Episode 227 -- April 2025 -- Part 1 AFP: American Family Physician

Summary

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Podcast Summary: AFP: American Family Physician Podcast

Episode 227 – April 2025 – Part 1
Date: April 16, 2025
Contributors: Dr. Steven Brown, Dr. Valeria Vasquez, Dr. Satyam Patel

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Episode Overview

In this episode, the AFP Podcast team from the University of Arizona College of Medicine-Phoenix Family Medicine Residency reviews the April 2025 issue of American Family Physician. They deliver high-yield clinical updates on: labor management, acute migraine treatment, tirzepatide for sleep apnea, options for unintended pregnancies, the evolving role of artificial intelligence scribes, and testosterone replacement in men with sexual dysfunction.

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Key Discussion Points

1. Labor Management – New ACOG Guidelines

[00:34–04:02]

• Guideline Source: American College of Obstetrics and Gynecology, summarized by Dr. Hwang and Banks, with a commentary by Dr. Arnold
• Trustworthiness: “This guideline gets 7 out of 8 yes answers on the G Trust Scorecard, so that’s pretty good.” (Steve Brown, 01:57)
• Labor Stages:
  • First Stage:
    • Latent phase: Regular, painful contractions, dilation <6 cm
    • Active phase: Begins at 6 cm dilation
    • Active phase arrest: No dilation after 4 hours with adequate contractions or 6 hours of oxytocin
    • Avoid cesarean for latent phase arrest
  • Second Stage:
    • Starts at 10 cm to delivery
    • Prolonged: >3 hours pushing for nulliparous, >2 hours for multiparous
• Interventions & Recommendations:
  • Neuraxial analgesia (epidural) can be used at any labor stage
  • Early amniotomy shortens labor time with no increase in C-section rates
  • Continuous one-on-one support and upright maternal positions (e.g., sitting or kneeling, "peanut ball") improve outcomes and reduce C-sections
  • In second stage, immediate pushing is preferred to “laboring down”
• Quote:

  "Upright maternal positions like sitting or kneeling may reduce the duration of the first stage of labor and decreases cesarean delivery rates."
  (Steve Brown, 03:38)

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2. Acute Migraine Headache Treatment

[04:04–08:25]

• Prevalence:
  • “Migraines affect about 15% of the population, with women being disproportionately affected.” (Valeria Vasquez, 04:14)
• Diagnosis Tools:
  • POUND mnemonic: Pulsatile, One-day, Unilateral, Nausea, Disability
    • Three or more = likely migraine; four or five = very high specificity (PLR 24)
  • SNOOP10 mnemonic to rule out secondary causes
• Severity Assessment:
  • MIDAS questionnaire for stratified management
• Treatment Algorithm:
  • Mild migraines (MIDAS 1–2): NSAIDs, simple analgesics
  • Moderate–Severe (MIDAS 3–4):
    • First line: Triptans
    • Second line: Gepants (ubrogepant, rimegepant—good for CV risk but costly), Ditans (lasmiditan—sedation risk, driving restriction)
    • Parenteral options: For refractory cases (IV dihydroergotamine, ketorolac)
• Special Populations:
  • Children: Start with lifestyle and simple analgesics; triptans if >6 years
  • Older adults: Be cautious with NSAIDs/triptans; consider gepants/ditans
  • Pregnant patients: Acetaminophen with caffeine preferred; triptans only if benefits outweigh risks; avoid in 1st trimester; no gepants/ditans
• Additional Approaches:
  • Neuromodulation (FDA-approved devices), occipital nerve blocks
  • Lifestyle: Triggers to avoid (odors, smoke), improve sleep
• Quote:

  "About one third of patients don’t respond well to their first triptan, so it’s crucial to try a different one if necessary."
  (Valeria Vasquez, 06:07)

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3. Tirzepatide for Obstructive Sleep Apnea

[08:25–10:46]

• Clinical Question: Is tirzepatide (Zepbound) effective for OSA?
• Key Study Data:
  • Phase 3 RCTs in adults with moderate–severe OSA, with and without PAP therapy
  • Outcome:
    • Reduction in apnea-hypopnea index (AHI) by ~20 points
    • Average 16–17% weight loss in obese patients
  • Effectiveness: Significant improvement only in patients with obesity, not in those with diabetes
• Quote:

  "Tirzepatide seems to work by addressing one of the root causes of obstructive sleep apnea, obesity."
  (Satyam Patel, 10:07)

• Takeaway: Tirzepatide is a valuable adjunct for OSA management in obese patients, particularly with weight loss.

