Post-Test — Testosterone Deficiency in Men CE

Part I — The HPG Axis, Androgen Physiology, and What 'Low T' Actually Means

1
A 52-year-old man with a BMI of 34 has a total testosterone of 265 ng/dL drawn at 8 a.m. fasting. His symptoms are equivocal. What is the most appropriate next step?
Begin testosterone cypionate 200 mg IM every two weeksRepeat the total testosterone on a separate morning and add SHBG with calculated free testosteroneOrder a pituitary MRIReassure him that this is normal for his age and take no further action
2
Which of the following conditions is associated with a DECREASE in SHBG?
HyperthyroidismCirrhosisObesity with insulin resistanceAnticonvulsant therapy

3
A 41-year-old man has two morning fasting total testosterone values of 190 and 205 ng/dL with an LH of 8.9 IU/L and FSH of 14.2 IU/L. How should this be classified, and what additional evaluation is most appropriate?
Secondary hypogonadism; obtain pituitary MRIPrimary hypogonadism; consider karyotype and testicular examinationNormal axis; no further workupSHBG artifact; repeat with equilibrium dialysis
4
Which statement about the ADAM questionnaire is correct?
It is highly specific and can establish the diagnosisIt is sensitive but poorly specific and is not recommended for population screeningIt replaces the need for confirmatory laboratory testingIt reliably distinguishes primary from secondary hypogonadism

5
A 34-year-old man with confirmed secondary hypogonadism and a stated desire to father children within two years asks to start testosterone cypionate. What is the most appropriate response?
Start testosterone cypionate and reassess fertility laterStart a transdermal gel, which does not suppress spermatogenesisAvoid testosterone monotherapy and refer for fertility-preserving management such as hCG or SERM therapyStart testosterone and add an aromatase inhibitor to protect fertility
6
Which of the following is an absolute contraindication to initiating testosterone therapy?
Hematocrit of 48 percentTreated and well-controlled obstructive sleep apneaActive breast cancerBMI of 33

7
Which formulation carries a boxed warning regarding secondary exposure of women and children?
Testosterone cypionate intramuscular injectionTestosterone gel 1.62% (AndroGel)Testosterone pellets (Testopel)Testosterone undecanoate oral (Jatenzo)
8
A patient on testosterone cypionate 200 mg every two weeks has a subtherapeutic trough, a symptom crash in week two, and a hematocrit of 51 percent. What is the best next step?
Increase to 250 mg every two weeksSplit to 100 mg weekly, preferably subcutaneouslyDiscontinue therapy entirelyAdd an aromatase inhibitor

9
A man on testosterone cypionate has a hematocrit of 55 percent at his 6-month visit. What is the most appropriate management?
Continue the current regimen and recheck in one yearHold or reduce the dose, evaluate for sleep apnea and other contributors, and consider switching to a transdermal formulationAdd an aromatase inhibitorIncrease fluid intake and continue unchanged
10
Which laboratory test does NOT require routine monitoring in a man on modern testosterone replacement therapy?
HematocritLiver function testsPSA in men aged 40 and olderTotal testosterone

11
A man on stable testosterone therapy with a level of 560 ng/dL reports persistent fatigue despite improved libido. What is the most appropriate next step?
Increase the dose to target a level above 900 ng/dLAdd an aromatase inhibitorReopen the differential and screen for sleep apnea, depression, thyroid disease, and anemiaDiscontinue testosterone therapy
12
Which of the following is the most appropriate first-line approach to new gynecomastia in a man on every-2-week testosterone cypionate?
Immediately start anastrozoleDiscontinue testosterone permanentlyExamine the breast tissue, then reduce peak exposure by shortening the dosing interval or lowering the doseOrder routine estradiol by standard immunoassay and treat any value above the reference range

13
Which of the following was a finding of the TRAVERSE trial?
Testosterone increased major adverse cardiovascular events compared with placeboTestosterone reduced clinical fracture incidenceTestosterone was non-inferior to placebo for major adverse cardiovascular events, with higher rates of atrial fibrillation and pulmonary embolismTestosterone increased prostate cancer incidence
14
A hypogonadal man asks whether testosterone therapy will prevent the fractures his father had. The most accurate response is:
Yes, testosterone reliably prevents fracturesTestosterone improves bone density but has not been shown to reduce clinical fractures; osteoporosis risk should be managed separatelyTestosterone has no effect on boneTestosterone is first-line therapy for male osteoporosis

15
A man discontinuing testosterone after three years of therapy asks how long until his sperm production recovers. The most accurate counseling is:
Two to four weeksSix to twenty-four months in most men, with a minority not fully recoveringRecovery is immediate once the drug clearsRecovery never occurs after more than one year of therapy
16
Which referral is most appropriate for a man on testosterone therapy whose PSA rises from 0.9 to 2.6 ng/mL over ten months with a normal digital rectal examination?
No referral; this is expected on therapyEndocrinologyUrology, after confirming the value and excluding confoundersHematology