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

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

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

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Question 1 of 8

1. Question
Diseases now showing benefits from PDE-5 Inhibitors (choose the correct answer):
- Migraines and vasospastic diseases like Raynaud's and Prinzmetal angina
- Peyronie's disease (very effective) and other fibrotic diseases (possibly pulmonary fibrosis)
- Glaucoma and macular degeneration
- Female sexual hypo-responsiveness, vaginal dryness
- Altitude sickness
- BPH
- Pulmonary hypertension
- Possible adverse effects: NAION – non-arteric anterior ischemic optic neuropathy – very rare
- All of the above are true
Correct

Incorrect
Question 2 of 8

2. Question
Case history of pulmonary hypertension and multiple vasospastic symptoms and relief with Sildenafil (choose the correct answer):
- 47 YO Gii/Pii peri-menopausal female with fluctuating symptoms including intermittent angina-like chest pains, migraine headaches worse during menses, Raynaud's phenomenon over many years but worsening
- Heart cath showed NO arterial plaque, but elevated pulmonary artery pressure (“borderline” PAH)
- Treatment with Tadalafil was stopped due to intolerance and poor response of symptoms
- Sildenafil 40 up to 75 mg ER capsules twice daily resulted in normalization of all symptoms including reduced PA pressure on cardiac U/S
- All of the above are true
Correct

Incorrect
Question 3 of 8

3. Question
Treatment of Peyronie’s disease with PDE-5 inhibitors: An antifibrotic strategy.

L-arginine and phosphodiesterase (PDE) inhibitors counteract fibrosis in the Peyronie’s fibrotic plaque and related fibroblast cultures (choose the correct answer):
- In PD there is increased Nf Kappa-B that increases iNOS, peroxynitrite, ROS, and inflammatory mediators that increase the fibrotic process
- All these processes result in the proliferation of fibroblasts and myo-fibroblasts and excessive production of collagen between the layers of the tunica albuginea (penile plaque)
- L-arginine increases NO that increases Guanylate cyclase that increases cGMP/cAMP, which can inhibit collagen synthesis and induce fibroblast/myofibroblast apoptosis, thus acting as antifibrotic agents
- Pentoxifylline acts as a PDE inhibitor increasing cAMP, which has antifibrotic effects
- Animal studies and one human case report confirm that there is synergism in the combined use of these complementary treatments that are effective in the reversal of PD changes
- All of the above are true
Correct

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Question 4 of 8

4. Question
Case reports: Peyronie’s disease successfully treated with L-arginine, Tadalafil or Sildenafil ER and Pentoxifylline (choose the correct answer):
- I have treated 3 patients ages 40–47–55 with early Peyronie’s disease with palpable penile plaque, ED, curvature or constriction of shaft with erection and loss of fullness even with PDE-5 treatments before sex
- Treatment was L-arginine/L-citrulline 5 grams daily, Pentoxifylline ER 400mg tid, and Tadalafil 15 mg daily or Sildenfil ER 75-150 mg daily (both compounded)
- All three men experienced complete resolution of all manifestations of PD with the exception that all men continued the PDE-5 inhibitor daily for ED and one continued all three treatments for general health benefits
- All of the above are true
Correct

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Question 5 of 8

5. Question
Some observations from treatment experience (choose the correct answer):
- There is a lot of individual differential responses to the different PDE-5 inhibitors
- Start slowly and increase as needed to achieve responses
- Sildenafil has about a 12-hour effect and Tadalafil 24- to 36-hour effects
- Compounded formulas can be made as SR capsules that greatly reduce side effect potential and can easily be adjusted
- All of the above are true
Correct

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Question 6 of 8

6. Question
Some observations from treatment experience (choose the correct answer):
- Women have lower tolerance to PDE-5 inhibitors so start lower and advance more slowly
- Dosage ranges published for treatment of pulmonary hypertension range from Tadalafil 10–40 mg daily and Sildenafil 20–80 mg tid
- I have used slightly higher doses of Sildenafil in cases of dementia as tolerance has allowed up to 150 mg SR caps twice daily
- All of the above are true
Correct

Incorrect
Question 7 of 8

7. Question
Some observations from treatment experience (choose the correct answer):
- Cost savings are greatest with GoodRx discount coupons, but compounded formulas are still much cheaper than standard Rx pricing and have the advantage of SR capsules
- I have had geat responses to aging patients of both sexes for treatment of many aging diseases with few side effects and many remarkable unexpected benefits
- Both of the above are true
Correct

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Question 8 of 8

8. Question
Take-home points (choose the correct answer):
- The majority of age-related diseases and causes of early mortality can be strongly related to reduced cGMP/cAMP
- Despite a growing literature demonstrating clear benefits and physiologic mechanisms, this category of drugs has few prescribers due to many factors – lack of long-term randomized controlled studies, resistance to new uses, unfamiliarity with the now low costs of most of these drugs, perceptions that the PDE-5 inhibitors are basically sex drugs alone
- With the growing reports of combined modalities of treatment with the PDE-5 inhibitors, the future benefits in almost every aspect of aging morbidities and mortality can greatly be improved NOW
- All of the above are true
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