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4. Options for Unintended Pregnancy

[11:22–14:54]

• Prevalence: Still persistent issue, though overall pregnancy rates have declined 12% over 10 years
• Clinical Steps:
  • Confirm pregnancy first
  • Motivational interviewing to gauge patient goals and feelings
• All-Options Counseling:
  • Continue pregnancy (and parent)
  • Continue pregnancy (and adoption)
  • Medical or procedural abortion
• Impact of Legislation:
  • Post-Roe v. Wade, many states have enacted abortion bans
  • Telemedicine for abortion is increasing in regions with limited access
    • "For every 100 mile increase in distance to an abortion facility, there was a 60% increase in online requests for abortion medications." (Valeria Vasquez, 12:45)
• Clinical Resources:
  • Table 2 in the referenced AFP article for counseling, state law overviews
  • AAFP's Neighborhood Navigator for local support resources
• Medical Management:
  • Confirm intrauterine pregnancy (rule out ectopic)
  • Check Rh status; give Rhogam if indicated
  • Mifepristone + misoprostol increases success (92–99% effective at home in 1st trimester)
  • Procedural abortion is 99% effective; preferred in 2nd trimester
• Quote:

  "Abortion is safe, effective and it does not affect future conception or fertility."
  (Satyam Patel, 13:43)

• Role of Clinician: Stay unbiased, support patient choices, and be well-versed in all care options.

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5. Artificial Intelligence Scribes in Healthcare

[14:54–16:43]

• Current Trends:
  • 38% of physicians are now using AI in practice
  • Scribe tools offer ambient listening, note generation, coding, and order suggestions
• Key Challenges:
  • Accuracy is the chief concern; claims of 90–99% but no robust comparative studies
  • Costs: $200–400/month per user; trustworthiness and acceptance remain in question
• Resources:
  • Table comparison of 8 AI scribe vendors in the AFP article
  • Additional tips in March/April 2025 Family Practice Management (FPM)
• Quote:

  “If you start to save time with an AI scribe, don’t be tempted to schedule more patients. Consider other options to protect your well-being like going home earlier.”
  (Satyam Patel, 16:30)

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6. Testosterone Replacement for Sexual Dysfunction (without Hypogonadism)

[16:43–19:22]

• Review Source: 43 RCTs, >11,000 men, ages 40+
• Definitions: Sexual dysfunction = acquired decreased libido or erectile dysfunction—not attributed to confirmed hypogonadism
• Efficacy Endpoints: Erectile dysfunction, sexual quality of life
• Findings:
  • Short term (3–12 months): No significant difference between testosterone and placebo
  • Long term (12–24 months): Evidence is low-certainty, unclear benefit
  • Adding testosterone to PDE5 inhibitors (e.g., sildenafil) doesn't improve outcomes vs. PDE5i alone
• Concerns:
  • Nearly half the studies were pharma-funded; exclusion of patients with comorbidities/psychiatric disease limits generalizability
• Guidelines:
  • Only use testosterone therapy in those with documented hypogonadism, per AUA and Endocrine Society guidelines
• Quote:

  "In men with only sexual dysfunction without any known testosterone deficiency, there's no benefit of testosterone replacement therapy over placebo in the short term."
  (Satyam Patel, 19:04)

• Overall Recommendation:
  • "Medicine by the Numbers" rating is yellow—for uncertain benefit

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Memorable Moments & Notable Quotes

• “GLPs for everything.” (Steve Brown, 10:46)
• “Wow, that’s pretty high.” [On AI adoption in practice] (Steve Brown, 15:38)
• “Please rate and comment wherever you get your podcasts… Escúchanos en español en Revista America AFP.” (Outro, 19:34)

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Timestamps for Major Segments

• Labor Management Guidelines: 00:34–04:02
• Acute Migraine Headache: 04:04–08:25
• Tirzepatide for Sleep Apnea: 08:25–10:46
• Unintended Pregnancy Options: 11:22–14:54
• AI Scribes in Health Care: 14:54–16:43
• Testosterone Replacement in Sexual Dysfunction: 16:43–19:22

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Tone and Language

• The episode is informative, evidence-focused, and conversational, with a mix of clinical pearls, guidelines, and practical advice. The hosts frequently reference their own clinical experiences and maintain an approachable, sometimes humorous, tone throughout: “Good job on the Japants on the first take there. That was well done.” (Steve Brown, 06:32)

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Summary Takeaway

This episode of the AFP Podcast delivers concise, actionable updates on practical clinical topics—equipping family physicians with evidence-based strategies for labor and delivery, migraine, sleep apnea, reproductive options, technology in practice, and men’s health. The discussions stress shared decision-making, up-to-date practice guidelines, and the evolving digital landscape in family medicine.

