production for arterial vasodilation to initiate filling
- Will not work well if bulbo-ischio-cavernosal muscles have atrophied
- Will work better in the presence of testosterone replacement which raises NO production, improve neuromuscular response and add libido and associated neural responses
Correct

Incorrect
Question 5 of 12

5. Question
Impotence: Improving blood flow (choose incorrect answer):
- Try Cialis 20 mg 1/2–1 tablet every other day
- May boost with shorter acting Viagra or Levitra in low doses
- Resveratrol is a type 5 PDI
- Pomagranate extract – improves vascular response and reduces endothelial thickening
- Yohimbe sometimes helps both libido and response centrally
- Ginkgo extract 120 mg bid, also acts centrally
- Increasing frequency of masturbation
- Trental 400 mg tid improves blood flow
- L-arginine 3000 mg 1 hour pre-sex and daily 3000 mg bid – works best after 4–6 weeks, increases NO production
- Stop smoking – interferes with vasodilation
- No alcohol for 4–6 hours pre-sex – dampens whole sexual response
Correct

Incorrect
Question 6 of 12

6. Question
Kegel exercises for men (choose incorrect answer):
- Kegels 10–20x daily
- Rebuilding muscles at base of penis can occur within first few months
- Perform them at red lights or advertisements on TV
- Takes 3–9 months for maximum effects
- If done properly, there will be a lifting of the perineum and the testicles will rise
Correct

Incorrect
Question 7 of 12

7. Question
Impotence (choose incorrect answer):
- Animal studies show slow reversal in all functions with testosterone replacement
- Return of function in humans requires >6–9 months Rx or longer
- The closer to youthful hormonal levels or above with Rx, the more successful and rapid the outcomes
- Kegel exercises improve bulbo and ischio-cavernosal response – critical for maintaining rigidity and pulsatile contractions
- The longer the deficiency, the longer the time for improvement – increased failure of Rx
Correct

Incorrect
Question 8 of 12

8. Question
Impotence: Time for restoration: The diagram below illustrates length of time for restoration of function.

True or false: Encourage patient to be patient re restoration of function.
- True
- False
Correct

Incorrect
Question 9 of 12

9. Question
If all else fails, try “Quadmix”.

Quadmix (choose incorrect answer):
- Contains PGE 1
- Contains Phentolamine
- Contains Atropine
- Contains Papaverine
- Injections given with insulin syringe and 5/16” 31 gauge needle
- Give into the lower 1/2 of the lateral shaft at a 45-degree angle down, 90 degree to shaft
- The longer one does the quadmix or the trimix, the less effective the erections get
- Those with prostate surgery that disrupts penile nerve supply will require direct injection
Correct

Incorrect
Question 10 of 12

10. Question
Resveratrol – eNOS and Phosphodiesterase type 5 activities (choose incorrect answer):
- Resveratrol has been shown to both increase eNOS which has anti-thrombotic, arterial vasodilatory and anti-atherogenic effects
- Resveratrol will also reverse priapism in a quadmix overdose
- Resveratrol, but not grape seed, has PDE type 5 inhibitory effects
- Although a weak effect, it may be more effective over time
Correct

Incorrect
Question 11 of 12

11. Question
Resveratrol and anti-aging genes (choose incorrect answer):
- David Sinclair, PhD from Harvard, discovered that the anti-aging gene SIRT1 is activated by resveratrol
- The anti-aging gene SIRT1 is directly related to erectile function
- Experiments with various test animals from worms to mice clearly extend lifespan and general health
- Interestingly, oncogenes and anti-aging genes are closely related
- Factors that activate anti-aging genes may have anti-cancer effects
Correct

Incorrect
Question 12 of 12

12. Question
Low libido (choose incorrect answer):
- Libido has a biophysiological relationship to dopamine
- Low dopamine states are associated with lessened libido
- Sinemet 25/100 mg – 1/2 tablet twice daily, a lower dose
- Correct prolactin with very low doses of Cabergoline 0.1 mg sl minitroches twice weekly
- Danazol 10–30 mg SR caps daily if SHBG is >35 umol/l
- Correct dopamine and you will succeed at libido restoration
- Reduce E2 if elevated >40 pg/ml
- Some herbals may help: maca, ashwagandha, ginseng
Correct

Incorrect

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