madman
Super Moderator
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 explains the need to check the liver enzymes when patients are using oral testosterone. He ends by sharing why it is important to consider the whole couple when treating patients with testosterone and not just one partner.
The video, titled “Testosterone & Hypogonadism: A Clinical Perspective w/ Dr. Mohit Khera | Urology Podcast Ep. 124,” features Dr. Mohit Khera discussing testosterone and hypogonadism from a clinical perspective. He explains that hypogonadism refers to a man having a low serum testosterone value and discusses the symptoms associated with low testosterone. Dr. Khera emphasizes the importance of considering the couple as a whole when treating low libido or erectile dysfunction. He also mentions the role of weight loss, sleep, exercise, and stress reduction in improving testosterone levels. Dr. Khera provides insights on the different options for testosterone replacement therapy, including oral formulations, injections, and pellets. He highlights the importance of monitoring hormone levels and the potential use of aromatase inhibitors. Dr. Khera also discusses the impact of testosterone therapy on fertility and addresses concerns about testosterone and the risk of cardiovascular events and prostate cancer.
*Hypogonadism refers to a man having a low serum testosterone value.
*Symptoms of low testosterone include low energy, low libido, erectile dysfunction, increased fat deposition, decreased muscle mass, and poor sleep.
*The most sensitive symptoms of low testosterone are sexual symptoms, including libido and erectile dysfunction.
*Weight loss, exercise, sleep improvement, and stress reduction can help improve testosterone levels.
*Testosterone replacement therapy options include oral formulations, injections, and pellets.
*Aromatase inhibitors may be used to manage elevated estrogen levels.
*Patients who want to preserve fertility should avoid exogenous testosterone and consider options like HCG or clomiphene citrate.
*It is important to monitor hormone levels and adjust treatment as necessary.
*Testosterone therapy does not increase the risk of cardiovascular events or prostate cancer, according to the Traverse trial.
*The management of testosterone therapy in patients with a history of radiation and prostate cancer may require additional considerations.
