Androgens and anabolic steroids US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Androgens and anabolic steroids. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Androgens and anabolic steroids US Medical PG Question 1: A researcher is investigating whether there is an association between the use of social media in teenagers and bipolar disorder. In order to study this potential relationship, she collects data from people who have bipolar disorder and matched controls without the disorder. She then asks how much on average these individuals used social media in the 3 years prior to their diagnosis. This continuous data is divided into 2 groups: those who used more than 2 hours per day and those who used less than 2 hours per day. She finds that out of 1000 subjects, 500 had bipolar disorder of which 300 used social media more than 2 hours per day. She also finds that 400 subjects who did not have the disorder also did not use social media more than 2 hours per day. Which of the following is the odds ratio for development of bipolar disorder after being exposed to more social media?
- A. 1.5
- B. 6 (Correct Answer)
- C. 0.17
- D. 0.67
Androgens and anabolic steroids Explanation: ***6***
- To calculate the odds ratio, we first construct a 2x2 table [1]:
- Bipolar Disorder (Cases): 500
- No Bipolar Disorder (Controls): 500 (1000 total subjects - 500 cases)
- Cases exposed to more social media (>2 hrs/day): 300
- Cases not exposed to more social media (≤2 hrs/day): 200 (500 - 300)
- Controls not exposed to more social media (≤2 hrs/day): 400
- Controls exposed to more social media (>2 hrs/day): 100 (500 - 400)
- The odds ratio (OR) is calculated as (odds of exposure in cases) / (odds of exposure in controls) = (300/200) / (100/400) = 1.5 / 0.25 = **6** [1].
*1.5*
- This value represents the **odds of exposure** (more than 2 hours of social media) in individuals with bipolar disorder (300 cases exposed / 200 cases unexposed = 1.5).
- It is not the odds ratio, which compares these odds to the odds of exposure in the control group.
*0.17*
- This value is close to the reciprocal of 6 (1/6 ≈ 0.166), suggesting a potential miscalculation or an inverted odds ratio.
- An odds ratio of 0.17 would imply a protective effect (lower odds of bipolar disorder with more social media), which is contrary to the calculation and typical interpretation in this context.
*0.67*
- This value is the reciprocal of 1.5 (1/1.5 ≈ 0.67) which represents the odds of *not* being exposed in cases (200/300).
- It does not represent the correct odds ratio, which compares the odds of exposure in cases to the odds of exposure in controls.
Androgens and anabolic steroids US Medical PG Question 2: A 19-year-old South Asian male presents to the family physician concerned that he is beginning to go bald. He is especially troubled because his father and grandfather "went completely bald by the age of 25," and he is willing to try anything to prevent his hair loss. The family physician prescribes a medication that prevents the conversion of testosterone to dihydrotestosterone. Which of the following enzymes is inhibited by this medication?
- A. Cyclooxygenase 2
- B. Desmolase
- C. Aromatase
- D. cGMP phosphodiesterase
- E. 5-alpha-reductase (Correct Answer)
Androgens and anabolic steroids Explanation: ***5-alpha-reductase***
- The medication described inhibits the conversion of **testosterone to dihydrotestosterone (DHT)**, which is catalyzed by the enzyme **5-alpha-reductase**.
- **Androgenetic alopecia** (male pattern baldness) is driven by DHT, and inhibiting this enzyme reduces DHT levels in the scalp, thereby slowing hair loss.
*Cyclooxygenase 2*
- **Cyclooxygenase 2 (COX-2)** is involved in the synthesis of **prostaglandins** from arachidonic acid, mediating inflammation and pain.
- COX-2 inhibitors are used as anti-inflammatory drugs (e.g., celecoxib), not for male pattern baldness.
*Desmolase*
- **Cholesterol desmolase** (CYP11A1) is an enzyme that catalyzes the first committed step in **steroidogenesis**, converting cholesterol to pregnenolone.
- Inhibition of desmolase would affect the synthesis of all steroid hormones, not specifically target the conversion of testosterone to DHT for hair loss treatment.
*Aromatase*
- **Aromatase** is an enzyme responsible for converting androgens (like testosterone) into **estrogens**.
- Aromatase inhibitors are used in the treatment of estrogen-receptor positive breast cancer, not male pattern baldness.
*cGMP phosphodiesterase*
- **cGMP phosphodiesterase (PDE5)** is an enzyme that breaks down cyclic GMP (cGMP), which is involved in smooth muscle relaxation.
