A4M EXAM QUESTIONS AND ANSWERS
where is estrogen produced? - Correct Answers -ovaries
Where is DHEA produced? - Correct Answers -adrenal gland
estrogen can also be made from? - Correct Answers -DHEA
estrogen should always be prescribed which route? - Correct Answers -transdermally
NOT PO- inflammatory
how should transdermal estrogen be applied? - Correct Answers -apply to thigh and rub
in for 2 minutes. can transfer for up to 12 hours.
hormonal holiday - Correct Answers -after patient has been on hormones for 6 months,
must take holiday every month.
1. take hormones monday to saturday. none on sunday.
2. take hormones days 1-25 and 4 days off.
3. if patient wishes to cycle then take all hormones including T every day except for
progesterone days 14-25 (mock cycling)
estrogen and progesterone replacement therapy is contraindicated in which patients? -
Correct Answers -history of hormonally related cancer- breast, ovarian, uterine
how to lower excess levels of estrogen? - Correct Answers -improve phase I and phase
II detox in the liver, exercise, lower dose of estrogen replacement, weight loss
estrone - Correct Answers -E1
estradiol - Correct Answers -E2
estriol - Correct Answers -E3
estrogen replacement relieves what symptoms of menopause? - Correct Answers -
cognitive decline
bone loss
cardiovascular disease
cataracts
macular degeneration
any disease associated with mitochondrial dysfunction
s/s of estrogen deficiency in males? - Correct Answers -osteopenia/osteoporosis
cognitive decline
dyslipidemia
,functions of estrogen in males? - Correct Answers -helps maintain memory
regulates gonadotropin feedback
bone maturation/regulation of bone resorption
lipid metabolism
medicines that decrease estrogen levels in men? - Correct Answers -phenobarbital
chlordiazepoxide
carbamepazine
trazodone
sulcrafate
overdose of medication that lower estrogen? - Correct Answers -chrysin (usually used
transdermally)
anastrozole and other aromatase inhibitors
when is estriol replacement being used in males? - Correct Answers -autoimmune
encephalitis and multiple sclerosis
contraindications in estrogen therapy in males - Correct Answers -prostate or breast
cancer
s/s of elevated estrogen in males? - Correct Answers -gynecomastia, increased risk of
heart disease/prostate cancer, ED, CVA double risk, BPH
cause of elevated estrogen in male? - Correct Answers -increased aromatase activity
alteration in liver function
zinc deficiency - Low zinc may increase the aromatization of testosterone to estrogen
high dose vitamin E
grapefruit
high doses of testosterone
medications: pain meds, abx, anti fungals, statins, antidepressant, antipsychotic, BP
meds, antacids
what BP med causes elevated estrogen and decreased testosterone? - Correct
Answers -amiodarone
how to lower high estrogen levels in males? - Correct Answers -decrease T dose
zinc
chrysin
anastrozole and other aromatase inhibitors
maca
grape see extract
wild nettle root
decrease alcohol
lose weight
,resveratrol
high dose vit C
niacin
what is progesterone made from? - Correct Answers -pregnenolone
cause of progesterone deficiency? - Correct Answers -antidepressants
hypothyroid
def vit A B6 zinc and C
excessive arginine consumption
impaired production due to increase prolactin levels
saturated fat intake
stress
high sugar intake
aging process
progesterone can be given PO or transdermally - Correct Answers -PO-
perimenopausal and menopausal for better breast protection
if the patient has anxiety or insomnia give PO since progesterone will cross the BBB
and hit GABA receptors and have calming effect
best if used SR (E4M) but the GI tract needs to be healthy for optimal release
transdermal application-
do not put on breast tissue
do not apply to abdomen- can slow bowels
best applied to thigh and rotate sites, can transfer up to 12 hours
what type of estrogen to measure in males? - Correct Answers -estrone and estradiol
functions of progesterone in males? - Correct Answers -5 alpha reductase inhibitor
helps with myelination
influences spermiogenesis
blocking of gonadotropin secretion
sleep improvement
effects of the potentiation of GABA
neuroprotective
immunoprotective
cardioprotective
calming effect
s/s of progesterone deficiency in males
s/s of progesterone elevation in males - Correct Answers -d- prostate enlargement
e- sexual dysfunction
, cause of elevated levels of progesterone in females or males? - Correct Answers -
patient prescribed too much progesterone or pregnenolone
E3 protective against what? - Correct Answers -less stimulatory effect on breast and
uterine lining
protects against breast cancer
estrogen receptor alpha binding site - Correct Answers -increases cell growth
estrogen receptor beta binding site - Correct Answers -decreases cell growth and helps
prevent breast cancer development
which estrogen binds to which receptor? - Correct Answers -E1 activates alpha in a 5 to
1 ratio
E2 equally activates alpha and beta
E3 binds to beta in a 3 to 1 ratio
biest percentage - Correct Answers -20% E2
80% E3
how fast is natural estrogen eliminated from the body through urine versus synthetic? -
Correct Answers -within a day versus 13 weeks
premarin - Correct Answers -most common form of synthetic estrogen
estrone E1
contains horse estrogens (equaling and equilenin)
detoxification organs - Correct Answers -liver
GI tract
kidneys
skin
lungs
xenoestrogens - Correct Answers -environmental compounds that mimic the effects of
natural estrogen
Phase I Detoxification - Correct Answers -enzymes in the cytochrome P450 system use
oxygen to modify toxic compounds, medications and steroid hormones into intermediate
compounds
occurs in the liver
SNPs:
increased phase I clearance without increased phase II clearance? can lead to the
buildup of intermediates that may be more toxicant than the original substance
where is estrogen produced? - Correct Answers -ovaries
Where is DHEA produced? - Correct Answers -adrenal gland
estrogen can also be made from? - Correct Answers -DHEA
estrogen should always be prescribed which route? - Correct Answers -transdermally
NOT PO- inflammatory
how should transdermal estrogen be applied? - Correct Answers -apply to thigh and rub
in for 2 minutes. can transfer for up to 12 hours.
hormonal holiday - Correct Answers -after patient has been on hormones for 6 months,
must take holiday every month.
