Quiz 8: Paying Attention to SHBG

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Question 1 of 6

1. Question
What is UNTRUE concerning high SHBG patients – a new category of “relative hypogonadism”?
- SHBG may be excessive due to genetic over-production or from secondary factors that increase production, i.e. high estrogen levels or high prolactin
- Pre-diabetes can lead to elevated levels of SHBG and should be tested for whenever SHBG elevation is encountered
- Very high levels well above the "normal ranges" are frequently seen
- Levels in the 60–125 nmol/l result in such high binding of testosterone that deficiency symptoms may be present despite normal or quite high levels of total testosterone
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Question 2 of 6

2. Question
Rx with Danazol: Which answer is INCORRECT?
- Treatment with low doses of Danazol, an estrogen blocker and androgen activator, may significantly reduce SHBG levels
- Danazol can be given in 25–50 mg SR capsules
- Bromocriptine, which inhibits excess prolactin and increases insulin sensitivity, also reduces SHBG
- Bromocriptine tends to be more effective and less costly than Danazol
- Bromocriptine 1.25–5.0 mg oral tablets in AM only may help reduce prolactin rise and SHBG levels
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Question 3 of 6

3. Question
What is TRUE of low SHBG?
- It is often associated with liver function abnormalities
- It is often associated with pre-diabetes or insulin resistance
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Question 4 of 6

4. Question
True or false: “Low” SHBG patients need very little “boosting” to achieve midnormal levels:
- True
- False
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Question 5 of 6

5. Question
If you are not getting a good enough response with Clomiphene:
- Try hCG
- Treat with testosterone replenishment
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Question 6 of 6

6. Question
What is NOT true regarding testing?
- Test for testosterone, E2 2–3 weeks after adjusting doses of any treatment
- SHBG may be checked periodically, but generally remains within the same general range over time
- Check SHBG 4–6 weeks after Danazol Rx
- CBC every 6 months x 2, then yearly if no change
- Check DHT every 6–9 months
- PSA after 3–6 months depending on level
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