- PDE5 inhibitors (e.g., sildenafil) are used to treat **erectile dysfunction** and **pulmonary hypertension**, not hair loss.
Androgens and anabolic steroids US Medical PG Question 3: A 57-year-old presents to your clinic complaining of baldness. He is overweight, has been diagnosed with BPH, and is currently taking atorvastatin for hyperlipidemia. The patient has tried several over-the-counter products for hair-loss; however, none have been effective. After discussing several options, the patient is prescribed a medication to treat his baldness that has the additional benefit of treating symptoms of BPH as well. Synthesis of which of the following compounds would be expected to decrease in response to this therapy?
- A. Testosterone
- B. FSH
- C. LH
- D. GnRH
- E. DHT (Correct Answer)
Androgens and anabolic steroids Explanation: ***DHT***
- The medication described is likely **finasteride**, a **5-alpha-reductase inhibitor**. This enzyme converts **testosterone** to **dihydrotestosterone (DHT)**.
- Decreased DHT levels are beneficial for treating both **androgenetic alopecia (baldness)** and **benign prostatic hyperplasia (BPH)** due to its potent androgenic effects on hair follicles and prostate growth.
*Testosterone*
- While finasteride inhibits the conversion of testosterone to DHT, it does not directly decrease testosterone synthesis. In fact, **testosterone levels may slightly increase** as its conversion to DHT is blocked.
- Testosterone itself is not the primary androgen responsible for male pattern baldness or BPH; it's its more potent metabolite, DHT.
*FSH*
- **Follicle-stimulating hormone (FSH)** is a gonadotropin released from the anterior pituitary that stimulates sperm production and ovarian follicle development.
- The medication prescribed does not directly affect FSH synthesis or release; its action is peripheral, affecting androgen metabolism.
*LH*
- **Luteinizing hormone (LH)** is another gonadotropin that stimulates testosterone production in Leydig cells.
- The drug's mechanism of action is local inhibition of an enzyme, not a central regulation of pituitary hormones like LH.
*GnRH*
- **Gonadotropin-releasing hormone (GnRH)** is released from the hypothalamus and stimulates the anterior pituitary to release FSH and LH.
- This therapy specifically targets the conversion of an androgen and does not impact the hypothalamic-pituitary-gonadal axis at the level of GnRH.
Androgens and anabolic steroids US Medical PG Question 4: A 31-year-old woman makes an appointment with a fertility specialist because she has not been able to conceive despite trying for over a year with her husband. She is concerned because her husband has 2 children from a previous marriage whereas she has no children. After obtaining a detailed history as well as lab tests, the specialist prescribes a certain drug. Interestingly, this drug is able to stimulate receptors in the presence of low hormone levels and inhibit the same receptors in the presence of high hormone levels. The drug that is most likely being prescribed in this case is associated with which of the following adverse events?
- A. Hirsutism
- B. Deep venous thrombosis
- C. Thrombophilia
- D. Osteoporosis
- E. Visual disturbances (Correct Answer)
Androgens and anabolic steroids Explanation: ***Visual disturbances***
- The description of the drug activating receptors in low hormone states and inhibiting them in high hormone states, coupled with its use for infertility, strongly suggests **clomiphene citrate**, a selective estrogen receptor modulator (SERM).
- **Visual disturbances** such as blurred vision, scotomas, or photopsia are a relatively common adverse effect of clomiphene due to its effect on estrogen receptors in the retina.
*Hirsutism*
- **Hirsutism** (excessive hair growth) is typically associated with conditions causing androgen excess, like **polycystic ovary syndrome (PCOS)**, and is not a direct common adverse effect of clomiphene.
- While clomiphene aims to induce ovulation, it does not directly cause an increase in androgens leading to hirsutism.
*Deep venous thrombosis*
- Although some hormonal treatments can increase the risk of **DVT**, clomiphene's association with DVT is **not as primary or common** as other adverse effects, and it's less direct compared to estrogen-containing medications.
- The mechanism of action of clomiphene as a SERM modulating estrogen receptors does not typically lead to a significant procoagulant state comparable to exogenous estrogen.
*Thrombophilia*
- **Thrombophilia** refers to an increased tendency to form blood clots; while some hormonal medications can exacerbate thrombophilia, clomiphene is **not generally recognized** for causing thrombophilia or significantly increasing its risk.
