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

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Question 1 of 6

1. Question
Which is NOT true of Clomiphene?
- It is a SERM and causes the pituitary to "think" there is no testosterone around
- It can cause an increase in the FSH and LH
- It stimulates the testicles to produce more testosterone
- In higher doses, it may block estrogen receptors, which may affect sexuality
- It facilitates erectile function by increasing blood flow to the penis
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Question 2 of 6

2. Question
All are TRUE of hCG except:
- It usually works best with men <60
- It is very safe
- Low doses such as 250 u 3x/week may give good results (esp if man <40)
- A good starting dose is often +/- 500
- It may be very good for depression and pain
- If insufficient, it may fail to increase estrogen output
- If excessive, it may increase estrogen output
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Question 3 of 6

3. Question
What is FALSE about hCG?
- Basic hCG dose: 10,000 u vial
- 5 cc diluent: 1 cc = 2000 units; 0.25 cc = 500 units
- Alternative daily sq hCG mixed with 10 cc diluent (1000 units/cc – 0.1 cc = 100 hCG units); start at 0.2 cc sq daily in the AM
- Check levels midday after 2 weeks to adjust dose to reach “target level” on CFTI
- Less E2 stimulation, more even libido/ED effects, may be helpful in boosting IGF-1 if given with selegiline/Preg/DHEA and Sinemet 25/100mg 1/2 tab hs + L-arginine 3000 mg hs
- Increased demand for compounded hCG has led to increased production and reduced the price for manufactured pharmaceutical hCG
- Topical testosterone boosting drops may also be given
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Question 4 of 6

4. Question
What else is FALSE about hCG?
- Titrate hCG dose in 5 unit increments
- Test for testosterone and E2 every 3 weeks
- Reduce dose if E2 >60 pg/ml
- Replacement dosages are often 500 – 1000 IUs
- hCG can inadvertently elevate free T3 and free T4; thus, these should be assessed every 2 months until stable
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Question 5 of 6

5. Question
What is NOT true of prolactin?
- Diurnal cycle of prolactin gradually increases in total daily prolactin output
- Prolactin suppresses hypothalamic feedback loops for GnRH and gonadotrophins
- It decreases GhRH
- May upregulate aromatase and increases SHBG
- Can dramatically reduce insulin resistance
- Depresses libido, increases refractory period after climax, increases ED
- Increases gynecomastia, prostate growth
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Question 6 of 6

6. Question
What is UNTRUE about prolactin elevations?
- Prolactin treatment helps chronically low libido, syndrome X, high E2, high SHBG
- Low doses of bromocriptine – 1.25 – 5.0 mg daily given in the AM on arising
- Can be reduced by a combination of B12, B6, folic acid and vitamin D
- Selegiline topically 1-3 mg/day or orally 2.5 – 5 mg/day
- Low dose Sinemet 25/100mg 1/4 – 1/2 tab BID
- Dostinex – 0.5 mg 1/2 tablet twice weekly until improved, then every 5-7 days ($$)
- Measure midday prolactin levels to achieve levels <5
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Andropause Mastery

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

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