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

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Question 1 of 8

1. Question
Interdependence of hormone changes with aging:

Regarding regulation of testosterone (choose incorrect answer):
- Thyroid levels play a key role in the hypothalamic regulation of testosterone
- Aromatase and Estradiol play a key role in the hypothalamic regulation of testosterone
- Fat cell mass plays a key role in the hypothalamic regulation of testosterone
- Mitochondrial function – or dysfunction – plays a key role in the hypothalamic regulation of testosterone
- FSH and LH levels play a key role in the hypothalamic regulation of testosterone
- Prolactin level plays a key role in the hypothalamic regulation of testosterone
- Cortisol and DHEA levels play a key role in the hypothalamic regulation of testosterone
- Growth hormone levels play a key role in the hypothalamic regulation of testosterone
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Question 2 of 8

2. Question
Free testosterone levels (choose correct answer):
- Can be readily measured by ordering along with total testosterone
- Is present in such small amounts that it's challenging to measure accurately
- As a rough measurement can be approximated by the Curruthers nomogram:
- No target range, via nomogram or free testosterone, can be determined
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Question 3 of 8

3. Question
Total testosterone target and optimal ranges (choose correct answer):
- The nomogram is based on testosterone and free testosterone measured levels
- The nomogram is based on free testosterone and SHBG measured levels
- The nomogram is based on total testosterone and SHBG measured levels
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Question 4 of 8

4. Question
The “normal” patient with median SHBG (choose incorrect answer):
- Total testosterone maximum level – 1000 ng/dl
- Target level 700 ng/dl
- Target SHBG level: 40–80 nmol/l
- Total testosterone minimum level – 500 ng/dl
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Question 5 of 8

5. Question
The low SHBG patient (choose incorrect answer):
- Needs very little “boosting” to achieve mid-normal levels
- Very often is hypoglycemic
- Has as a target level – 500 ng/dl
- Has as an actual level – 300 ng/dl
- Their free testosterone levels are often much higher with a given total testosterone level because of low binding by SHBG
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Question 6 of 8

6. Question
The high SHBG patient (choose incorrect answer):
- There are a group of high SHBG genetic males (females as well)
- SHBG may run as high as 70 to 125+ ng/ml
- Testosterone tends to be high normal or even supraphysiologic ranges
- They tend to be mesomorphic – low incidence of insulin resistance/diabetes or FH of diabetes, and not obese
- Because of their normal or high testosterone, they tend to have normal or supra-normal erectile function
- This group of patients is frequently misdiagnosed despite clear symptoms and clearly subnormal free testosterone levels
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Question 7 of 8

7. Question
SHBG elevations can be successfully treated (choose incorrect answer):
- Treatment with low doses of Danazol, an estrogen blocker and weak aromatase inhibitor and androgen receptor activator, may significantly reduce SHBG levels.
- Danazol can be given in 50 mg capsules and as slow release.
- Only after diabetes and insulin resistance are successfully treated as the cause of the SHBG elevation.
- Danazol has widespread effects on endocrine function including suppression of estrogen effects and androgenic receptor activity. It suppresses FSH/LH at higher doses.
- It is useful in the treatment of chronic urticaria and hereditary angioedema, endometriosis, menorrhagia, fibroids and gynecomastia in men and pubertal girls.
- Danazol can be used to increase telomere length at higher doses.
- R/O hyperthyroidism as a cause of high SHBG, also seen in pellet therapy with high levels of estrogen.
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Question 8 of 8

8. Question
Quick hypogonadism screening test (choose incorrect answer):
- Pure testosterone in 25 mg/cc in a dropper bottle made by your compounding pharmacist can be used.
- If there are unfilled ARs due to less than optimal free testosterone, then 3–5 sublingual drops (2–4 mg) can be given in the office at the first visit as a physiologic test for adequate levels (only 1 drop for females).
- There will be a gradually increasing vasodilation and clearing of any mental “tiredness” within 10–15 minutes and lasting 3–4 hours.
- Occasionally, there will be a noticeable facial or palmar rubor or clearance of pallor if present before the test.
- The patient may take it periodically to test for adequacy of ANY treatment, giving a nice boost in energy and mental clarity at times of tiredness if treatment levels are below optimal levels.
- Sexual benefits will not occur with this immediate and low dose.
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Quiz 13: Testosterone Nomogram, Working High and Low SHBG, and Danazol

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