Testosterone

Question 1

What is primary testosterone deficiency?

Answer 1

Low T, Elevated LH/FSH (testicular failure)

Question 2

What is secondary testosterone deficiency?

Answer 2

Low T, low or normal LH/FSH

Question 3

What is criteria for testosterone deficiency diagnosis?

Answer 3

1. Low T
2. Signs/symptoms of low T.
3. H&P findings consistent with low T.

Question 4

What are some comorbidities of low T?

Answer 4

DM, Metsyn, IR, depression, CVD, osteoporosis, sarcopenia, hypothyroid, sleep loss, leptin resistance

Question 5

What is low T a biomarker for?

Answer 5

cardiometabolic disease

Question 6

How does treating low T affect metsyn?

Answer 6

improves insulin sensitivity
improves body composition
improves lipid profiles

Question 7

How does testosterone levels correlate with OSA?

Answer 7

Negatively correlated with severity of OSA

Question 8

Does fixing OSA help testosterone levels?

Answer 8

No

Question 9

How does sleep affect testosterone?

Answer 9

Less sleep esp <5 hours decreases levels

Question 10

Why does stress lower T?

Answer 10

Glucocorticoids inhibit GnRh

Question 11

What is opioid effect on T?

Answer 11

Suppresses GnRh, dose dependant

Question 12

What vitamin is needed for spermatogenesis?

Answer 12

Vitamin A

Question 13

What mineral helps Cd toxicity?

Answer 13

Selenium(and Zn)

Question 14

What mineral increases T?

Answer 14

Zinc

Question 15

What mineral deficiency should be considered in pubertal arrest ?

Answer 15

Zinc

Question 16

How does Vitamin D affect T?

Answer 16

It increases, free, total and bioactive forms T

Question 17

How does insulin, stress, leptin affect detox of testosterone?

Answer 17

It increases aromatase, 5 alpha reductase so less testosterone

Question 18

What are 4 nutritional supports for T?

Answer 18

Vitamin A, D, Se, Zn

Question 19

What is problem with Total Testosterone?

Answer 19

It has high false positive rate; Has low false negative rate so good at ruling out.

Question 20

What happens to SHBG as men age?

Answer 20

It increases

Question 21

What is biggest leverage point for low T?

Answer 21

Weight

Question 22

What inhibits 17,20 lyase?

Answer 22

Hyperinsulinemia
Stress
Inflammation
Licorice

Question 23

What stimulates 17,20 lyase?

Answer 23

Meditation

Question 24

What upregulates aromatase?

Answer 24

Etoh
Zinc def
IR, stress, obesity, cortisol, leptin, aging
Inflammation PGE2
Gonadotropins
BPA

Question 25

What is BPA effect on SHBG?

Answer 25

Increases

Question 26

How does metabolic endotoxemia affect T?

Answer 26

Creates inflammation which produces IL1B, TNFa, IL6 and impairs testicular leydig steroidogenesis

Question 27

How does obesity affect T?

Answer 27

Adipose tissue has high aromatase Heating of testicles by pelvic fat, oxidative stress, leptin Increased expression of 11 b hydroxysteroid dehydrogenase in adipose tissue which coverts cortosol into inactive form.

Question 28

What endocrine disruptor plays a role in low T?

Answer 28

Pthalates

Question 29

What metals are associated with low T?

Answer 29

Cd, Pb, Hg

Question 30

What happens to testosterone/cortisol ratio with heavy drinking?

Answer 30

Decreases

Question 31

How does marijuana affect T?

Answer 31

disrupts LH and HPA axis disrupts spermatogenesis disrupts orgasm, spermatogenesis and orgasm

Question 32

What structural problems does T help reverse?

Answer 32

Osteoporosis, sarcopenia

Question 33

What is biggest factor in elevated SHBG?

Answer 33

Age

Question 34

What are some hormonal decreases with aging men?

Answer 34

T, DHEA by 30 Progesterone by 50 Pregnenolone by 30

Question 35

What are some hormonal increases with aging men?

Answer 35

``` SHBG PSA, prostate volume E2 around age 50 LH, FSH Prolactin ```

Question 36

How does estrogen affect DHT?

Answer 36

It inhibits DHT metabolism by interfering with hydroxylation | It increases DHT receptors on prostate which inhibits prostate cell apoptosis and increases cell growth

Question 37

What blocks leptin's signal to brain?

Answer 37

TGL

Question 38

What are 3 botanicals for BPH?

Answer 38

Rye Grass Pollen, | Pygeum, Stinging nettle(root, not leaf)

Question 39

How does zinc inhibit BPH?

Answer 39

Weak 5 a reductase inhibitor Prevents androgens from binding to DHT receptor Inhibits prolactin(which like E2, increases DHT receptors on the prostate)