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The long-term use of TRT has not been extensively studied. Nevertheless if ulceration was present, biopsy would be imperative to exclude malignant change. Since the onset of DILI varies broadly ranging from asymptomatic hypertransaminasemia to acute liver failure, the clinicians must follow a careful liver toxicity assessment, taking into account several important factors, such as a history of the suspected drug, time to DILI clinical onset, and preexisting liver diseases, in order to confidently rule out other diagnostic possibilities.

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