Oral Arguments: Getting the Word Out About Oral TRT

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madman

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Injectable and gel versions of testosterone replacement therapy have long been considered cumbersome by both patients and providers, for a litany of reasons from being difficult to administer to an overwhelming insurance burden. However, research from ENDO 2024 revealed that a new oral therapy could potentially eliminate these barriers and be a safer option.



Although testosterone replacement therapy (TRT) has been around for decades, a recent survey jointly undertaken by pharmaceutical company Tolmar, Inc. and the online physician community Sermo found that many patients who could benefit from TRT may not be effectively treated, for a variety of reasons.

The survey polled more than 300 physicians in February, seeking their perspectives on barriers to effective treatment, among other points of interest including prescribing preferences and unmet patient needs. The results from this survey were presented at ENDO 2024 in June by Adrian Dobs, MD, professor of medicine and oncology at The Johns Hopkins School of Medicine, in Baltimore, Md., and Sandeep Dhindsa, MBBS, director of the Division of Endocrinology, Diabetes and Metabolism at the St. Louis University School of Medicine in Missouri.

Tolmar is the maker of Jatenzo®, an oral TRT approved by the U.S. Food and Drug Administration in 2019. “Tolmar wanted to understand the current landscape of TRT among physicians who write a lot of TRT prescriptions a month,” Dhindsa says, “and they wanted a good representation of endocrinologists and urologists, the two relevant specialties. In the end they had 100 endocrinologists, 100 urologists, and 103 other specialties. To disseminate the findings of this comprehensive survey, they chose to do so at ENDO 2024, and they contacted Dr. Dobs and me who are both interested in clinical andrology to present at the product theater.”

Jatenzo® is testosterone undecanoate (TU) unlike the previous formulation of oral TRT, methyltestosterone, which was found to cause liver damage. “TU is a different kind of esterified testosterone, and it is absorbed through the lymphatic system, where it goes directly into the peripheral circulation,” Dobs explains. “The oral preparation that was available many years ago had a methylated group to improve absorption. But the problem was, it was directly absorbed through the portal vein into the liver, and that caused abnormal liver function.” This pharmacokinetic profile of this drug has shown that liver monitoring is not required, and TU’s safety has been rigorously tested.


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