MCQ Quiz: Testosterone Replacement Therapy

Testosterone Replacement Therapy (TRT) is the standard of care for managing symptomatic hypogonadism, a key topic in the “Men’s Health Disorders” module of the Patient Care 5 curriculum. While TRT can significantly improve a patient’s quality of life, its management requires careful patient selection, ongoing monitoring, and extensive patient counseling to ensure safety and efficacy. This quiz will test your knowledge on the practical aspects of managing TRT, from choosing a formulation to monitoring for adverse effects.

1. What is the primary indication for initiating Testosterone Replacement Therapy (TRT)?

• a. A desire for increased athletic performance.
• b. Normal age-related decline in energy.
• c. Symptomatic hypogonadism with consistently low morning testosterone levels.
• d. Erectile dysfunction in a patient with normal testosterone levels.

Answer: c. Symptomatic hypogonadism with consistently low morning testosterone levels.

2. Which of the following is an absolute contraindication to starting TRT?

• a. Type 2 Diabetes
• b. Benign Prostatic Hyperplasia (BPH) with mild symptoms.
• c. A history of active prostate cancer.
• d. Age over 65.

Answer: c. A history of active prostate cancer.

3. What is the main therapeutic goal of TRT?

• a. To achieve supraphysiologic levels of testosterone for maximal muscle gain.
• b. To restore serum testosterone levels to the mid-normal range for a young, healthy man.
• c. To suppress spermatogenesis completely.
• d. To shrink the prostate gland.

Answer: b. To restore serum testosterone levels to the mid-normal range for a young, healthy man.

4. A patient is using a 1.62% testosterone gel. What is the most critical counseling point to prevent transference to others?

• a. Apply the gel to the scrotum.
• b. Wash hands thoroughly after application and cover the application site with clothing after it dries.
• c. Apply a very thin layer to minimize the dose.
• d. Shower immediately after application.

Answer: b. Wash hands thoroughly after application and cover the application site with clothing after it dries.

5. Which laboratory parameter must be monitored at baseline and regularly during TRT due to the risk of polycythemia?

• a. Serum potassium
• b. Hemoglobin and Hematocrit
• c. Liver function tests
• d. Serum glucose

Answer: b. Hemoglobin and Hematocrit

6. The “Management of Testosterone Deficiency” is a specific lecture in which course?

• a. PHA5787C Patient Care 5
• b. PHA5104 Sterile Compounding
• c. PHA5703 Pharmacy Law and Ethics
• d. PHA5878C Patient Care 3

Answer: a. PHA5787C Patient Care 5

7. Testosterone cypionate and enanthate are long-acting formulations administered via which route?

• a. Oral
• b. Transdermal patch
• c. Intramuscular injection
• d. Sublingual

Answer: c. Intramuscular injection

8. A major advantage of transdermal gels over intramuscular injections for TRT is that gels:

• a. Are less expensive.
• b. Have a lower risk of transference.
• c. Provide more stable, physiologic serum levels with less peak-and-trough fluctuation.
• d. Require less frequent administration.

Answer: c. Provide more stable, physiologic serum levels with less peak-and-trough fluctuation.

9. A patient on TRT develops gynecomastia. This side effect is due to:

• a. The direct effect of testosterone on breast tissue.
• b. The peripheral conversion of testosterone to estradiol by the aromatase enzyme.
• c. An allergic reaction.
• d. A decrease in prolactin levels.

Answer: b. The peripheral conversion of testosterone to estradiol by the aromatase enzyme.

10. A patient’s hematocrit increases to 55% while on TRT. The pharmacist should recognize this as a potential safety concern requiring:

• a. An increase in the testosterone dose.
• b. The addition of an iron supplement.
• c. Holding or reducing the testosterone dose and a potential phlebotomy referral.
• d. No action, as this is a desired effect.

Answer: c. Holding or reducing the testosterone dose and a potential phlebotomy referral.

11. The management of men’s health disorders is a topic within the Patient Care 5 curriculum.

• a. True
• b. False

Answer: a. True

12. Before initiating TRT, it is essential to screen for and assess a patient’s risk for:

• a. Benign Prostatic Hyperplasia (BPH) and prostate cancer.
• b. GERD.
• c. Migraines.
• d. Allergic rhinitis.

Answer: a. Benign Prostatic Hyperplasia (BPH) and prostate cancer.

13. Which of the following is NOT a potential benefit of TRT in a truly hypogonadal man?

• a. Improved libido
• b. Increased bone density
• c. Improved mood and energy
• d. Maintained or improved fertility

Answer: d. Maintained or improved fertility

14. What is the primary reason older oral androgens like methyltestosterone are no longer used?

• a. They are not effective.
• b. High risk of hepatotoxicity.
• c. They are too expensive.
• d. They cause severe sedation.

