HRT HRT for Male Patients (Testosterone Therapy) 1 — Questions and Answers
Question 1: 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 (Correct answer)
- Total testosterone <500 ng/dL on one reading
- FSH >10 mIU/mL alone
- Free testosterone <1% of total
Correct answer: Total testosterone <300 ng/dL on two separate morning measurements
The Endocrine Society recommends diagnosing male hypogonadism when two separate morning total testosterone levels are below 300 ng/dL, ideally with consistent clinical symptoms.
Question 2: Why should testosterone levels be measured in the morning for male HRT evaluation?
- Testosterone follows a diurnal rhythm, peaking in the morning and declining throughout the day (Correct answer)
- Labs only process samples in the morning
- Afternoon samples require a different reference range
- Morning samples avoid dietary interference
Correct answer: Testosterone follows a diurnal rhythm, peaking in the morning and declining throughout the day
Testosterone secretion follows a circadian pattern, with peak levels occurring in the morning (6–10 AM); afternoon draws may yield falsely low results.
Question 3: Which laboratory value must be checked before initiating testosterone therapy in men to rule out secondary causes of hypogonadism?
- LH and FSH (Correct answer)
- Vitamin D only
- Thyroid TSH only
- A1C
Correct answer: LH and FSH
LH and FSH distinguish primary hypogonadism (high LH/FSH, failing testes) from secondary hypogonadism (low LH/FSH, pituitary/hypothalamic cause) to guide treatment.
Question 4: Testosterone therapy in men suppresses which endogenous process, potentially reducing fertility?
- Spermatogenesis via hypothalamic-pituitary-gonadal axis suppression (Correct answer)
- Hepatic albumin synthesis
- Adrenal cortisol production
- Thyroid hormone conversion
Correct answer: Spermatogenesis via hypothalamic-pituitary-gonadal axis suppression
Exogenous testosterone suppresses LH and FSH via negative feedback, inhibiting intratesticular testosterone needed for spermatogenesis and reducing sperm production.
Question 5: For men on testosterone therapy who wish to preserve fertility, which adjunctive therapy is used to maintain spermatogenesis?
- Human chorionic gonadotropin (hCG) (Correct answer)
- Clomiphene citrate only
- Aromatase inhibitors only
- GnRH antagonist
Correct answer: Human chorionic gonadotropin (hCG)
hCG mimics LH, stimulating testicular testosterone production and maintaining intratesticular testosterone levels necessary for spermatogenesis even during TRT.
Question 6: Polycythemia (elevated hematocrit) is a known complication of testosterone therapy. At what hematocrit level should TRT be paused?
- >54% (Correct answer)
- >45%
- >50%
- >60%
Correct answer: >54%
A hematocrit above 54% during TRT indicates clinically significant erythrocytosis requiring dose reduction, phlebotomy, or temporary TRT cessation to reduce thrombotic risk.