- Its mechanism of action primarily involves stimulating gonadotropin release rather than directly altering coagulation factors to induce thrombophilia.
*Osteoporosis*
- While **estrogen deficiency** can lead to osteoporosis, clomiphene's role is to modulate estrogen receptors; it can cause some anti-estrogenic effects, but **osteoporosis is not a common acute or direct adverse event** of its short-term use for fertility.
- Long-term use of anti-estrogenic drugs like tamoxifen can increase osteoporosis risk, but clomiphene is typically used for a limited duration, making osteoporosis less relevant as an immediate adverse event.
Androgens and anabolic steroids US Medical PG Question 5: A 27-year-old woman comes to the physician for the evaluation of infertility. She has been unable to conceive for the past 2 years. Menses occur at 45 to 80-day intervals. She is 168 cm (5 ft 6 in) tall and weighs 77 kg (170 lb); BMI is 27.4 kg/m2. Physical examination shows facial acne and pigmented hair on the upper lip. Serum studies show elevated levels of testosterone and an LH:FSH ratio of 4:1. Treatment with the appropriate drug for this patient's infertility is begun. Which of the following is the primary mechanism of action of this drug?
- A. Activation of pituitary dopamine receptors
- B. Activation of granulosa cell aromatase
- C. Activation of ovarian luteinizing hormone receptors
- D. Inhibition of hypothalamic estrogen receptors (Correct Answer)
- E. Inhibition of endometrial progesterone receptors
Androgens and anabolic steroids Explanation: ***Inhibition of hypothalamic estrogen receptors***
- The patient presents with classic symptoms of **polycystic ovarian syndrome (PCOS)**, including **oligomenorrhea** (menses every 45-80 days), **hirsutism**, **acne**, **elevated BMI**, **elevated testosterone**, and an **elevated LH:FSH ratio (4:1)**.
- **Clomiphene citrate** is the first-line drug for ovulation induction in PCOS patients with infertility.
- Clomiphene is a **selective estrogen receptor modulator (SERM)** that acts as a **competitive antagonist at estrogen receptors in the hypothalamus**.
- By blocking estrogen receptors, clomiphene prevents normal **negative feedback inhibition** of GnRH release.
- This results in increased **GnRH pulsatility**, leading to increased **FSH and LH secretion** from the anterior pituitary, which promotes **follicular development and ovulation**.
*Activation of pituitary dopamine receptors*
- This mechanism is characteristic of **dopamine agonists** (e.g., **bromocriptine**, **cabergoline**), which are used to treat infertility due to **hyperprolactinemia**.
- These agents activate D2 receptors in lactotroph cells, inhibiting prolactin secretion.
- The patient shows no signs of hyperprolactinemia (e.g., galactorrhea, amenorrhea from elevated prolactin).
*Activation of granulosa cell aromatase*
- Aromatase converts androgens to estrogens in granulosa cells.
- While aromatase activity is important in follicular development, **activating aromatase is not a mechanism of any standard ovulation-inducing drug**.
- In PCOS, there is often relative aromatase insufficiency, but drugs do not directly activate this enzyme for fertility treatment.
*Activation of ovarian luteinizing hormone receptors*
- While **exogenous LH or hCG** (which acts on LH receptors) may be used in assisted reproductive technology, this is not the mechanism of **first-line ovulation induction** in PCOS.
- Clomiphene works by increasing endogenous LH/FSH release, not by directly activating ovarian receptors.
*Inhibition of endometrial progesterone receptors*
- This is the mechanism of **mifepristone** (RU-486), an antiprogestin used for medical abortion and occasionally for **endometriosis** or **uterine fibroids**.
- Inhibiting progesterone receptors would **prevent implantation** or disrupt pregnancy, which is opposite to the goal of fertility treatment.
Androgens and anabolic steroids US Medical PG Question 6: A 69-year-old man comes to the physician because of a 3-month history of urinary urgency, nocturia, and progressive pain in his lower back. The pain is worse at night and does not respond to ibuprofen. Rectal examination shows an enlarged, asymmetric prostate with a nodular surface. Prostate-specific antigen concentration is 11 ng/ml (N < 4). A biopsy of the prostate shows a high-grade adenocarcinoma. A CT scan of the pelvis shows multiple osteoblastic lesions of the lumbar spine. The patient is started on a drug that competes with androgens for interaction with the testosterone receptors. Treatment with which of the following drugs was most likely initiated in this patient?
