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IMF-052-02-0001-en	Why should libido, erection, ejaculation, orgasm, and fertility be assessed as separable functions?	They are related but distinct, so a person can have normal erections with impaired spermatogenesis, or low desire with intact genital physiology.	Integrated Medical Foundations; chapter 52, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 8fe332d5d81517c2e2c0e1017b5bfba14234f6c630579480cfcb0343bf446690; editorial review pending	imf lang::en chapter::052 module::052-02 review::pending
IMF-052-02-0002-en	Why does continuous rather than pulsatile gonadotropin-releasing hormone exposure lower testosterone?	The hormone is normally released in pulses, and continuous exposure suppresses pituitary gonadotropins, removing the drive to Leydig cells.	Integrated Medical Foundations; chapter 52, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 8fe332d5d81517c2e2c0e1017b5bfba14234f6c630579480cfcb0343bf446690; editorial review pending	imf lang::en chapter::052 module::052-02 review::pending
IMF-052-02-0003-en	Why can a total testosterone concentration misrepresent biologically available hormone?	Most circulating testosterone is protein-bound, and sex-hormone-binding globulin changes with age, obesity, thyroid and liver disease, insulin, and medications.	Integrated Medical Foundations; chapter 52, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 8fe332d5d81517c2e2c0e1017b5bfba14234f6c630579480cfcb0343bf446690; editorial review pending	imf lang::en chapter::052 module::052-02 review::pending
IMF-052-02-0004-en	What do low or inappropriately normal gonadotropins with low testosterone imply, and what follows?	Hypothalamic or pituitary suppression, prompting assessment of prolactin, pituitary symptoms, opioids, glucocorticoids, obesity, undernutrition, and systemic disease.	Integrated Medical Foundations; chapter 52, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 8fe332d5d81517c2e2c0e1017b5bfba14234f6c630579480cfcb0343bf446690; editorial review pending	imf lang::en chapter::052 module::052-02 review::pending
IMF-052-02-0005-en	In secondary hypogonadism with fertility wishes, why is exogenous testosterone avoided?	It suppresses sperm production, so treating the cause and restoring endogenous gonadotropin drive, including gonadotropins or selective receptor modulation under specialists, preserves fertility.	Integrated Medical Foundations; chapter 52, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 8fe332d5d81517c2e2c0e1017b5bfba14234f6c630579480cfcb0343bf446690; editorial review pending	imf lang::en chapter::052 module::052-02 review::pending
IMF-052-02-0006-en	Why is irreversible infertility not concluded from semen analysis immediately after stopping testosterone or steroids?	Recovery of spermatogenesis takes months, and anabolic steroids can cause prolonged secondary hypogonadism after cessation.	Integrated Medical Foundations; chapter 52, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 8fe332d5d81517c2e2c0e1017b5bfba14234f6c630579480cfcb0343bf446690; editorial review pending	imf lang::en chapter::052 module::052-02 review::pending
IMF-052-02-0007-en	How does nitric oxide lead to blood being trapped in the penis during erection?	Nitric oxide raises cyclic guanosine monophosphate, relaxing cavernosal smooth muscle; arterial inflow expands sinusoids, which compress subtunical veins.	Integrated Medical Foundations; chapter 52, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 8fe332d5d81517c2e2c0e1017b5bfba14234f6c630579480cfcb0343bf446690; editorial review pending	imf lang::en chapter::052 module::052-02 review::pending
IMF-052-02-0008-en	Why do preserved morning or masturbation erections not prove a purely psychological cause?	They suggest preserved physiology, but physical contributors can coexist, so situational variability, performance fear, and relationship stress are explored without dismissing them.	Integrated Medical Foundations; chapter 52, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 8fe332d5d81517c2e2c0e1017b5bfba14234f6c630579480cfcb0343bf446690; editorial review pending	imf lang::en chapter::052 module::052-02 review::pending
IMF-052-02-0009-en	When a phosphodiesterase type-five inhibitor appears to fail, what should be reviewed instead of escalating the dose?	Timing, food effect, dose and repeated correct trials, testosterone where indicated, vascular disease, neurological injury, and alternative devices, because unsafe escalation adds risk.	Integrated Medical Foundations; chapter 52, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 8fe332d5d81517c2e2c0e1017b5bfba14234f6c630579480cfcb0343bf446690; editorial review pending	imf lang::en chapter::052 module::052-02 review::pending
IMF-052-02-0010-en	Why do alpha blockers or pelvic surgery cause low-volume or dry orgasm?	Ejaculation needs sympathetic emission and bladder-neck closure; impairing these gives failed emission or retrograde ejaculation with sperm in post-ejaculatory urine.	Integrated Medical Foundations; chapter 52, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 8fe332d5d81517c2e2c0e1017b5bfba14234f6c630579480cfcb0343bf446690; editorial review pending	imf lang::en chapter::052 module::052-02 review::pending
IMF-052-02-0011-en	Why must systemic treatment, including in sickle cell disease, not delay corporal decompression in ischaemic priapism?	Stagnant hypoxic blood in a closed compartment causes time-dependent smooth-muscle necrosis and later fibrosis, and systemic measures do not substitute for local decompression.	Integrated Medical Foundations; chapter 52, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 8fe332d5d81517c2e2c0e1017b5bfba14234f6c630579480cfcb0343bf446690; editorial review pending	imf lang::en chapter::052 module::052-02 review::pending
IMF-052-02-0012-en	Why are both testes fixed after torsion, and why can urinary symptoms or partial relief not exclude it?	Anatomical predisposition is commonly bilateral; torsion causes infarction within hours, and age, urinary symptoms, partial relief, or one normal sign cannot exclude it.	Integrated Medical Foundations; chapter 52, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 8fe332d5d81517c2e2c0e1017b5bfba14234f6c630579480cfcb0343bf446690; editorial review pending	imf lang::en chapter::052 module::052-02 review::pending
IMF-052-02-0013-en	Why is trans-scrotal biopsy avoided for a suspected testicular tumour?	It disrupts lymphatic drainage and staging, so radical inguinal orchidectomy is used for both diagnosis and treatment.	Integrated Medical Foundations; chapter 52, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 8fe332d5d81517c2e2c0e1017b5bfba14234f6c630579480cfcb0343bf446690; editorial review pending	imf lang::en chapter::052 module::052-02 review::pending
IMF-052-02-0014-en	In azoospermia, what distinguishes absent production from obstruction, and why can the cause matter for offspring?	Testicular size, gonadotropins, genetics, and examination separate them; severe oligospermia or absent vas deferens can reveal chromosomal or cystic-fibrosis-related conditions.	Integrated Medical Foundations; chapter 52, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 8fe332d5d81517c2e2c0e1017b5bfba14234f6c630579480cfcb0343bf446690; editorial review pending	imf lang::en chapter::052 module::052-02 review::pending