Disorders of sex hormones MCQs With Answer provide B. Pharm students a focused, exam-ready review of endocrine pharmacology, clinical features, diagnostics, and drug therapies related to sex hormone imbalances. This concise, keyword-rich introduction covers androgen and estrogen disorders, hypogonadism, polycystic ovarian syndrome (PCOS), congenital adrenal hyperplasia (CAH), hormonal contraceptives, and hormone replacement strategies. Emphasis is on mechanisms, receptor pharmacology, laboratory assays, and commonly used drugs like GnRH analogs, SERMs, aromatase inhibitors, and antiandrogens. Practical, application-based questions reinforce therapeutic decision-making and adverse-effect management. Now let’s test your knowledge with 50 MCQs on this topic.
Q1. Which enzyme catalyzes the conversion of testosterone to dihydrotestosterone (DHT)?
- Aromatase
- 5-alpha reductase
- 17-beta hydroxysteroid dehydrogenase
- Sulfotransferase
Correct Answer: 5-alpha reductase
Q2. The principal circulating estrogen in premenopausal women is:
- Estrone
- Estriol
- Estradiol
- Estetrol
Correct Answer: Estradiol
Q3. A common endocrine cause of hirsutism in women is:
- Turner syndrome
- Polycystic ovarian syndrome (PCOS)
- Sheehan syndrome
- Primary ovarian insufficiency
Correct Answer: Polycystic ovarian syndrome (PCOS)
Q4. Which drug is a selective estrogen receptor modulator (SERM) used for ovulation induction and breast cancer prevention?
- Letrozole
- Clomiphene citrate
- Anastrozole
- Fulvestrant
Correct Answer: Clomiphene citrate
Q5. Congenital adrenal hyperplasia due to 21-hydroxylase deficiency typically leads to increased production of:
- Aldosterone
- Cortisol
- Androgens
- Estrogens
Correct Answer: Androgens
Q6. Which hormone directly stimulates Leydig cells to produce testosterone?
- Follicle-stimulating hormone (FSH)
- GnRH
- Luteinizing hormone (LH)
- Prolactin
Correct Answer: Luteinizing hormone (LH)
Q7. Aromatase inhibitors are most useful in treating estrogen-dependent breast cancer by:
- Blocking estrogen receptors
- Inhibiting estrogen synthesis
- Promoting estrogen metabolism
- Increasing SHBG levels
Correct Answer: Inhibiting estrogen synthesis
Q8. Klinefelter syndrome (47,XXY) commonly presents with:
- Hyperestrogenism and low testosterone leading to gynecomastia
- High testosterone and small testes
- Excess cortisol production
- Primary adrenal insufficiency
Correct Answer: Hyperestrogenism and low testosterone leading to gynecomastia
Q9. Which laboratory test is the most reliable initial assay to assess male hypogonadism?
- Serum estradiol
- Serum luteinizing hormone
- Serum total testosterone
- Serum DHT
Correct Answer: Serum total testosterone
Q10. Spironolactone helps treat hirsutism by which primary mechanism?
- Inhibiting aromatase
- Blocking androgen receptors and inhibiting androgen synthesis
- Increasing SHBG production
- Stimulating FSH release
Correct Answer: Blocking androgen receptors and inhibiting androgen synthesis
Q11. Anastrozole is classified pharmacologically as a:
- Selective estrogen receptor modulator (SERM)
- Aromatase inhibitor
- Progesterone receptor agonist
- Gonadotropin analog
Correct Answer: Aromatase inhibitor
Q12. Primary ovarian failure (premature ovarian insufficiency) typically shows elevated levels of:
- Estradiol and progesterone
- FSH and LH
- Progesterone only
- Androstenedione
Correct Answer: FSH and LH
Q13. Androgen insensitivity syndrome (AIS) is caused by defects in:
- Aromatase enzyme
- Androgen receptor
- LH receptor
- FSH receptor
Correct Answer: Androgen receptor
Q14. Which drug is a 5-alpha reductase inhibitor used to treat benign prostatic hyperplasia and androgenic alopecia?
- Finasteride
- Flutamide
- Spironolactone
- Ketoconazole
Correct Answer: Finasteride
Q15. In PCOS, the typical hormonal pattern includes:
- Low LH, high FSH, high estrogen
- High LH:FSH ratio and hyperandrogenism
- High prolactin and low androgens
- High cortisol and low androgens
Correct Answer: High LH:FSH ratio and hyperandrogenism
Q16. The main therapeutic action of clomiphene in infertility is to:
- Suppress ovulation
- Act as a GnRH agonist
- Stimulate ovulation by blocking estrogen feedback
- Directly increase FSH production from the pituitary
Correct Answer: Stimulate ovulation by blocking estrogen feedback
Q17. Which condition is characterized by absence of uterus and presence of XY karyotype with testicular tissue?