- A. Docetaxel
- B. Flutamide (Correct Answer)
- C. Finasteride
- D. Degarelix
- E. Leuprolide
Androgens and anabolic steroids Explanation: ***Flutamide***
- The patient has **metastatic prostate cancer** with osteoblastic lesions, indicating a need for **androgen-deprivation therapy**. Flutamide is an **androgen receptor antagonist** that competes with androgens for binding to testosterone receptors.
- It is often used in combination with **GnRH agonists** (like leuprolide) to prevent **tumor flare** caused by the initial surge in testosterone, or as monotherapy in some cases.
*Docetaxel*
- **Docetaxel** is a **chemotherapeutic agent** (a taxane) used primarily for patients with **castration-resistant prostate cancer** or when hormonal therapies are no longer effective.
- It works by stabilizing microtubules, preventing cell division, and does not compete with androgens for testosterone receptors.
*Finasteride*
- **Finasteride** is a **5-alpha reductase inhibitor** that blocks the conversion of testosterone to **dihydrotestosterone (DHT)**, which is the more potent androgen in the prostate.
- It is used for **benign prostatic hyperplasia (BPH)** and **androgenic alopecia**, but not typically for metastatic prostate cancer as the primary treatment mechanism described.
*Degarelix*
- **Degarelix** is a **GnRH receptor antagonist** that directly suppresses the release of LH and FSH, leading to a rapid and sustained reduction in testosterone levels without an initial flare.
- While it causes androgen deprivation, it does not directly compete with androgens for binding to the testosterone receptors on cancer cells; its action is upstream.
*Leuprolide*
- **Leuprolide** is a **GnRH agonist** that initially causes a surge in LH and FSH, followed by downregulation and desensitization of the GnRH receptors, leading to reduced testosterone production.
- Like degarelix, it causes androgen deprivation, but it does not directly compete with androgens at the receptor level; its action is also upstream.
Androgens and anabolic steroids US Medical PG Question 7: A 5-year-old male visits his pediatrician for a check-up. His height corresponds to the 99th percentile for his age, and pubic hair is present upon physical examination. Serum renin and potassium levels are high, as is 17-hydroxyprogesterone. Which of the following is likely deficient in this patient?
- A. 11ß-hydroxylase
- B. 21-hydroxylase (Correct Answer)
- C. Aromatase
- D. 5a-reductase
- E. 17a-hydroxylase
Androgens and anabolic steroids Explanation: ***21-hydroxylase***
- A deficiency in **21-hydroxylase** leads to the accumulation of **17-hydroxyprogesterone**, as conversion to 11-deoxycorticosterone and 11-deoxycortisol is blocked, which aligns with the high levels observed in the patient.
- The shunting of precursors towards **androgen synthesis** due to the block explains the **precocious puberty** (pubic hair, advanced height for age).
- **Mineralocorticoid deficiency** (low aldosterone) causes **salt-wasting** with sodium loss and potassium retention (hyperkalemia), which stimulates compensatory **renin elevation**, explaining the high renin and potassium levels.
*11ß-hydroxylase*
- A deficiency would cause an accumulation of **11-deoxycorticosterone** and **11-deoxycortisol**, not primarily 17-hydroxyprogesterone.
- This deficiency typically presents with **hypertension** and **virilization** due to elevated 11-deoxycorticosterone (has mineralocorticoid activity) and androgens, but mineralocorticoid excess would **suppress renin**, which contradicts the high renin observed.
*Aromatase*
- **Aromatase** is responsible for converting androgens to estrogens. Its deficiency in males would typically result in **tall stature** due to delayed epiphyseal fusion but would not cause precocious puberty or the specific hormonal imbalance seen (high 17-hydroxyprogesterone, high renin/potassium).
- The absence of estrogen conversion would lead to **continued growth** and delayed bone maturation rather than early virilization with adrenal androgen excess.
*5a-reductase*
- **5a-reductase** converts testosterone to the more potent dihydrotestosterone (DHT). A deficiency in males would cause **undervirilization** at birth (ambiguous genitalia) and incomplete masculinization at puberty.
- This scenario contradicts the observed signs of **precocious puberty** and virilization in a 5-year-old male.