Answer: b. High risk of hepatotoxicity.

15. Counseling patients on the appropriate use of medications and devices is a key objective for student pharmacists.

• a. True
• b. False

Answer: a. True

16. Testosterone replacement therapy can worsen which of the following conditions?

• a. Benign Prostatic Hyperplasia (BPH)
• b. Obstructive Sleep Apnea
• c. Both a and b
• d. Neither a nor b

Answer: c. Both a and b

17. The “Introduction to Urological Disorders” is a lecture within the Patient Care 5 curriculum.

• a. True
• b. False

Answer: a. True

18. A patient using a testosterone patch (e.g., Androderm) should be counseled to:

• a. Apply the patch to the scrotum.
• b. Rotate application sites each night to avoid skin irritation.
• c. Wear the same patch for one week.
• d. Cut the patch if a lower dose is needed.

Answer: b. Rotate application sites each night to avoid skin irritation.

19. Why does exogenous testosterone administration cause infertility?

• a. It directly damages sperm.
• b. It suppresses GnRH, LH, and FSH, which shuts down natural testicular function and spermatogenesis.
• c. It has no effect on fertility.
• d. It causes erectile dysfunction.

Answer: b. It suppresses GnRH, LH, and FSH, which shuts down natural testicular function and spermatogenesis.

20. An active learning session on urological disorders is part of the Patient Care 5 course.

• a. True
• b. False

Answer: a. True

21. A patient on TRT should have their Prostate-Specific Antigen (PSA) level monitored because:

• a. TRT causes prostate cancer.
• b. TRT can stimulate the growth of a pre-existing or occult prostate cancer.
• c. PSA is a direct measure of testosterone levels.
• d. It is used to monitor for gynecomastia.

Answer: b. TRT can stimulate the growth of a pre-existing or occult prostate cancer.

22. Which of the following is a symptom of symptomatic hypogonadism?

• a. Increased energy and stamina.
• b. Reduced muscle mass and increased body fat.
• c. Increased facial hair growth.
• d. Enhanced cognitive function.

Answer: b. Reduced muscle mass and increased body fat.

23. A patient’s testosterone level is 350 ng/dL (normal range 300-1000 ng/dL) but he feels well and has no symptoms. Is TRT indicated?

• a. Yes, because his level is in the lower part of the normal range.
• b. Yes, to prevent future symptoms.
• c. No, because treatment is reserved for symptomatic hypogonadism.
• d. Yes, but only with an oral formulation.

Answer: c. No, because treatment is reserved for symptomatic hypogonadism.

24. An active learning session on men’s health is part of which course?

• a. PHA5787C Patient Care 5
• b. PHA5163L Professional Skills Lab 3
• c. PHA5781 Patient Care I
• d. PHA5782C Patient Care 2

Answer: a. PHA5787C Patient Care 5

25. A pharmacist’s role in TRT includes all of the following EXCEPT:

• a. Counseling on the risk of transference with topical products.
• b. Recommending monitoring for Hct and PSA.
• c. Diagnosing hypogonadism.
• d. Teaching proper injection technique.

Answer: c. Diagnosing hypogonadism.

26. The goal testosterone level during replacement therapy should be:

• a. As high as possible.
• b. In the low-normal range.
• c. In the mid-normal range for a young adult male.
• d. In the supraphysiologic range.

Answer: c. In the mid-normal range for a young adult male.

27. A common side effect of intramuscular testosterone injections is:

• a. The “peak and trough” effect, leading to fluctuations in mood and energy.
• b. A low risk of transference.
• c. Pain at the injection site.
• d. Both a and c.

Answer: d. Both a and c.

28. An active learning session on urological disorders is part of which course module?

• a. Module 8: Urological Disorders
• b. Module 1: Diabetes Mellitus
• c. Module 3: Women’s Health
• d. Module 6: Geriatrics

Answer: a. Module 8: Urological Disorders

29. Which of the following is NOT an approved formulation for TRT?

• a. Transdermal patch
• b. Intramuscular injection
• c. Topical gel
• d. Intravenous infusion

Answer: d. Intravenous infusion

30. The “Management of Testosterone Deficiency” is a lecture within the Patient Care 5 curriculum.

• a. True
• b. False

Answer: a. True

31. A patient asks about over-the-counter “testosterone boosters.” The pharmacist should counsel that these products:

• a. Are FDA-approved and proven to be effective.
• b. Are safe substitutes for prescription TRT.
• c. Are generally not proven to be effective and may contain unsafe ingredients.
• d. Have no potential for side effects.

Answer: c. Are generally not proven to be effective and may contain unsafe ingredients.

