Andropause Mastery

Question 1 of 23

1. Question
Key questions (choose correct answer):
- Is CVD an endocrine disorder?
- Are the major determinants of atheroma formation/stability driven by estrogen and testosterone?
- Are the major “risk factors” surrogates of the relationships of estrogen and testosterone in men and women?
- All of the above are correct
- One of the above is incorrect
Correct

Incorrect
Question 2 of 23

2. Question
Epidemiologic studies: Cross sectional

True or false: Circulating testosterone levels does correlate with CAD. The higher the levels, the higher the incidence of CAD.
- True
- False
Correct

Incorrect
Question 3 of 23

3. Question
Prospective and case control studies

True or false: Circulating testosterone levels does correlate with CAD. The higher the levels, the higher the incidence of CAD.
- True
- False
Correct

Incorrect
Question 4 of 23

4. Question
Key questions (choose correct answer):
- Can early monitoring of hormonal status and early treatment of changing endocrine relationships prevent, reverse, or treat CVD?
- Are estrogen and testosterone relationships similarly protective or pathogenic in men and women?
- What are the most compelling reasons to support hormonal intervention as a valid primary/secondary treatment?
- All of the above are correct
- One of the above is incorrect
Correct

Incorrect
Question 5 of 23

5. Question
Estradiol (E2) is anti-atherogenic (choose correct answer):
- Reduction in atheroma formation was in greater degree with increased number of pregnancies
- Atheromas at necropsy were 1/4 the density of non-pregnancy females
- The density was inversely related to the calculated elevation of E2 with pregnancies
- Pregnancy-associated inhibition of coronary artery atherosclerosis in monkeys – evidence of a relationship with endogenous estrogen
- All of the above are correct
- One of the above is incorrect
Correct

Incorrect
Question 6 of 23

6. Question
Aromatase expression in vessel wall:

Syndrome X: Equation for testosterone deficiency:

Polycystic ovary syndrome (PCOS)/syndrome X (choose correct answer):
- Syndrome X in males is the equivalent of PCOS in females
- In syndrome X and PCOS, insulin resistance is at the core of endocrine changes
- Women with PCOS have androgen dominance relative to E2
- Men with syndrome X have E2 dominance relative to testosterone
- Both have increased CVD risk factors
- All of the above are correct
- One of the above is incorrect
Correct

Incorrect
Question 7 of 23

7. Question
Inverse relationship between testosterone and BMI

Direct relationship between testosterone and HDL

Estradiol/testosterone ratio and BMI

Testosterone and insulin resistance

True or false: Because the greater the BMI and fat cells, the greater the conversion by aromatization of testosterone to estrogen.
- True
- False
Correct

Incorrect
Question 8 of 23

8. Question
The estrogen paradox (choose correct answer):
- Both deficiency and excess E2 are associated with increased CVD
- Men with aromatase deficiency or estrogen receptor defects (estrogen deficiency or lack of estrogen effect) have increased coronary calcification
- Men with increased E2:T ratios (men with relative excess estrogen/normal or low T) have early atherosclerosis
- All of the above are correct
- One of the above is incorrect
Correct

Incorrect
Question 9 of 23

9. Question
Relationships in men of sex hormones, insulin, adiposity and risk factors for myocardial infarction (choose correct answer):
- Syndrome X, the insulin-resistance syndrome, or the metabolic syndrome are associated with increased risk for myocardial infarction
- Testosterone and the ratio of estradiol-to-testosterone (E:T) correlated with insulin resistance
- Visceral adipose tissue correlated more strongly with risk factors for MI
- Estradiol may play a more important role in the sex hormone-insulin relationship than has generally been considered
- All of the above are correct
- One of the above is incorrect
Correct

Incorrect
Question 10 of 23

10. Question
Androgen decline and CAD (choose incorrect answer):
- Androgen decline is the most common endocrine change in aging men
- This decline is paralleled by simultaneous increase in almost all CV risk factors and the appearance of overt cardiovascular events
- Is there evidence that there is an etiologic relationship between the complex pathologies of cardiovascular disease?
- Androgen decline is associated with estrogen dominance in males
Correct

Incorrect
Question 11 of 23

11. Question
Androgen receptors mediate hypertrophy in cardiac myocytes (choose incorrect answer):
- Androgen receptors (AR) are found in many species
- Skeletal muscles, per gram, have the maximum amount of ARs
- Activation of androgen receptor activity induces anabolic muscular effects – hypertrophy and increased regeneration of mitochondria
- Cardiac myocytes have higher numbers of ARs than skeletal or smooth muscles throughout the body
- Bio-energetic pathways for ATP regeneration are dependent on adequate androgen status
Correct

Incorrect
Question 12 of 23

12. Question
True or false: Since its discovery in 1929, synthesis in the 30s, and clinical use in the 40s, there has been a steady literature reporting of the benefits of testosterone in relation to cardiovascular disease.
- True
- False
Correct

