In this episode of BackTable Urology, Dr. Jose Silva interviews Dr. Mohit Khera, professor of Urology at Baylor College of Medicine, about hypogonadism and testosterone replacement therapy.

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SHOW NOTES

First, Dr. Khera explains how comorbid conditions, such as diabetes, metabolic syndrome, and obesity, can decrease testosterone levels as men age. We also discuss the importance of the four pillars of health - diet, exercise, sleep, and stress reduction - and the role of weight loss in increasing natural testosterone levels. Additionally, Dr. Kera outlines the lab results he orders to confirm hypogonadism, which includes testosterone, free testosterone, LH, FSH, prolactin, estradiol, DHT, TSH, IGF-1, and vitamins D and B12.

Next, Dr. Khera discusses how to detect low free testosterone levels in patients with normal total testosterone levels and how to adjust treatment depending on the patient's sensitivity to testosterone. The doctors also discuss the role of testosterone in treating depression, the importance of managing estrogen levels, and avoiding overuse of aromatase inhibitors. Dr. Khera gives a brief history of testosterone replacement therapy (TRT), starting from the first oral testosterone formulation created in the 1930s to the new testosterone products developed in 2019. They also discuss the FDA's 2015 requirement for hypertensive testing, as well as the low risk of erythrocytosis associated with these new medications.

Finally, Dr. Khera discusses the importance of checking testosterone levels frequently and the controversy surrounding the best time to do so. He explains the difference between using injectables, gels, and pellets, and the importance of checking the trough level instead of the mid-week level. He ends by sharing why it is important to consider the whole couple when treating patients with testosterone and not just one partner.

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RESOURCES

Miner MM, Khera M, Bhattacharya RK, Blick G, Kushner H. Baseline data from the TRiUS registry: symptoms and comorbidities of testosterone deficiency. Postgrad Med. 2011 May;123(3):17-27. doi: 10.3810/pgm.2011.05.2280. PMID: 21566412.

https://pubmed.ncbi.nlm.nih.gov/21566412/

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