HRT HRT for Male Patients (Testosterone Therapy) 2 — Questions and Answers
Question 1: Testosterone aromatizes to estradiol in peripheral tissues. Which enzyme performs this conversion?
- Aromatase (CYP19A1) (Correct answer)
- 5-alpha reductase
- 11-beta hydroxylase
- 3-beta HSD
Correct answer: Aromatase (CYP19A1)
Aromatase (CYP19A1) converts androgens including testosterone to estrogens in peripheral tissues such as adipose, liver, and brain.
Question 2: Excessive estradiol levels in men on TRT can cause which side effect?
- Gynecomastia and water retention (Correct answer)
- Increased libido only
- Elevated testosterone levels
- Hypoglycemia
Correct answer: Gynecomastia and water retention
Excess estradiol from testosterone aromatization stimulates breast gland tissue causing gynecomastia and promotes renal sodium and water retention.
Question 3: Which drug class is used to reduce estradiol levels in men on TRT who develop symptoms of estrogen excess?
- Aromatase inhibitors (e.g., anastrozole) (Correct answer)
- Progestogens
- SERMs only
- Dopamine agonists
Correct answer: Aromatase inhibitors (e.g., anastrozole)
Aromatase inhibitors block the conversion of testosterone to estradiol, lowering serum estrogen in men who develop gynecomastia or other estrogen excess symptoms during TRT.
Question 4: Prior to initiating TRT, a digital rectal exam (DRE) and PSA test are required to screen for which condition?
- Prostate cancer (Correct answer)
- Benign prostatic hyperplasia screening only
- Rectal cancer
- Bladder cancer
Correct answer: Prostate cancer
Testosterone stimulates prostate tissue, so undetected prostate cancer could be accelerated by TRT; DRE and PSA baseline screening are mandatory before initiation.
Question 5: How does obstructive sleep apnea (OSA) relate to testosterone therapy in men?
- TRT can worsen OSA; sleep apnea should be treated or controlled before initiating TRT (Correct answer)
- TRT cures sleep apnea
- OSA has no relationship to TRT safety
- TRT improves OSA by improving muscle tone
Correct answer: TRT can worsen OSA; sleep apnea should be treated or controlled before initiating TRT
Testosterone can stimulate upper airway muscle changes and erythrocytosis that worsen sleep apnea severity; uncontrolled OSA is a relative contraindication to TRT.
Question 6: Testosterone replacement therapy is contraindicated in men with which hematologic condition due to risk of dangerous erythrocytosis?
- Polycythemia vera (Correct answer)
- Iron deficiency anemia
- Thalassemia trait
- Hemophilia B
Correct answer: Polycythemia vera
Polycythemia vera is a myeloproliferative disorder already causing excessive red blood cell production; TRT-induced erythrocytosis would compound this to life-threatening levels.
HRT HRT for Male Patients (Testosterone Therapy) 2
Testosterone aromatizes to estradiol in peripheral tissues.
Which enzyme performs this conversion?