- Turner syndrome
- Complete androgen insensitivity syndrome
- Potter sequence
- Functional hypothalamic amenorrhea
Correct Answer: Complete androgen insensitivity syndrome
Q18. Elevated serum androstenedione with low cortisol suggests a block at which enzyme in steroidogenesis?
- Aromatase
- 21-hydroxylase
- 5-alpha reductase
- 17-beta hydroxysteroid dehydrogenase
Correct Answer: 21-hydroxylase
Q19. Which medication is commonly used to reduce prolactin secretion in prolactinomas causing hypogonadism?
- Ketoconazole
- Cabergoline
- Clomiphene citrate
- Leuprolide
Correct Answer: Cabergoline
Q20. Estriol is the predominant estrogen during:
- Premenopause
- Menopause
- Pregnancy
- Puberty
Correct Answer: Pregnancy
Q21. Which therapeutic is a GnRH agonist used to suppress gonadal steroid production in hormone-sensitive cancers?
- Leuprolide
- Oxandrolone
- Mifepristone
- Finasteride
Correct Answer: Leuprolide
Q22. Aromatase is responsible for conversion of:
- Testosterone to DHT
- Androstenedione to estrone and testosterone to estradiol
- Cortisol to cortisone
- Progesterone to aldosterone
Correct Answer: Androstenedione to estrone and testosterone to estradiol
Q23. Which condition commonly causes gynecomastia in adult males due to increased estrogen to androgen ratio?
- Hypothyroidism
- Liver cirrhosis
- Type 1 diabetes mellitus
- Hyperaldosteronism
Correct Answer: Liver cirrhosis
Q24. The major binding protein for testosterone in plasma is:
- Albumin
- Sex hormone-binding globulin (SHBG)
- Corticosteroid-binding globulin
- Thyroxine-binding globulin
Correct Answer: Sex hormone-binding globulin (SHBG)
Q25. Which drug is an antiandrogen that competitively blocks the androgen receptor and is used in prostate cancer?
- Flutamide
- Letrozole
- Spironolactone
- Metformin
Correct Answer: Flutamide
Q26. In menopause, which hormone decreases most markedly leading to vasomotor symptoms?
- Progesterone
- Estradiol
- Testosterone
- Aldosterone
Correct Answer: Estradiol
Q27. A long-term adverse effect of androgenic anabolic steroid abuse includes:
- Decreased erythropoiesis
- Infertility and testicular atrophy
- Hypergonadotropic hypogonadism
- Increased HDL cholesterol
Correct Answer: Infertility and testicular atrophy
Q28. Which of the following is a progesterone receptor agonist used in contraception and hormone therapy?
- Medroxyprogesterone acetate
- Raloxifene
- Letrozole
- Finasteride
Correct Answer: Medroxyprogesterone acetate
Q29. Elevated 17-hydroxyprogesterone is a screening marker for:
- Primary hypothyroidism
- 21-hydroxylase deficiency (CAH)
- PCOS
- Klinefelter syndrome
Correct Answer: 21-hydroxylase deficiency (CAH)
Q30. Which drug is an aromatase inhibitor preferred for ovulation induction in PCOS with better endometrial profile than clomiphene?
- Letrozole
- Anastrozole
- Exemestane
- Fulvestrant
Correct Answer: Letrozole
Q31. Which receptor subtype mediates most classical genomic effects of estrogens?
- Membrane G protein-coupled estrogen receptor only
- Estrogen receptor alpha (ERα) and beta (ERβ) nuclear receptors
- Androgen receptor
- Progesterone receptor
Correct Answer: Estrogen receptor alpha (ERα) and beta (ERβ) nuclear receptors
Q32. Anti-Mullerian hormone (AMH) levels are clinically used to assess:
- Adrenal androgen excess
- Ovarian reserve
- Testicular DHT production
- Hypothalamic GnRH secretion
Correct Answer: Ovarian reserve
Q33. Which medication is an estrogen receptor antagonist used in advanced ER-positive breast cancer?
