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

Morning Quiz 129 ☕️

Author

Dr. Shoaib Ahmad Baig
June 15, 2025

Morning Quiz ☕️ 

A 40-year-old man presents to the office with complaints of:

  • Erectile dysfunction

  • Loss of libido

Relevant History

  • Previously treated for Hodgkin lymphoma with chemotherapy.

Physical Examination Findings

  • Normal exam except for small testes.

Laboratory Evaluation

  • Consistently low total and free early morning testosterone levels.

  • Elevated serum LH (luteinizing hormone).

Management

  • Transdermal testosterone therapy is prescribed.

Question

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

Answer Choices

  • A. ECG

  • B. Hematocrit 

  • C. Serum cortisol

  • D. Serum creatinine

  • E. Serum TSH and thyroxine

Correct Answer 🎯:B. Hematocrit 

⚙️

Testosterone patch/gel/IM

⬇

Aromatized to dihydrotestosterone (DHT) in tissues

⬇

Trophic effect on prostate → ↑ PSA

⬇

Monitor PSA before and during therapy

⚙ Testosterone ⛓ suppresses hepcidin

⬇

↑ Iron absorption from gut → ↑ RBC synthesis

⬇

↑ Hematocrit

⬇

🧠 Erythrocytosis

⬇

↑ Risk of thromboembolism

⬇

Monitor Hematocrit

Differential Table ⚖️

Differential ⚖️

Mechanism ⚙️

Why Incorrect? 🔴

Secondary Hypogonadism

Pituitary/Hypothalamus ↓ GnRH → ↓ LH → ↓ T

LH is ↑ here → not central cause

Hyperprolactinemia🧪

↑ Prolactin GnRH → ↓ LH → ↓ T

LH is elevated, not suppressed

Androgen Insensitivity

Normal T 🧪 → defective receptor → no feedback = ↑ LH

These patients look phenotypically female, not applicable

Klinefelter (XXY)

Dysgenesis 🏚 → ↓ T & inhibin → ↑ LH/FSH

Possible, but unlikely at 40y with prior sexual function & no gynecomastia

Practice Questions ⏳️ 

Stay Hungry, Stay Curious!

Your Brother in This Struggle

Dr. Shoaib Ahmad