32. A patient on TRT develops edema and complains of shortness of breath. The pharmacist should be concerned about:

• a. A common, mild side effect.
• b. Potential exacerbation of underlying heart failure.
• c. A sign of polycythemia.
• d. A skin reaction to the medication.

Answer: b. Potential exacerbation of underlying heart failure.

33. The principles of special patient populations are covered in the Drug Therapy Individualization course.

• a. True
• b. False

Answer: a. True

34. The decision to start TRT should be a shared decision between the patient and provider after a discussion of:

• a. The potential benefits on symptoms.
• b. The potential risks and need for monitoring.
• c. The costs and different formulations.
• d. All of the above.

Answer: d. All of the above.

35. A patient who wishes to maintain fertility should be counseled that TRT:

• a. Will improve their fertility.
• b. Will likely impair or eliminate their fertility while on treatment.
• c. Has no effect on fertility.
• d. Is the first-line treatment for male infertility.

Answer: b. Will likely impair or eliminate their fertility while on treatment.

36. A key counseling point for testosterone gels is to apply them to:

• a. The scrotum and penis.
• b. Clean, dry, intact skin of the shoulders, upper arms, or abdomen.
• c. The legs and feet.
• d. The face and neck.

Answer: b. Clean, dry, intact skin of the shoulders, upper arms, or abdomen.

37. Which of the following lab values should be monitored in a patient on TRT?

• a. Serum Testosterone
• b. Hematocrit
• c. PSA
• d. All of the above

Answer: d. All of the above

38. The lecture “Management of Men’s Health Disorders” is part of which course?

• a. PHA5787C Patient Care 5
• b. PHA5163L Professional Skills Lab 3
• c. PHA5781 Patient Care I
• d. PHA5782C Patient Care 2

Answer: a. PHA5787C Patient Care 5

39. Testosterone is classified as what schedule of controlled substance?

• a. Schedule II
• b. Schedule III
• c. Schedule IV
• d. Schedule V

Answer: b. Schedule III

40. An active learning session covering men’s health is part of which course?

• a. PHA5787C Patient Care 5
• b. PHA5163L Professional Skills Lab 3
• c. PHA5781 Patient Care I
• d. PHA5782C Patient Care 2

Answer: a. PHA5787C Patient Care 5

41. The risk of polycythemia with TRT is thought to be due to testosterone’s effect on:

• a. Erythropoietin and direct stimulation of the bone marrow.
• b. Iron absorption.
• c. Vitamin B12 levels.
• d. Platelet production.

Answer: a. Erythropoietin and direct stimulation of the bone marrow.

42. A patient with untreated, severe obstructive sleep apnea has a relative contraindication to starting TRT.

• a. True
• b. False

Answer: a. True

43. A pharmacist reviewing a TRT order should verify:

• a. The patient has a confirmed diagnosis of symptomatic hypogonadism.
• b. Baseline labs like PSA and Hct have been checked.
• c. The dose and formulation are appropriate.
• d. All of the above.

Answer: d. All of the above.

44. Which of the following is NOT a desired outcome of TRT?

• a. Improvement in sexual desire.
• b. Improvement in bone density.
• c. An increase in PSA above the normal range.
• d. Improvement in energy and mood.

Answer: c. An increase in PSA above the normal range.

45. The half-life of an injectable testosterone ester is determined by:

• a. The length of the ester chain.
• b. The volume of the injection.
• c. The site of the injection.
• d. The patient’s age.

Answer: a. The length of the ester chain.

46. A patient on TRT should be counseled that resolution of symptoms like increased muscle mass may take:

• a. A few days.
• b. A few weeks.
• c. Several months.
• d. Over a year.

Answer: c. Several months.

47. Counseling on men’s health disorders is a topic within the Patient Care 5 curriculum.

• a. True
• b. False

Answer: a. True

48. An active learning session on men’s health is part of which course module?

• a. Module 8: Urological Disorders
• b. Module 1: Diabetes Mellitus
• c. Module 4: Medication Safety
• d. Module 6: Geriatrics

Answer: a. Module 8: Urological Disorders

49. The overall management of a patient on TRT is:

• a. A one-time prescription with no follow-up.
• b. A dynamic process requiring regular monitoring and dose adjustments.
• c. Focused only on improving libido.
• d. Handled exclusively by the patient.

Answer: b. A dynamic process requiring regular monitoring and dose adjustments.

50. The ultimate goal of learning about testosterone replacement therapy is to:

• a. Safely and effectively manage therapy for appropriately diagnosed patients to improve their quality of life while minimizing risks.
• b. Be able to recommend TRT for athletic performance.
• c. Pass the final exam.
• d. Memorize every available brand of testosterone gel.

Answer: a. Safely and effectively manage therapy for appropriately diagnosed patients to improve their quality of life while minimizing risks.