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Transcript

[Podcast Host/Announcer]

The AFP podcast is brought to you by the American Academy of Family Physicians and by the AAFP's upcoming Family Centered Pregnancy Care course, happening August 25th through the 28th in Denver, Colorado. Arrive early for advanced life support obstetrics courses for providers and instructors. Register [e-mail] FCPC2025 welcome to the American.

[Steve Brown]

Family Physician Podcast for part one of the April 2025 issue. I'm Steve.

[Valeria Vasquez]

I'm Valeria.

[Satyam Patel]

I'm Sati.

[Steve Brown]

We are residents and faculty, mostly residents, from the University of Arizona College of Medicine, Phoenix Family Medicine Residency. Today on the podcast we're going to talk about labor management, acute migraine headache, tirzepatide for sleep apnea, options for unintended pregnancy, artificial intelligence scribes, and testosterone replacement in men with sexual dysfunction.

[Valeria Vasquez]

The opinions expressed in the podcast are our own and do not represent the opinions of the American Academy of Family Physicians, the editor of American Family Physician or Banner Health. Do not use this podcast for medical advice. Instead, see your own family doctor for medical care.

[Satyam Patel]

We're on a mission Delivering the Best from American Family Physician on a nation.

[Valeria Vasquez]

Delivering the Best from.

[Steve Brown]

Let'S start with a practice guideline from the American College of Obstetrics and Gynecology. This is Labor Management A new guideline. This is from Dr. Hwang and Banks from the Naval Medical Center, Camp Lejeune in North Carolina with a comment from Dr. Arnold. This guideline gets 7 out of 8 yes answers on the G Trust Scorecard, so that's pretty good. Conflict of interest is not specified.

[Valeria Vasquez]

The guideline is based on a systematic review and has clear and actionable recommendations.

[Satyam Patel]

Let's review the stages of labor. Stage one, latent phase, includes regular and painful uterine contractions with cervical dilation of less than 6cm.

[Steve Brown]

There is no accepted definition of latent phase arrest. Cesarean delivery for latent phase arrest should be avoided.

[Valeria Vasquez]

Active phase begins with 6 cm cervical dilation. Active phase arrest is defined as lack of further dilation and ruptured membranes despite 4 hours of adequate contractions or 6 hours of oxytocin with inadequate contractions.

[Satyam Patel]

The second stage starts with 10 cm of cervical dilation and ends with the delivery of the infant.

[Steve Brown]

Second stage is considered prolonged with three hours of pushing in a nulliparous patient or two hours of pushing in a multiparous patient.

[Valeria Vasquez]

Okay, now let's talk a little more about first stage management.

[Satyam Patel]

The guidelines recommend active management of the first state of labor compared to expected management to avoid prolonged labor neuraxial analgesia.

[Steve Brown]

Like an Epidural can be offered at any stage of labor.

[Valeria Vasquez]

Early amniotomy is recommended. It decreases total time and labor without increasing C section risk.

[Satyam Patel]

The continuous presence of a person for one on one emotional support improves outcomes and should be integrated into practice systems.

[Steve Brown]

Upright maternal positions like sitting or kneeling may reduce the duration of the first stage of labor and decreases cesarean delivery rates. Maybe you could try a peanut ball.

[Valeria Vasquez]

Yes. And in the second stage of labor, immediate pushing is safe and recommended, not laboring down.

[Satyam Patel]

Helpful tips here for pregnancy care from A G Trust approved guideline.

[Valeria Vasquez]

Yes.

[Steve Brown]

Okay, let's talk about acute migraine headache treatment strategies from Drs. Wiley, Watson and Lehman from Iowa and Nebraska.

[Valeria Vasquez]

Migraines affect about 15% of the population, with women being disproportionately affected.

[Satyam Patel]

The question is, how do we diagnose and treat it effectively?

[Valeria Vasquez]

That is a question, and one helpful tool we use is the pound mnemonic. P for pulsatile quality, O for one day duration from 4 to 72 hours, U for unilateral location, N for nausea, and D for disability. If a patient has at least three of those symptoms, it's a good sign. It's a migraine.

[Steve Brown]

Yeah. And four or five positives on the pound mnemonic. The positive likelihood ratio is 24. Basically, you're done. It's a migraine.