*17a-hydroxylase*
- A **17a-hydroxylase deficiency** would block the synthesis of cortisol and sex steroids, leading to increased production of mineralocorticoids like **corticosterone** and **11-deoxycorticosterone**.
- This typically results in **hypertension**, **hypokalemia** (mineralocorticoid excess), and **absent or delayed puberty** (lack of sex steroids), which are contrary to the symptoms presented in this patient (high potassium, precocious puberty).
Androgens and anabolic steroids US Medical PG Question 8: A 56-year-old homeless male presents to a free clinic for a health evaluation. He states that he has not seen a physician in over 25 years but finally decided to seek medical attention after he noticed recent chronic fatigue and weight gain. Upon questioning, he endorses drinking 2 handles of whiskey per day. On exam, the physician observes the findings shown in Figures A-D. Which of the following findings would also be expected to be observed in this patient?
- A. Microcytic anemia
- B. 4-hertz hand tremor
- C. Direct hyperbilirubinemia
- D. Nystagmus
- E. Testicular atrophy (Correct Answer)
Androgens and anabolic steroids Explanation: ***Testicular atrophy***
- The image shows **caput medusae**, a sign of severe **portal hypertension** due to **cirrhosis**, likely from chronic alcohol abuse. Testicular atrophy is a common finding in alcoholic cirrhosis due to **impaired liver metabolism of estrogens**, leading to hyperestrogenism and hypogonadism.
- **Malnutrition** and **direct toxic effects of alcohol** on the testes also contribute to atrophy.
*Microcytic anemia*
- **Chronic alcohol abuse** typically causes **macrocytic anemia** (due to folate deficiency) or occasionally normocytic anemia, not microcytic anemia.
- Microcytic anemia is usually associated with **iron deficiency**, **thalassemia**, or **sideroblastic anemia**.
*4-hertz hand tremor*
- A **4-6 Hz "action" tremor** is characteristic of **essential tremor**, while **alcohol withdrawal** can cause a coarse, rapid tremor.
- Tremors associated with chronic liver disease are typically **asterixis** (flapping tremor), which is an irregular, high-amplitude tremor, not a 4-hertz hand tremor.
*Direct hyperbilirubinemia*
- **Cirrhosis** can lead to hyperbilirubinemia, but it's typically **mixed hyperbilirubinemia** (both direct and indirect) or predominantly indirect in early stages.
- Predominant **direct hyperbilirubinemia** is usually seen in **biliary obstruction** or **cholestatic liver diseases**, which are not directly implied by the presentation of alcoholic cirrhosis.
*Nystagmus*
- **Nystagmus** is often associated with **Wernicke encephalopathy**, a complication of severe **thiamine deficiency** often seen in chronic alcoholics.
- While possible, it is a specific neurological finding, whereas **testicular atrophy** is a more systemic and direct consequence of hormonal imbalances in advanced liver disease.
Androgens and anabolic steroids US Medical PG Question 9: A 59-year-old man comes to the physician because of a 3-month history of frequent urination. He has to urinate every 1–2 hours during the day and wakes up at least 2–3 times at night to urinate. He also reports that over the last 2 months, he has difficulty initiating micturition and the urinary stream is weak, with prolonged terminal dribbling. His pulse is 72/min, and blood pressure is 158/105 mm Hg. Rectal exam shows a smooth, symmetrically enlarged prostate without any tenderness or irregularities. Prostate-specific antigen is within the reference range and urinalysis shows no abnormalities. A postvoid ultrasound shows a residual bladder volume of 110 mL. Which of the following is the most appropriate next step in management?
- A. Transurethral resection of the prostate
- B. Terazosin therapy (Correct Answer)
- C. Bladder catheterization
- D. Finasteride therapy
- E. Cystoscopy
Androgens and anabolic steroids Explanation: ***Terazosin therapy***
- Terazosin is an **alpha-1 adrenergic antagonist** that blocks receptors in the prostate and bladder neck, causing relaxation of the smooth muscle and improving urinary flow. This is a first-line medical treatment for symptomatic **benign prostatic hyperplasia (BPH)**.
- The patient presents with **obstructive and irritative lower urinary tract symptoms (LUTS)**, a symmetrically enlarged prostate, and a postvoid residual volume that indicates bladder outlet obstruction, all consistent with BPH.
