A4M EXAM QUESTIONS WITH
COMPLETE SOLUTIONS
estrogen can also be made from? - ANSWER-DHEA
estrogen should always be prescribed which route? - ANSWER-transdermally
NOT PO- inflammatory
how should transdermal estrogen be applied? - ANSWER-apply to thigh and rub in
for 2 minutes. can transfer for up to 12 hours.
hormonal holiday - ANSWER-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? - ANSWER-history of hormonally related cancer- breast, ovarian, uterine
how to lower excess levels of estrogen? - ANSWER-improve phase I and phase II
detox in the liver, exercise, lower dose of estrogen replacement, weight loss
estrone - ANSWER-E1
estradiol - ANSWER-E2
estriol - ANSWER-E3
estrogen replacement relieves what symptoms of menopause? - ANSWER-cognitive
decline
bone loss
cardiovascular disease
cataracts
macular degeneration
any disease associated with mitochondrial dysfunction
s/s of estrogen deficiency in males? - ANSWER-osteopenia/osteoporosis
cognitive decline
dyslipidemia
functions of estrogen in males? - ANSWER-helps maintain memory
regulates gonadotropin feedback
,bone maturation/regulation of bone resorption
lipid metabolism
medicines that decrease estrogen levels in men? - ANSWER-phenobarbital
chlordiazepoxide
carbamepazine
trazodone
sulcrafate
overdose of medication that lower estrogen? - ANSWER-chrysin (usually used
transdermally)
anastrozole and other aromatase inhibitors
when is estriol replacement being used in males? - ANSWER-autoimmune
encephalitis and multiple sclerosis
contraindications in estrogen therapy in males - ANSWER-prostate or breast cancer
s/s of elevated estrogen in males? - ANSWER-gynecomastia, increased risk of heart
disease/prostate cancer, ED, CVA double risk, BPH
cause of elevated estrogen in male? - ANSWER-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? - ANSWER-
amiodarone
how to lower high estrogen levels in males? - ANSWER-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? - ANSWER-pregnenolone
cause of progesterone deficiency? - ANSWER-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 - ANSWER-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? - ANSWER-estrone and estradiol
functions of progesterone in males? - ANSWER-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 - ANSWER-d- prostate enlargement
e- sexual dysfunction
cause of elevated levels of progesterone in females or males? - ANSWER-patient
prescribed too much progesterone or pregnenolone
E3 protective against what? - ANSWER-less stimulatory effect on breast and uterine
lining
protects against breast cancer
estrogen receptor alpha binding site - ANSWER-increases cell growth
, estrogen receptor beta binding site - ANSWER-decreases cell growth and helps
prevent breast cancer development
which estrogen binds to which receptor? - ANSWER-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 - ANSWER-20% E2
80% E3
how fast is natural estrogen eliminated from the body through urine versus
synthetic? - ANSWER-within a day versus 13 weeks
premarin - ANSWER-most common form of synthetic estrogen
estrone E1
contains horse estrogens (equaling and equilenin)
detoxification organs - ANSWER-liver
GI tract
kidneys
skin
lungs
xenoestrogens - ANSWER-environmental compounds that mimic the effects of
natural estrogen
Phase I Detoxification - ANSWER-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
decreased phase I clearance? will cause toxic accumulation in the body. adverse
reactions to meds are often d/t a decreased capacity for clearing them from your
system
Phase II Detoxification - ANSWER-the intermediate compounds are neutralized
through the addition of a water soluble molecule which the transformed toxins are
then able to be eliminated through urine or feces
stage 1: glutathione conjugation- requires glutathione (strongest antioxidant made by
the body) and vitamin B6
stage II: amino acid conjugation- requires glycine, taurine, and glutamine
stage III: methylation. needed to detox estrogen and breakdown homocysteine.