[Satyam Patel]

And we can't forget to rule out secondary headache causes like a brain tumor or infection. That's where the Snoop 10 mnemonic comes in. Two N's, two O's and Snoop.

[Steve Brown]

Yeah, exactly. It's a super long mnemonic, but super helpful for thinking through your differential. So, all right, we've ruled out bad things. We know it's a migraine. The next step is treatment. So, Sati, how do you typically approach migraine treatment in your patients?

[Satyam Patel]

Well, once diagnosed, it's important to understand the severity. The Migraine Disability Assessment, Midus for short, is a validated questionnaire that can be used to assess migraine severity for stratified treatment.

[Valeria Vasquez]

Simple analgesics such as NSAIDs are recommended for migraines that are scored as midus grades one and two, or also mild.

[Steve Brown]

To moderate targeted migraine medications such as Triptans, which are first line, and Japans or Ditans, which are second line, are recommended for Midas grade 3 and 4, which is moderate to severe. There are three pants and only one Ditan for now.

[Valeria Vasquez]

But here's the catch. About one third of patients don't respond well to their first triptan, so it's crucial to try A different one if necessary.

[Satyam Patel]

Japant, like ubrogepant and Remejapant target neuroinflammation and vasodilation without the vascular risks of triptans, which is great for people with cardiovascular concerns. They're effective, but cost can be a barrier.

[Steve Brown]

Good job on the Japants on the first take there. That was well done.

[Valeria Vasquez]

Wow. Ditans including lasmiditan also show good efficacy but come with risks of somnolence and impaired driving. There's an FDA boxed a warning on.

[Steve Brown]

This medication in refractory migraine or status migrainosis. We may need to escalate treatment to parenteral options such as IV dihydro, ergotamine or ketorolac.

[Satyam Patel]

Non pharmacologic options are also important to consider for patients who don't respond well to medications or have contraindications. Neuromodulatory devices like vagus nerve stimulation have FDA approval for acute migraine treatment. And greater occipital nerve blocks are effective for both acute and chronic migraines.

[Valeria Vasquez]

When treating children, start with lifestyle changes and simple analgesics. Triptans are appropriate for kids over 6 if necessary.

[Steve Brown]

In older adults, be cautious with NSAIDs and triptans due to comorbidities and consider Japantes or ditans with careful monitoring.

[Valeria Vasquez]

For pregnant patients, acetaminophen with a caffeine is preferred with caution around triptans. They may be used if benefits outweigh the risks, but avoid in the first trimester if possible. Japants and detants aren't recommended due to limited data.

[Satyam Patel]

Managing migraines requires a nuanced approach based on severity, comorbidities and treatment response. Regular re evaluation of treatment plans is essential to ensure optimal outcomes.

[Valeria Vasquez]

Don't forget, for migraines, first line treatment are avoiding triggers like strong odors and smoke and making lifestyle changes. Maybe better sleep will help. First line medications are ibuprofen and triptans.

[Steve Brown]

Okay, we have a poem. Poems are patient oriented evidence that matters. And this poem's entitled Tirzepatide causes weight loss and improves sleep apnea symptoms. This is from Dr. Abel.

[Valeria Vasquez]

The clinical question here is is tirzepatide or zepbound effective for the treatment of obstructive sleep apnea?

[Satyam Patel]

Well, I hope so because I just prescribed it today.

[Steve Brown]

Oh wow.

[Satyam Patel]

Good job. Well, the answer is yes, but there's a catch. The study shows that tirzepatide induces significant weight loss and improves sleep apnea symptoms, but only in patients with obesity, not those with diabetes. Right?

[Steve Brown]

So this study reviews two similar randomized controlled trials. The studies were phase three randomized controlled trials involving adults with moderate to severe obstructive sleep apnea and they received either tirzepatide or placebo.

[Satyam Patel]

The main measure of success was the apnea hypopnea Index ahi, which tracks how often a person's breathing is interrupted during sleep per hour.

[Valeria Vasquez]

One study included patients who were unable or unwilling to use Pap therapy and the other included patients who had been using Pap for at least three months and planned to continue using it at baseline.

[Steve Brown]

The groups were balanced with a mean age of 48 years and 52 years in each study and an average body mass index of 39. Analysis was by intention to treat tirzepatide.

[Valeria Vasquez]

Reduces the ahi by about 20 points whether they were on Pap therapy or not, and improved sleep apnea symptoms. The patient started with an ahi of about 50.

