HRT Cheat Sheet 2026

The 30 highest-yield HRT facts, distilled from real exam questions. Print it, save it as a PDF, or study it here — free, no sign-up.

1. Which HRT delivery method provides the most consistent serum hormone levels by bypassing first-pass hepatic metabolism? → Transdermal patch
2. In a patient with controlled hypertension, which HRT route is generally preferred to avoid further BP elevation? → Transdermal estrogen
3. What is the primary criticism major medical organizations such as ACOG raise about compounded bioidentical HRT? → Lack of long-term safety and efficacy data from large randomized controlled trials
4. Which organization provides voluntary accreditation to compounding pharmacies to demonstrate adherence to quality standards? → PCAB (Pharmacy Compounding Accreditation Board)
5. Which test would be used to evaluate cortisol rhythm in suspected adrenal disorders? → 24-hour salivary cortisol
6. Testosterone aromatizes to estradiol in peripheral tissues. Which enzyme performs this conversion? → Aromatase (CYP19A1)
7. Which hormone therapy is typically used for males with hypogonadism? → Testosterone therapy
8. Which progesterone/progestogen is considered to have the most favorable safety profile regarding breast cancer risk in HRT? → Micronized progesterone (Prometrium)
9. Advertising HRT services with claims like 'guaranteed to reverse aging' or 'clinically proven to cure menopause' would violate which regulatory standard? → FTC truth-in-advertising regulations prohibiting deceptive health claims
10. Why are estradiol levels monitored in hormone replacement therapy? → To evaluate estrogen balance
11. Testosterone replacement therapy is contraindicated in men with which hematologic condition due to risk of dangerous erythrocytosis? → Polycythemia vera
12. Testosterone supplementation in postmenopausal women is primarily indicated for which condition? → Hypoactive sexual desire disorder (HSDD)
13. Prometrium (micronized progesterone) is best classified as which type of hormone preparation? → An FDA-approved bioidentical hormone product
14. Which lab value should be monitored to detect polycythemia in patients on testosterone therapy? → Hematocrit
15. What is the primary quality concern with compounded hormone preparations that the FDA has identified? → Lack of mandatory pre-market testing for potency, sterility, and consistency
16. Which finding on endometrial ultrasound in a postmenopausal woman on HRT should prompt endometrial biopsy? → Endometrial stripe >5 mm
17. A patient on oral estrogen therapy develops elevated triglycerides. What delivery method change should be considered? → Switch to transdermal estrogen
18. How often should patients on HRT be monitored for hormone levels? → Every 3–6 months
19. Which laboratory value must be checked before initiating testosterone therapy in men to rule out secondary causes of hypogonadism? → LH and FSH
20. How does obesity impact HRT-related VTE risk? → Obesity independently increases VTE risk, compounding the risk added by oral estrogen
21. Which assessment tool is commonly used to quantify hot flash severity and frequency in clinical HRT trials? → Hot Flash Related Daily Interference Scale (HFRDIS)
22. According to the Menopause Society (NAMS) guidelines, what is the recommended minimum effective dose principle for menopausal HRT? → Use the lowest effective dose for the shortest duration consistent with treatment goals
23. What is an important safety consideration when prescribing HRT for patients with cardiovascular disease? → Evaluate cardiovascular risk
24. What is the diagnostic criterion for primary hypogonadism in men using morning serum total testosterone? → Total testosterone <300 ng/dL on two separate morning measurements
25. A twice-weekly estradiol patch is changed on Monday. The next change should occur on which day? → Thursday
26. What is the primary role of progesterone in the reproductive cycle? → Thickens the uterine lining
27. Testosterone is a Schedule III controlled substance in the United States. What does this classify it as? → A drug with accepted medical use but moderate potential for dependence and abuse
28. Which professional body publishes the most authoritative clinical practice guidelines for menopause management in the United States? → The Menopause Society (formerly NAMS — North American Menopause Society)
29. Sleep disturbances in menopause are most directly related to which hormonal change? → Declining estrogen and progesterone affecting sleep architecture
30. A male patient on weekly IM testosterone cypionate has a trough level of 180 ng/dL. The appropriate clinical response is to: → Increase the dose or shorten the injection interval