requires folic acid, choline, methionine, trimethylglycine, and s-adenosylmethionine
(SAMEe)
stage IV: sulfating. requires cysteine, methionine, and molybdenum
COMPLETE SOLUTIONS
estrogen can also be made from? - ANSWER-DHEA
estrogen should always be prescribed which route? - ANSWER-transdermally
NOT PO- inflammatory
how should transdermal estrogen be applied? - ANSWER-apply to thigh and rub in
for 2 minutes. can transfer for up to 12 hours.
hormonal holiday - ANSWER-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? - ANSWER-history of hormonally related cancer- breast, ovarian, uterine
how to lower excess levels of estrogen? - ANSWER-improve phase I and phase II
detox in the liver, exercise, lower dose of estrogen replacement, weight loss
estrone - ANSWER-E1
estradiol - ANSWER-E2
estriol - ANSWER-E3
estrogen replacement relieves what symptoms of menopause? - ANSWER-cognitive
decline
bone loss
cardiovascular disease
cataracts
macular degeneration
any disease associated with mitochondrial dysfunction
s/s of estrogen deficiency in males? - ANSWER-osteopenia/osteoporosis
cognitive decline
dyslipidemia
functions of estrogen in males? - ANSWER-helps maintain memory
regulates gonadotropin feedback
,bone maturation/regulation of bone resorption
lipid metabolism
medicines that decrease estrogen levels in men? - ANSWER-phenobarbital
chlordiazepoxide
carbamepazine
trazodone
sulcrafate
overdose of medication that lower estrogen? - ANSWER-chrysin (usually used
transdermally)
anastrozole and other aromatase inhibitors
when is estriol replacement being used in males? - ANSWER-autoimmune
encephalitis and multiple sclerosis
contraindications in estrogen therapy in males - ANSWER-prostate or breast cancer
s/s of elevated estrogen in males? - ANSWER-gynecomastia, increased risk of heart
disease/prostate cancer, ED, CVA double risk, BPH
cause of elevated estrogen in male? - ANSWER-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? - ANSWER-
amiodarone
how to lower high estrogen levels in males? - ANSWER-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? - ANSWER-pregnenolone
cause of progesterone deficiency? - ANSWER-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 - ANSWER-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? - ANSWER-estrone and estradiol
functions of progesterone in males? - ANSWER-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 - ANSWER-d- prostate enlargement
e- sexual dysfunction
cause of elevated levels of progesterone in females or males? - ANSWER-patient
prescribed too much progesterone or pregnenolone
E3 protective against what? - ANSWER-less stimulatory effect on breast and uterine
lining
protects against breast cancer
estrogen receptor alpha binding site - ANSWER-increases cell growth
, estrogen receptor beta binding site - ANSWER-decreases cell growth and helps
prevent breast cancer development
which estrogen binds to which receptor? - ANSWER-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 - ANSWER-20% E2
80% E3
how fast is natural estrogen eliminated from the body through urine versus
synthetic? - ANSWER-within a day versus 13 weeks
premarin - ANSWER-most common form of synthetic estrogen
estrone E1
contains horse estrogens (equaling and equilenin)
detoxification organs - ANSWER-liver
GI tract
kidneys
skin
lungs
xenoestrogens - ANSWER-environmental compounds that mimic the effects of
natural estrogen
Phase I Detoxification - ANSWER-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
decreased phase I clearance? will cause toxic accumulation in the body. adverse
reactions to meds are often d/t a decreased capacity for clearing them from your
system
Phase II Detoxification - ANSWER-the intermediate compounds are neutralized
through the addition of a water soluble molecule which the transformed toxins are
then able to be eliminated through urine or feces
stage 1: glutathione conjugation- requires glutathione (strongest antioxidant made by
the body) and vitamin B6
stage II: amino acid conjugation- requires glycine, taurine, and glutamine
stage III: methylation. needed to detox estrogen and breakdown homocysteine.
requires folic acid, choline, methionine, trimethylglycine, and s-adenosylmethionine
(SAMEe)
stage IV: sulfating. requires cysteine, methionine, and molybdenum
