HRT HRT Delivery Methods & Administration 2 — Questions and Answers
Question 1: A patient on oral estrogen therapy develops elevated triglycerides. What delivery method change should be considered?
- Switch to transdermal estrogen (Correct answer)
- Increase oral estrogen dose
- Add a statin and continue orals
- Switch to intramuscular progesterone
Correct answer: Switch to transdermal estrogen
Transdermal estrogen avoids hepatic first-pass metabolism, which is responsible for the triglyceride elevation seen with oral estrogen.
Question 2: What is the recommended rotation practice for transdermal estrogen patches to minimize skin irritation?
- Rotate sites with each patch change (Correct answer)
- Always apply to the same site
- Apply only to the abdomen
- Change site monthly
Correct answer: Rotate sites with each patch change
Rotating the application site with each patch change prevents skin irritation, contact sensitization, and poor adhesion from repeated use at the same spot.
Question 3: Testosterone pellet insertion is performed in which anatomical location?
- Upper buttock or hip subcutaneous tissue (Correct answer)
- Intra-abdominal cavity
- Deltoid muscle
- Antecubital fossa
Correct answer: Upper buttock or hip subcutaneous tissue
Testosterone pellets are inserted into the subcutaneous fat of the upper buttock or hip via a small trocar incision under local anesthesia.
Question 4: Which vehicle base is used in most compounded transdermal hormone creams to enhance skin penetration?
- PLO (Pluronic Lecithin Organogel) (Correct answer)
- Petroleum jelly
- Aqueous saline solution
- Isopropyl alcohol alone
Correct answer: PLO (Pluronic Lecithin Organogel)
PLO gel is the most common transdermal base in compounded HRT because its lecithin component enhances percutaneous absorption through the skin.
Question 5: For a patient who cannot tolerate oral progesterone due to sedation, which alternative route minimizes CNS side effects?
- Vaginal progesterone (Correct answer)
- Intranasal progesterone
- Higher-dose oral progesterone
- Intramuscular estrogen
Correct answer: Vaginal progesterone
Vaginal progesterone achieves high uterine levels with lower systemic absorption, significantly reducing the sedative CNS effects associated with oral use.
Question 6: When calculating testosterone pellet dosing, which factor is the PRIMARY determinant of pellet quantity?
- Patient's body weight and activity level (Correct answer)
- Patient's age alone
- Physician preference only
- Insurance formulary limits
Correct answer: Patient's body weight and activity level
Testosterone pellet dosing protocols primarily factor in body weight and activity level to estimate metabolic demand and determine the number of pellets inserted.
HRT HRT Delivery Methods & Administration 2
A patient on oral estrogen therapy develops elevated triglycerides.
What delivery method change should be considered?