1. take hormones monday to saturday. none on sunday.
2. take hormones days 1-25 and 4 days off.
3. if patient wishes to cycle then take all hormones including T every day except for
progesterone days 14-25 (mock cycling)
estrogen and progesterone replacement therapy is contraindicated in which patients? -
Correct Answers -history of hormonally related cancer- breast, ovarian, uterine
how to lower excess levels of estrogen? - Correct Answers -improve phase I and phase
II detox in the liver, exercise, lower dose of estrogen replacement, weight loss
estrone - Correct Answers -E1
estradiol - Correct Answers -E2
estriol - Correct Answers -E3
estrogen replacement relieves what symptoms of menopause? - Correct Answers -
cognitive decline
bone loss
cardiovascular disease
cataracts
macular degeneration
any disease associated with mitochondrial dysfunction
s/s of estrogen deficiency in males? - Correct Answers -osteopenia/osteoporosis
cognitive decline
dyslipidemia
,functions of estrogen in males? - Correct Answers -helps maintain memory
regulates gonadotropin feedback
bone maturation/regulation of bone resorption
lipid metabolism
medicines that decrease estrogen levels in men? - Correct Answers -phenobarbital
chlordiazepoxide
carbamepazine
trazodone
sulcrafate
overdose of medication that lower estrogen? - Correct Answers -chrysin (usually used
transdermally)
anastrozole and other aromatase inhibitors
when is estriol replacement being used in males? - Correct Answers -autoimmune
encephalitis and multiple sclerosis
contraindications in estrogen therapy in males - Correct Answers -prostate or breast
cancer
s/s of elevated estrogen in males? - Correct Answers -gynecomastia, increased risk of
heart disease/prostate cancer, ED, CVA double risk, BPH
cause of elevated estrogen in male? - Correct Answers -increased aromatase activity
alteration in liver function
zinc deficiency - Low zinc may increase the aromatization of testosterone to estrogen
high dose vitamin E
grapefruit
high doses of testosterone
medications: pain meds, abx, anti fungals, statins, antidepressant, antipsychotic, BP
meds, antacids
what BP med causes elevated estrogen and decreased testosterone? - Correct
Answers -amiodarone
how to lower high estrogen levels in males? - Correct Answers -decrease T dose
zinc
chrysin
anastrozole and other aromatase inhibitors
maca
grape see extract
wild nettle root
decrease alcohol
lose weight
,resveratrol
high dose vit C
niacin
what is progesterone made from? - Correct Answers -pregnenolone
cause of progesterone deficiency? - Correct Answers -antidepressants
hypothyroid
def vit A B6 zinc and C
excessive arginine consumption
impaired production due to increase prolactin levels
saturated fat intake
stress
high sugar intake
aging process
progesterone can be given PO or transdermally - Correct Answers -PO-
perimenopausal and menopausal for better breast protection
if the patient has anxiety or insomnia give PO since progesterone will cross the BBB
and hit GABA receptors and have calming effect
best if used SR (E4M) but the GI tract needs to be healthy for optimal release
transdermal application-
do not put on breast tissue
do not apply to abdomen- can slow bowels
best applied to thigh and rotate sites, can transfer up to 12 hours
what type of estrogen to measure in males? - Correct Answers -estrone and estradiol
functions of progesterone in males? - Correct Answers -5 alpha reductase inhibitor
helps with myelination
influences spermiogenesis
blocking of gonadotropin secretion
sleep improvement
effects of the potentiation of GABA
neuroprotective
immunoprotective
cardioprotective
calming effect
s/s of progesterone deficiency in males
s/s of progesterone elevation in males - Correct Answers -d- prostate enlargement
e- sexual dysfunction
, cause of elevated levels of progesterone in females or males? - Correct Answers -
patient prescribed too much progesterone or pregnenolone
E3 protective against what? - Correct Answers -less stimulatory effect on breast and
uterine lining
protects against breast cancer
estrogen receptor alpha binding site - Correct Answers -increases cell growth
estrogen receptor beta binding site - Correct Answers -decreases cell growth and helps
prevent breast cancer development
which estrogen binds to which receptor? - Correct Answers -E1 activates alpha in a 5 to
1 ratio
E2 equally activates alpha and beta
E3 binds to beta in a 3 to 1 ratio
biest percentage - Correct Answers -20% E2
80% E3
how fast is natural estrogen eliminated from the body through urine versus synthetic? -
Correct Answers -within a day versus 13 weeks
premarin - Correct Answers -most common form of synthetic estrogen
estrone E1
contains horse estrogens (equaling and equilenin)
detoxification organs - Correct Answers -liver
GI tract
kidneys
skin
lungs
xenoestrogens - Correct Answers -environmental compounds that mimic the effects of
natural estrogen
Phase I Detoxification - Correct Answers -enzymes in the cytochrome P450 system use
oxygen to modify toxic compounds, medications and steroid hormones into intermediate
compounds
occurs in the liver
SNPs:
increased phase I clearance without increased phase II clearance? can lead to the
buildup of intermediates that may be more toxicant than the original substance