- Fulvestrant
- Clomiphene citrate
- Medroxyprogesterone
- Raloxifene
Correct Answer: Fulvestrant
Q34. A low testosterone with low LH and low FSH suggests:
- Primary testicular failure
- Secondary (central) hypogonadism due to pituitary/hypothalamic dysfunction
- Androgen insensitivity
- Normal aging only
Correct Answer: Secondary (central) hypogonadism due to pituitary/hypothalamic dysfunction
Q35. Which class of drugs increases sex hormone-binding globulin (SHBG) and can lower free testosterone?
- Androgenic anabolic steroids
- Estrogens combined oral contraceptives
- Aromatase inhibitors
- GnRH antagonists
Correct Answer: Estrogens combined oral contraceptives
Q36. Tamoxifen acts as an estrogen antagonist in breast but agonist in bone by virtue of:
- Inhibiting aromatase
- Being a selective estrogen receptor modulator (SERM)
- Increasing estrogen metabolism
- Blocking estrogen synthesis in ovaries
Correct Answer: Being a selective estrogen receptor modulator (SERM)
Q37. Which of the following is an adverse effect of long-term androgen deprivation therapy in men?
- Increased bone mineral density
- Gynecomastia and osteoporosis
- Decreased cardiovascular risk
- Enhanced libido
Correct Answer: Gynecomastia and osteoporosis
Q38. In a patient with virilization and rapidly elevated serum testosterone, the most likely source is:
- Adrenal or ovarian tumor
- Cushing disease
- Hypothyroidism
- Prolactinoma
Correct Answer: Adrenal or ovarian tumor
Q39. Which laboratory finding is typical in androgen-secreting ovarian tumor?
- Markedly elevated estriol
- Markedly elevated testosterone
- Low androstenedione
- High SHBG
Correct Answer: Markedly elevated testosterone
Q40. Mifepristone exerts its antiglucocorticoid and antiprogestin effects by:
- Acting as a progesterone receptor antagonist
- Increasing progesterone synthesis
- Stimulating estrogen receptors
- Inhibiting 5-alpha reductase
Correct Answer: Acting as a progesterone receptor antagonist
Q41. Which laboratory test differentiates central precocious puberty from peripheral precocious puberty?
- Basal LH and GnRH-stimulated LH response
- Serum estriol level
- Serum cortisol at midnight
- Serum prolactin only
Correct Answer: Basal LH and GnRH-stimulated LH response
Q42. Treatment of classic congenital adrenal hyperplasia (21-hydroxylase deficiency) includes:
- Glucocorticoid replacement to suppress ACTH and androgen excess
- High-dose androgens
- GnRH agonists
- Aromatase inhibitors alone
Correct Answer: Glucocorticoid replacement to suppress ACTH and androgen excess
Q43. Which drug reduces testosterone synthesis by inhibiting cytochrome P450 enzymes in testes and adrenals?
- Ketoconazole
- Clomiphene
- Leuprolide
- Raloxifene
Correct Answer: Ketoconazole
Q44. Which medication is used as part of male contraception trials due to suppression of spermatogenesis?
- Combination of androgen plus progestin
- Clomiphene monotherapy
- Aromatase inhibitor alone
- Finasteride only
Correct Answer: Combination of androgen plus progestin
Q45. The primary therapeutic aim in estrogen replacement therapy for menopausal symptoms is to:
- Increase DHT levels
- Restore estradiol to physiologic levels and relieve vasomotor symptoms
- Suppress LH secretion permanently
- Increase catecholamine synthesis
Correct Answer: Restore estradiol to physiologic levels and relieve vasomotor symptoms
Q46. Which drug is a progesterone receptor modulator used for emergency contraception?
- Ulipristal acetate
- Letrozole
- Anastrozole
- Cabergoline
Correct Answer: Ulipristal acetate
Q47. Gynecomastia in adolescent males is most often due to:
- Physiologic transient imbalance between estrogens and androgens
- Permanent androgen deficiency
- Excess aldosterone
- Excess thyroid hormone
Correct Answer: Physiologic transient imbalance between estrogens and androgens
Q48. Which diagnostic imaging is most useful to evaluate an adrenal tumor secreting androgens?
- Transvaginal ultrasound
- Adrenal CT scan
- Mammography
- DEXA scan
Correct Answer: Adrenal CT scan
Q49. Which medication is used to treat testosterone-driven metastatic prostate cancer by blocking androgen receptor signaling?
- Metformin
- Enzalutamide
- Letrozole
- Clomiphene citrate
Correct Answer: Enzalutamide
Q50. In women with PCOS desiring pregnancy, the first-line pharmacologic agent for ovulation induction is typically:
- Metformin alone
- Letrozole
- Combined oral contraceptive pill
- Spironolactone
Correct Answer: Letrozole
