Testosterone and the Future of Men’s Health

madman

Super Moderator
This is a gem!

Dr. Mulhall knows where it's at when it comes to the methods/assays used for testing free testosterone!

Equilibrium Dialysis is whrere it's at!




In this landmark episode of Pearls & Perspectives, host Amy Pearlman, MD, sits down with one of the world’s foremost experts in sexual medicine, John P. Mulhall, MD, of Memorial Sloan Kettering Cancer Center in New York, New York. Known for shaping the way clinicians understand and manage testosterone deficiency and male sexual dysfunction, Mulhall offers an unfiltered, evidence-based deep dive into testosterone evaluation, treatment nuances, and evolving prostate cancer management strategies.




The episode covers:

• When and how to accurately measure total vs free testosterone—and why lab assays matter more than most think.


• Why symptoms alone are unreliable and why objective signs like bone density, A1c, and hematocrit are vital.

• The clinical implications of functional hypogonadism and the flaws in "wait-and-see" lifestyle approaches for obese men.

• The controversial relationship between testosterone and prostate cancer recurrence—and how the saturation model is changing practice.

• Emerging strategies in androgen deprivation therapy survivorship, including testosterone reintroduction post-treatment.

• Rational prescribing of testosterone therapies and clomiphene, with emphasis on LH targeting, fertility preservation, and cost-conscious decisions.

• The overlooked connection between unexplained high hematocrit and untreated sleep apnea in men with low T





From redefining how we interpret prostate-specific antigen to confronting outdated fears around testosterone therapy, Mulhall brings clarity, passion, and bold insights to every minute of this discussion.




Chapters

1:20 Checking total vs free testosterone

16:00 Preventing frailty in patients on ADT
26:25 A hypothetical patient 3 months away from radical prostatectomy
33:48 Collaborating with oncologists
28:15 Testosterone formulations
42:59 Topical testosterone
55:54 Obstructive sleep apnea and low testosterone
 
1:20 Checking total vs free testosterone




Go nuts it gets deep!






 
 
 
 
 

hCG Mixing Calculator

HCG Mixing Protocol Calculator

TRT Hormone Predictor Widget

TRT Hormone Predictor

Predict estradiol, DHT, and free testosterone levels based on total testosterone

⚠️ Medical Disclaimer

This tool provides predictions based on statistical models and should NOT replace professional medical advice. Always consult with your healthcare provider before making any changes to your TRT protocol.

ℹ️ Input Parameters

Normal range: 300-1000 ng/dL

Predicted Hormone Levels

Enter your total testosterone value to see predictions

Results will appear here after calculation

Understanding Your Hormones

Estradiol (E2)

A form of estrogen produced from testosterone. Important for bone health, mood, and libido. Too high can cause side effects; too low can affect well-being.

DHT

Dihydrotestosterone is a potent androgen derived from testosterone. Affects hair growth, prostate health, and masculinization effects.

Free Testosterone

The biologically active form of testosterone not bound to proteins. Directly available for cellular uptake and biological effects.

Scientific Reference

Lakshman KM, Kaplan B, Travison TG, Basaria S, Knapp PE, Singh AB, LaValley MP, Mazer NA, Bhasin S. The effects of injected testosterone dose and age on the conversion of testosterone to estradiol and dihydrotestosterone in young and older men. J Clin Endocrinol Metab. 2010 Aug;95(8):3955-64.

DOI: 10.1210/jc.2010-0102 | PMID: 20534765 | PMCID: PMC2913038

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