Hormone levels may be drawn and evaluated before therapy is started. This may include an FSH, estradiol, and testosterone (free and total) for women. Men need a PSA (prostate specific antigen), estradiol, testosterone, and blood count prior to starting therapy. Thyroid hormone levels (TSH) may also be evaluated. In men, follow up levels, including a PSA, blood count and estradiol, may be obtained prior to some of the subsequent testosterone implantation. Men are encouraged to notify their primary care physician and obtain a digital rectal exam each year. Women are advised to continue their monthly self-breast exam and obtain a mammogram and/or pap smear as advised by their gynecologist or primary care physician.
In Indonesia (where Longjack is known as pasak bumi), young plants are not used for medicinal purposes. Only roots of an age of at least 10 years are considered effective. And because Indonesia is the only country where it is still found in the wild, it also is the only country from where one can obtain old roots. There are simply no plantations where Longjack has been grown for at least ten years, no-where in the world. In Malaysia, the Longjack shrub has now been declared a protected plant, as over-collection in the wild has almost eradicated it from the forests of that country.
Research also conducted during the 1980s at Johns Hopkins University Medical Center similarly found, in several placebo controlled studies, that vitamin E is useful in reducing many PMS symptoms, as well as fibrocystic breast discomfort. Other studies have found that vitamin E supplementation reduced menopause related hot flashes, fatigue, and mood swings in 66 to 85 percent of the women tested, depending on the study. One additional study noted a decrease in the symptoms of vaginal atrophy in 50 percent of the postmenopausal women volunteers.