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Why Do Steroids Cause Psychosis?
**1. Sexual Function Assessment in Brain‑Tumor
Patients**
| Domain | What to Evaluate | Why It Matters |
|——–|——————|—————|
| **Physical Functioning** | • Erectile function (ED), ejaculatory issues, vaginal
lubrication
• Hormonal status: testosterone, estradiol, LH/FSH, prolactin | Tumors or treatment can disrupt neuro‑endocrine pathways → impotence, anorgasmia |
| **Psychological / Cognitive Impact** | • Mood (depression/anxiety), self‑esteem, body image
• Cognitive deficits: memory, attention, executive function | Neurocognitive decline affects
sexual desire and performance; mood disorders further impair libido |
| **Relationship Dynamics** | • Partner communication, intimacy expectations,
relational satisfaction | Relationship strain can exacerbate sexual dysfunction or conversely be a
source of support |
| **Treatment‑Related Factors** | • Surgical side‑effects (nerve damage), radiotherapy-induced fibrosis, chemotherapy neurotoxicity
• Hormonal therapies altering testosterone/estrogen levels |
Physical changes directly influence sexual function; endocrine shifts alter libido
and erectile capacity |
—
## Practical Clinical Recommendations
| Step | Action | Key Points |
|——|——–|————|
| 1 | **Initial Screening** | • Use brief questionnaires (e.g., PHQ‑2 for
depression, IIEF‑5 for erectile dysfunction) at each visit.
• Ask about sexual activity and satisfaction in a non‑judgmental way.
|
| 2 | **Detailed History** | • Document frequency, type of intercourse, use of lubricants/condoms, pain or dyspareunia, urinary symptoms, medication side‑effects.
|
| 3 | **Physical & Laboratory Review** | • Assess
prostate size (digital rectal exam), PSA trends.
• Check testosterone, LH/FSH if erectile dysfunction is persistent despite therapy.
|
| 4 | **Address Modifiable Factors** | • Encourage
weight loss, exercise, smoking cessation.
• Discuss sexual positioning to reduce pain for the woman. |
| 5 | **Therapeutic Interventions** | – **Vaginal
lubricants/creams**: non‑ionic, preservative‑free options.
– **Topical estrogen (for post‑menopausal)**: short course if symptomatic.
– **PDE‑5 inhibitors**: titrate dose; start low to assess tolerance.
– **Pelvic floor physical therapy**: can improve arousal and reduce pain. |
| 6 | **Follow‑Up Plan** | – Reassess after 4–6 weeks of PDE‑5 inhibitor use and lubricant regimen.
– If adequate response, maintain current dosing; if insufficient,
consider dose escalation or alternative agents (e.g., vardenafil).
– If still inadequate, evaluate for underlying endocrine disorders or psychological factors.
|
—
## 3. Evaluation & Management of Low Testosterone in the Context of Hirsutism
| Step | Action | Rationale |
|——|——–|———–|
| **Baseline labs** | • Serum total testosterone (morning 7–10 am)
• SHBG, albumin
• LH, FSH
• Estradiol
• Prostate‑specific antigen (PSA) if >50 yr or risk factors | Confirm androgen excess, rule out secondary causes.
|
| **Interpretation** | • Low testosterone with
normal/low SHBG suggests primary hypogonadism
• Elevated LH indicates primary testicular failure
• Normal LH/FSH may indicate secondary hypogonadism (pituitary/hypothalamic) | Tailor therapy accordingly.
|
| **Baseline labs before therapy** | • CBC, CMP, lipid panel,
fasting glucose, HbA1c, testosterone (morning), PSA (if >50 yr) | Establish baseline for monitoring.
|
—
## 4. Treatment Algorithm
### Step‑by‑Step Decision Tree
«`
START
|
|—> Check eligibility:
• No contraindications (no severe liver disease, untreated hypertension, etc.)
• Informed consent obtained.
|
|—> Baseline labs:
• CBC, CMP, fasting lipids, fasting glucose/HbA1c, testosterone (morning), PSA (if >50).
|
|—> Select anabolic agent:
|— Option A: Enobosarm (oral) – 2.5–10 mg daily
|— Option B: SARMs via injection (e.g., Ostarine 25 mg IM weekly)
|
|—> Determine dosing schedule based on product availability and patient’s preference.
|
|—> Initiate therapy:
|— Educate patient on potential side effects:
• Mild liver enzyme elevations
• Transient lipid changes (increase LDL, decrease HDL)
• Mood alterations
• Possible gynecomastia (rare)
|
|—> Monitoring plan:
|— Baseline labs: LFTs, fasting lipids, CBC,
testosterone levels.
|— Repeat labs at 4–6 weeks post-initiation,
then every 3 months.
|— Adjust dose or discontinue if AST/ALT > 2× ULN
or lipid abnormalities exceed thresholds.
|
|—> Duration:
|— Use for the shortest effective period (e.g.,
12–24 weeks).
|— After completion, reassess motivation and consider alternative interventions.
|
|—> Safety considerations:
|— Avoid use in individuals with uncontrolled hypertension, active liver disease,
or those on medications metabolized by CYP3A4
that could interact with ketone metabolism.
|— Monitor for signs of ketoacidosis (e.g., nausea,
vomiting, abdominal pain).
|
END
«`
**Key Points:**
– **Ketone supplements may alter brain fuel availability and influence motivation.**
– **Safety hinges on monitoring metabolic status
and avoiding high‑dose or prolonged use.**
– **A structured protocol can help balance potential benefits
against risks for those seeking to enhance task engagement.**
This approach offers a systematic way to evaluate whether ketone supplementation could be a viable tool for improving sustained effort in demanding cognitive
tasks, while ensuring participant safety.
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