[Satyam Patel]

Tirzepatide seems to work by addressing one of the root causes of obstructive sleep apnea, obesity. Patients with obesity saw an average of 16 to 17% reduction in weight, which likely contributed to those improvements in sleep apnea symptoms. This is especially true for those who were already using Pap therapy or could not use it effectively.

[Valeria Vasquez]

Absolutely, and I think the big takeaway here is that tirzepatide can be a valuable tool for treating sleep apnea in obese patients, particularly as part of a broader weight loss strategy. It gives us another option in the toolbox for managing these patients.

[Steve Brown]

GLPS for Everything.

[Satyam Patel]

Disclaimer Steve is not sponsored by the GLP lobby.

[Valeria Vasquez]

We'll be right back.

[Podcast Host/Announcer]

The AFP podcast is brought to you by the American Academy of Family Physicians and by a special rebroadcast of the AAFP's emergency and urgent care live stream May 13th through 17th. Experts in emergency medicine share the latest best practices on medical conditions often treated by family physicians. Register [e-mail] EUC2025.

[Steve Brown]

Okay, let's talk about options for unintended pregnancies from Drs. Valerio, Norby and Kremsreiter from Maryland and California.

[Satyam Patel]

Unintended pregnancies, defined as pregnancies that are unwanted, mistimed or unplanned are still very persistent, despite a decrease in the over overall pregnancy rate by 12% over the past decade.

[Valeria Vasquez]

So how should we approach a patient who comes to our clinic with an unintended pregnancy?

[Steve Brown]

So first you're going to confirm the pregnancy and then we can use motivational interviewing to understand how the patient perceives the pregnancy and what plans they might have.

[Satyam Patel]

Family medicine physicians should provide all options counseling for patients, which includes continuing the pregnancy and parenting the child, continuing the pregnancy and pursuing adoption and pursuing a medical or procedural abortion.

[Valeria Vasquez]

The literature shows that providing all options counseling leads to a more positive patient experience regardless of which decision they ultimately choose.

[Steve Brown]

Since the Supreme Court overturned Roe v. Wade, many states have enacted total bans on abortion, which has severely hampered the ability of thousands of people to enact their health care decisions even after discussing all options with their physician.

[Satyam Patel]

Telemedicine can fill some of the void that has been created since the 2022 Supreme Court ruling.

[Valeria Vasquez]

One study found that for every 100 mile increase in distance to an abortion facility, there was a 60% increase in online requests for abortion medications.

[Steve Brown]

Yeah, there are lots of useful resources listed in Table 2 of this article that can help clinicians review options counseling, state laws about abortion access, and more.

[Satyam Patel]

For parents who choose to continue the pregnancy, prenatal care should be initiated immediately.

[Valeria Vasquez]

These patients also tend to have greater social and health service needs as well.

[Steve Brown]

The AAFP Everyone Project Neighborhood Navigator can be a useful tool for clinicians to identify local resources for patients.

[Satyam Patel]

Parents who choose to go with adoption should have their decision affirmed by their family medicine physician.

[Valeria Vasquez]

Yes, and family physicians play a crucial role in providing unbiased counseling for these patients as well as emotional support.

[Steve Brown]

So patients might choose to have either a medical or a procedural abortion.

[Satyam Patel]

It's important for patients to know that abortion is safe, effective and it does not affect future conception or fertility.

[Valeria Vasquez]

Make sure to screen for any risk factors for an ectopic pregnancy, as patients with symptoms of ectopic pregnancy should have an ultrasound done to confirm an intrauterine.

[Steve Brown]

Pregnancy and make sure to also obtain RH status as an RH negative patient who gets an abortion after 12 weeks should get a shot of Rhogam.

[Satyam Patel]

For medication based abortion, adding mifepristone to misoprostol is shown to increase the chances of a successful abortion.

[Valeria Vasquez]

Medication induced abortion is 92 to 99% effective compared to a 99% effective rate for procedural abortion.

[Steve Brown]

Medication administered abortion can be done at home and so that gives the patients more control, but it does come with more bleeding and cramping which some patients might find burdensome.

[Satyam Patel]

The first trimester is the safest time to have an abortion and medication induced abortions are very effective during this period.

[Valeria Vasquez]

During the second trimester, procedural abortions seem to be more effective and have fewer drawbacks.

[Steve Brown]

As family physicians, we really should aim to be well versed in all the options to counsel our patients and utilize our rapport with our patients to help them make a decision that aligns with their life goals and desires. We have a Graham center one pager here. Artificial intelligence scribes shape healthcare delivery from Drs. Blasig and Huffstetler from Salt Lake City and Washington, D.C. the Graham center issues.

