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 14: Human Chorionic Gonadotropin (hCG)

Andropause Mastery Evaluation and treatment of testosterone deficiency Part 3 Human Chorionic Gonadotropin (hCG) Quiz 14: Human Chorionic Gonadotropin (hCG)

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

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Question 1 of 11

1. Question
hCG (choose incorrect answer):
- Heterodimer of two α/β chains
- Has strong LH homology and effects
- Also has lesser FSH, TSH and GH stimulation boosting
- There are LH/hCG receptors in most tissues including the reproductive and CNS areas
- Does not activate fully until adolescence
Correct

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Question 2 of 11

2. Question
When hCG is given SQ or IM (choose correct answer):
- It results in pulsatile testosterone output
- Like testosterone replenishment, it results in steady levels of testosterone, not pulsatile
Correct

Incorrect
Question 3 of 11

3. Question
Administering hCG SQ or IM (choose incorrect answer):
- Chorionic Gonadotrophin (CG) 10,000 units per vial – reconstitute with 5 cc – 0.5cc = 1000 units, 0.25 cc = 500 IU
- Train patient to self-administer in anterior thigh using saline in 50 unit insulin syringe with 30 gauge 5/16” needle (painless)
- Give CG 500 units (0.25 cc) nightly, every other night, for 2 weeks
- Obtain blood test for testosterone, total and E2 on the morning after the final dose
- Continue CG every other night until results come back (usually 1 week)
- Target is within the mid-normal calculated free testosterone (CFT) range for free T or higher
- Choose another method if full androgen benefits are not achieved
Correct

Incorrect
Question 4 of 11

4. Question
hCG Treatment Curve secret to success (choose incorrect answer):
- Titrate hCG dose in 5–10 unit increments
- Test for Testosterone and E2 every 3 weeks
- Reduce dose if E2 >40–50 pg/ml
- The more the hCG that is given, the better outcome for CFT and total T
Correct

Incorrect
Question 5 of 11

5. Question
Treatment with hCG (choose correct answer):
- Men up to 75 have done well with hCG Rx, but usually best results on men <60 years age
- Should not be given to men who have low FSH and LH
- Doses as low as 250 units 3X weekly may give good responses, particularly in younger men <50, maximum dose 1500 units 2–3X weekly
- Doses may be increased every two weeks until good response clinically and normal T levels >500 ng/dl (WITHOUT excess E2 increases)
- E2 increase signals excess dosing of hCG
- May be cycled with Clomiphene every 2–3 months to increase Leydig cell differentiation and test the HPT axis for return of normal responsiveness
- May be used with low doses of aromatase inhibitor which increases response (decreases feedback loop) anastrozole 0.1–0.2 mg 2–3x weekly
Correct

Incorrect
Question 6 of 11

6. Question
Recombinant Chorionic Gonadotropin (Ovidrel) (choose incorrect answer):
- Recombinant CG (RhCG) has been available in a 250 unit injection usually for fertility
- 250 units is about equivalent to 10,000 units of standard hCG derived from pregnant women’s urine
- Is less expensive than hCG
- It can be diluted in 5cc water to make up an equivalent source of hCG when supplies are low
- Dosing would be the same as low dose protocols 500–1500 units 3x weekly
Correct

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Question 7 of 11

7. Question
hCG off-label uses (choose correct answer):
- Forrest Tennant, MD reported that severe pain patients, many with severe fibromyalgia, frequently were able to reduce opioid doses significantly after injecting hCG 500–1500 units 2–3 times weekly.
- Harold Frampton, MD reported that juvenile diabetes treatment could become responsive to oral hypoglycemic agents with concomitant hCG daily dosaging.
Correct

Incorrect
Question 8 of 11

8. Question
hCG and spinal cord and CNS (choose incorrect answer):
- There are LH/hCG receptors widespread throughout the spinal cord and brain that are thought to have neuroregenerative effects.
- Receptors identified in the hippocampus, dentate gyrus, hypothalamus, cortex, brain stem, area postrema, cerebellum, choroid plexus, ependymal cells, glial cells, neural retina, pituitary gland, and neuron processes of the spinal cord.
- Neurotropic effects of LH and hCG have been demonstrated in fetal rat brain. LH and hCG also induce several behavioral and other changes that are associated with the hippocampus, which contains the highest density of LH/hCG receptors.
- These research findings may open new approaches to spinal cord and CNS injury and diseases.
- May be used with low doses of aromatase inhibitor which increases response (decreases feedback loop) anastrozole 0.1–0.2mg 2–3x weekly.
- This work was brought to light by Jonathan Wright, MD.
- May be used with low doses of Danazol to increase effectiveness of treatment.
Correct

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Question 9 of 11

9. Question
Low-dose Chorionic Gonadotropin for fertility and prevention of testicular atrophy (choose incorrect answer):
- Research on intra-testicular testosterone production (ITT) has shown that doses of hCG as low as 250–300 units 2–3 weekly will result in maximal ITT levels and no atrophic changes when given along with full testosterone replacement dosing.
- This is very useful in preventing testicular atrophy in young men being treated with testosterone replenishing.
- 500 hCG units lead to 26% higher than baseline.
- 1000 IU daily can lead to testicular enlargement and supranormal sperm counts.
Correct

Incorrect
Question 10 of 11

10. Question
RhCG high dose: RhCG 250 mcg vial equivalent to 10,000 units hCG given twice weekly for 3 months.

Research on effects of RhCG given 250 mcg showed (choose incorrect answer):
- Improvement in insulin resistance
- Increased lean muscle mass
- Decreased fat mass
- No change in other quality of life symptoms (libido or sex functions)
Correct

Incorrect
Question 11 of 11

11. Question
RhCG and high estradiol: 40 men ages 6–85 given RhCG 250 mcg 2x weekly for 3 months.
- This is quite a high dosage
- Increased lean mass and reduced fat mass
- No changes in sexuality during the trial or one month after (obviously, too much estradiol)
- More hCG is not better
- All of above are true
Correct

Incorrect

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