- Alpha-blockers provide **rapid symptom relief** (within days to weeks) and may also help with the patient's **elevated blood pressure** (158/105 mm Hg).
*Transurethral resection of the prostate*
- **Transurethral resection of the prostate (TURP)** is a surgical intervention reserved for patients with severe BPH symptoms refractory to medical therapy or those with complications like recurrent urinary retention or renal dysfunction.
- Given that the patient has not yet tried medical therapy, and his symptoms are not immediately life-threatening, surgery is not the most appropriate first step.
*Bladder catheterization*
- **Bladder catheterization** is indicated for acute urinary retention or in cases of severe bladder obstruction leading to renal impairment.
- While the patient has significant LUTS and a postvoid residual volume, he is not in acute urinary retention, so immediate catheterization is not necessary as a long-term management strategy.
*Finasteride therapy*
- **Finasteride** is a **5-alpha reductase inhibitor** that reduces prostate size by inhibiting the conversion of testosterone to dihydrotestosterone. It is more effective in patients with larger prostate volumes and takes several months to show its full effect.
- Though a valid treatment for BPH, alpha-blockers like terazosin provide faster symptomatic relief by addressing dynamic obstruction and are generally preferred as initial therapy, often in combination with 5-alpha reductase inhibitors for larger prostates.
*Cystoscopy*
- **Cystoscopy** is an invasive procedure used to visualize the bladder and urethra directly. It is typically reserved for cases where there is suspicion of other pathologies like bladder stones, strictures, or bladder cancer, or for preoperative planning.
- The patient's symptoms and examination findings are consistent with BPH, and his PSA is normal, so primary cystoscopy is not indicated as the next step in management.
Androgens and anabolic steroids US Medical PG Question 10: A 50-year-old woman comes to the physician for the evaluation of excessive hair growth on her chin over the past 2 weeks. She also reports progressive enlargement of her gums. Three months ago, she underwent a liver transplantation due to Wilson disease. Following the procedure, the patient was started on transplant rejection prophylaxis. She has a history of poorly-controlled type 2 diabetes mellitus. Temperature is 37°C (98.6°F), pulse is 80/min, respirations are 22/min, and blood pressure is 150/80 mm Hg. Physical examination shows dark-pigmented, coarse hair on the chin, upper lip, and chest. The gingiva and the labial mucosa are swollen. There is a well-healed scar on her right lower abdomen. Which of the following drugs is the most likely cause of this patient's findings?
- A. Daclizumab
- B. Cyclosporine (Correct Answer)
- C. Sirolimus
- D. Methotrexate
- E. Tacrolimus
Androgens and anabolic steroids Explanation: **Cyclosporine**
* This patient's **combination of hirsutism** (excessive hair growth) **and gingival hyperplasia** (gum enlargement) is the classic presentation of cyclosporine toxicity, an immunosuppressant commonly used for transplant rejection prophylaxis.
* Cyclosporine is a **calcineurin inhibitor** that prevents T-cell activation and is highly effective in preventing graft rejection.
* The **simultaneous presence of both hirsutism and prominent gingival hyperplasia** is particularly characteristic of cyclosporine.
*Daclizumab*
* **Daclizumab** is a **monoclonal antibody** targeting the IL-2 receptor, which was previously used for transplant prophylaxis but has been discontinued for this indication.
* It is not associated with hirsutism or gingival hyperplasia.
*Sirolimus*
* **Sirolimus** is an **mTOR inhibitor** used as an immunosuppressant, known for side effects like hyperlipidemia, myelosuppression, and delayed wound healing.
* It does **not** typically cause hirsutism or gingival hyperplasia.
*Methotrexate*
* **Methotrexate** is an **antimetabolite** and immunosuppressant commonly used in autoimmune diseases and cancer, with side effects including bone marrow suppression, mucositis, and liver toxicity.
* Hirsutism and gingival hyperplasia are **not** characteristic side effects of methotrexate.
*Tacrolimus*
* **Tacrolimus** is another **calcineurin inhibitor**, similar to cyclosporine, but with a different side effect profile. While tacrolimus can cause hirsutism, **gingival hyperplasia is significantly less common** with tacrolimus compared to cyclosporine.
* The **presence of prominent gingival hyperplasia alongside hirsutism strongly favors cyclosporine** over tacrolimus.
* Tacrolimus is more commonly associated with **neurotoxicity** (e.g., tremor) and **nephrotoxicity**.
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