[Satyam Patel]

A plea as artificial intelligence or AI changes healthcare delivery, primary care must be at the forefront to shape practice transformation.

[Valeria Vasquez]

Currently, 38% of physicians are using AI in their practices.

[Steve Brown]

Wow, that's pretty high. AI scribe programs decrease EHR workload. However, there are few studies on AI scribes and none compare the various AI products.

[Satyam Patel]

There's a table comparing eight commercially available AI scribes.

[Valeria Vasquez]

Services offered include ambient listening, note generation, coding, and order recommendations.

[Steve Brown]

Sounds pretty amazing, but accuracy is the most cited concern. Some services claim 90 to 99% accuracy. Currently, Scribe programs cost around 2 to $400 per month per user.

[Satyam Patel]

The trustworthiness and acceptance of AI remains uncertain.

[Valeria Vasquez]

If you want to learn even more about AI virtual scribe tools, check out the March and April 2025 issue of FPM for 2020 tips.

[Satyam Patel]

My favorite tip if you start to save time with an AI scribe, don't be tempted to schedule more patients. Consider other options to protect your well being like going home earlier.

[Steve Brown]

So break we're going to close out with Medicine by the Numbers Testosterone Replacement in men with Sexual Dysfunction in the Absence of Hypogonadism this is from doctors To Shet and Williams from Newport News, Virginia.

[Satyam Patel]

It's time to put the numbers to the test. Osterone this is terrible. This article reviewed 43 randomized controlled trials which included over 11,000 men aged 40 years or greater with sexual dysfunction.

[Valeria Vasquez]

Sexual dysfunction was defined in these articles as acquired, decreased libido or erectile dysfunction.

[Steve Brown]

The efficacy endpoints included erectile dysfunction and sexual quality of life.

[Satyam Patel]

The harm endpoints included cardiovascular mortality, lower urinary tract symptoms, prostate related outcomes, and adverse effects leading to treatment withdrawal.

[Valeria Vasquez]

While associations like the American Urological association and the Endocrine Society recommend that testosterone replacement therapy only be used in patients with repeatedly low documented testosterone levels, studies show that testosterone replacement is regularly used in men with vague symptoms without documented testosterone levels.

[Steve Brown]

The results of this Cochrane review showed that there was likely no difference in erectile function and sexual quality of life between testosterone and placebo in the short term.

[Satyam Patel]

Short term here was defined as any timeframe between 3 and 12 months.

[Valeria Vasquez]

This was demonstrated with moderate certainty evidence.

[Steve Brown]

However, there was low certainty evidence that showed unclear results when comparing testosterone versus placebo in the long term, which is more like 12 to 24 months.

[Satyam Patel]

There was some low certainty evidence that also demonstrated no difference between testosterone plus a PDE5 inhibitor compared to a PDE5 inhibitor alone for sexual quality of life and erectile dysfunction.

[Valeria Vasquez]

It is important to note that nearly half of these studies had pharmaceutical company funding.

[Steve Brown]

Also, patients with common chronic medical conditions and psychiatric conditions are excluded from the studies, which limit generalizability overall.

[Satyam Patel]

In men with only sexual dysfunction without any known testosterone deficiency, there's no benefit of testosterone replacement therapy over placebo in the short term.

[Valeria Vasquez]

Over the long term, it is uncertain if testosterone replacement is beneficial or not.

[Satyam Patel]

Medicine by the Numbers gives this a yellow for uncertain benefits.

[Valeria Vasquez]

Please email [e-mail] or tweet @AFPpodcast. Please rate and comment wherever you get your podcasts.

[Satyam Patel]

Escucha nos en espanol en Revista America.

[Valeria Vasquez]

A FFP Our podcast team is Christopher Alvarez, Jake Anderson, Steve Brown, Sarah Coles, Marian Dawson, Hayley Hochstein, Nadia Mohammed, Satyam Patel, Valeria Vasquez, Sydney Vowles, and Sierra Voigt. Our sound and technical guru is Tyler Coles. Our theme song is written and recorded by family physicians Bill Dabbs, Ryan Evans, and Justin Jenkins. This podcast is brought to you by the residents and faculty of the University of Arizona College of Medicine, Phoenix Family Medicine Residency.

[Satyam Patel]

We'll talk to you soon for the next edition of the American Family Physician Podcast.