Incorrect
Question 13 of 23

13. Question
The association of hypo-testosteronemia with coronary artery disease in men (choose correct answer):
- Study – 55 men undergoing angiography who had not previously had an MI
- Testosterone and free T correlated inversely with the degree of coronary artery disease
- Testosterone and free T correlated inversely with the risk factors fibrinogen, PAI-1, and insulin; positively with high-density lipoprotein cholesterol
- All of the above are correct
- One of the above is incorrect
Correct

Incorrect
Question 14 of 23

14. Question
Testosterone and coronary artery plaque density in coronary artery disease: In 154 men undergoing cardiac catheterization (choose correct answer):
- Plaque density had NO correlation to the well-established risk factors; hyperlipidemia, hypertension, diabetes, smoking or obesity alone or in combination
- There was a strong inverse correlation of plaque density with free testosterone
- Both of the above are correct
- Neither of the above is correct
Correct

Incorrect
Question 15 of 23

15. Question
True or false: Degree of CAD and risk factors correlate very well – the greater the number of risk factors, the higher the probability of CAD.
- True
- False
Correct

Incorrect
Question 16 of 23

16. Question
True or false: Degree of CAD and risk factors: Most significant inverse correlations are with age and free testosterone.
- True
- False
Correct

Incorrect
Question 17 of 23

17. Question
True or false: Men with coronary artery disease have significantly lower levels of androgens than normal controls, challenging the preconception that physiologically high levels of androgens in men account for their increased relative risk for coronary artery disease.
- True
- False
Correct

Incorrect
Question 18 of 23

18. Question
Major cardiovascular risk factors and testosterone deficiency (choose incorrect answer):
- Lipid changes of the most atherogenic type – small dense particle size, lower HDL 2
- Increased insulin resistance
- Increased lipoprotein a – Lp(a)
- Increased thrombotic (fibrinogen) and decreased thrombolytic factors (increased PAI-1)
- Pro-inflammatory shift – increased iNOS, IL-6, PGE2, TNFa, MMP activity (plaque instability)
- Increased CRP
- Decreased collagen quality (plaque instability)
- Increased testosterone leads to all of the risk factors listed above
Correct

Incorrect
Question 19 of 23

19. Question
The association of hyper-estrogenemia with coronary thrombosis in men (select incorrect answer):
- Study: 18 men who had had an MI (i.e., thrombosis) and 50 men with no history of MI (i.e., no thrombosis) whose degree of CAD was in the same range
- The mean levels of testosterone, free testosterone, insulin, DHEA, cholesterol, HDL, and systolic and diastolic blood pressure did not differ significantly
- Estradiol was the only variable measured that showed a significant relationship to MI
- Keep in mind that after an MI, there can be a significant shift to increased testosterone, skewing this study
Correct

Incorrect
Question 20 of 23

20. Question
Decreased serum testosterone in men with acute ischemic stroke (choose correct answer):
- Total and free testosterone and 17B-estradiol in 144 men with acute ischemic stroke and 47 healthy male control subjects
- Both total and free testosterone were significantly inversely associated with stroke severity and 6-month mortality
- Both significantly inversely associated with infarct size
- There was no difference between patients and control subjects in serum 17B-estradiol levels
- These results support the idea that testosterone affects the pathogenesis of ischemic stroke in men
- All of the above are correct
- One of the above is incorrect
Correct

Incorrect
Question 21 of 23

21. Question
Mechanisms for cardio-protection by testosterone (choose correct answer):
- Increased glucose utilization
- Increases insulin sensitivity
- Increases Krebs Cycle (aerobic) pathway
- Increases efficiency of ATP regeneration
- Decreases lactate – local acidosis (ischemia)
- Increases # mitochondria in myocytes
- Maintains cardiac muscle mass – increased cardiac output
- Direct vasodilator effects – calcium channel suppression
- Aromatized in vascular endothelium to E2 – increases eNOS activity
- All of the above are correct
- One of the above is incorrect
Correct

Incorrect
Question 22 of 23

22. Question
Longitudinal relation between endogenous testosterone and cardiovascular disease risk factors in middle-aged men: A 13-year follow-up of former Multiple Risk Factor Intervention Trial (MRFIT) participants.

With 66 men aged 41–61 years, the longitudinal analysis revealed:
- Decreases in endogenous testosterone levels with age in men are associated with potentially unfavorable changes in triglycerides and high density lipoprotein cholesterol
- Higher type A coronary-prone behavior score, greater pack-years of cigarette smoking, and the MRFIT special intervention group were associated with larger decreases in total testosterone and higher cardiovascular risk
- Both of the above are correct
- Neither of the above is correct
Correct

Incorrect
Question 23 of 23

23. Question
True or false: Prospective findings are consistent with previous, mainly cross-sectional reports, suggesting that low levels of testosterone and SHBG do not play some role in the development of insulin resistance and subsequent type 2 diabetes.
- True
- False
Correct

Incorrect