Morning Quiz ☕️ 

A 40-year-old man presents with:

• Erectile dysfunction

• Loss of libido

Relevant History:

• Treated for Hodgkin lymphoma with chemotherapy in the past.

Physical Examination Findings:

• Small testes (otherwise normal exam).

Laboratory Findings:

• Low total and free testosterone (early morning levels).

• Elevated LH.

Diagnosis:

• Primary hypogonadism

Treatment Initiated:

• Transdermal testosterone therapy.

Question:

Which of the following should be periodically monitored during this patient's treatment?

Options:
A. ECG
B. Hematocrit
C. Serum cortisol
D. Serum creatinine
E. Serum TSH and thyroxine

Correct Answer 🎯: B. Hematocrit

⚙️

Chemotherapy (cytotoxic agents)

⬇

Testicular germ cell + Leydig cell damage

⬇

Impaired testosterone synthesis

⬇

↓ Serum testosterone levels

⬇

Loss of negative feedback on hypothalamus and pituitary

⬇

↑ LH secretion

⬇

Small testes (atrophy due to loss of germ cell activity)

⬇

Clinical features: Erectile dysfunction + Loss of libido (due to ↓ testosterone)

Treatment Effect and Need for Monitoring:

Transdermal testosterone therapy

⬇

Stimulates erythropoiesis (via testosterone acting on erythroid progenitor cells)

⬇

↑ Hematocrit levels

⬇

Risk of polycythemia (hyperviscosity, thrombosis risk)

⬇

Need to periodically monitor Hematocrit 

Differential Table ⚖️

Practice Questions ⏳️ 

Stay Hungry, Stay Curious!

Your Brother in This Struggle

Dr. Shoaib Ahmad