Testosterone Controversies and Myths- Lecture by Dr. Mohit Khera

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Nelson Vergel

Founder, ExcelMale.com

  • 00:29 Testosterone therapy controversies include cardiovascular risk, deep vein thrombosis (DVT), prostate cancer, and benign prostatic hyperplasia (BPH).
  • 01:30 Concerns arise from the misuse of testosterone, with a significant percentage of men starting therapy without proper testing or follow-up.
  • 02:28 Three perspectives on testosterone therapy controversies: FDA labels, AUA guidelines, and Endocrine guidelines, each with slightly different viewpoints.
  • 04:57 Studies suggest conflicting evidence on testosterone's association with cardiovascular risk, with some indicating potential benefits in reducing risk factors.
  • 08:21 The AUA and Endocrine guidelines differ on the timeframe for restarting testosterone therapy after a cardiovascular event, but both lack definitive evidence of increased risk.
  • 10:47 No direct link between elevated hematocrit levels from testosterone therapy and deep vein thrombosis (DVT) has been established through trials, highlighting the need for further research.
  • 14:15 FDA guidelines emphasize testosterone therapy for men with documented medical conditions causing low testosterone levels, cautioning against use for age-related decline alone.
  • 16:38 Adult onset hypogonadism encompasses patients with low testosterone due to various causes, including age-related comorbidities like obesity and diabetes, not solely aging itself.
  • 18:08 While total testosterone levels may not significantly decline with age, free testosterone levels are impacted by increasing sex hormone binding globulin (SHBG), necessitating consideration beyond total testosterone in assessing hormone status.
  • 21:29 Lab reference ranges for testosterone levels vary widely, causing confusion in diagnosis and treatment.
  • 22:26 Some insurance companies use lower reference ranges, leading to denial of treatment for patients with low testosterone levels.
  • 23:21 Alternative options such as compounding pharmacies provide more affordable testosterone treatments for patients not covered by insurance.
  • 24:21 ⚖️ There is variability in individual testosterone thresholds for symptom improvement, influenced by factors like androgen receptor sensitivity and thyroid function.
  • 26:21 Despite common beliefs, testosterone therapy is not linked to an increased risk of developing prostate cancer, as per American Urological Association guidelines.
  • 28:15 Testosterone plays a role in maintaining bladder health through nitric oxide stimulation, potentially improving urinary symptoms in men with BPH.
  • 31:36 The prostate saturation model suggests that increasing testosterone levels above a certain threshold does not significantly affect PSA or prostate growth.
  • 33:27 Low testosterone levels may actually increase the risk of prostate cancer and worsen its outcomes, contrary to common beliefs.
  • 36:47 Recent studies explore using testosterone therapy to treat metastatic prostate cancer, showing promising results in reducing PSA levels and improving quality of life.
  • 39:46 Testosterone therapy in men on active surveillance for prostate cancer does not appear to increase cancer progression, although more research is needed.
  • 41:41 Testosterone therapy for men potentially having occult prostate cancer lacks definitive evidence of increased prostate cancer risk compared to untreated men.
  • 42:38 Early testosterone therapy post-radical prostatectomy may aid in erectile function recovery, particularly within the first six months.
  • 44:04 Testosterone therapy can significantly decrease sperm count, affecting fertility, especially concerning for young men with reproductive plans.
  • 45:30 Testosterone use, particularly at higher doses, may lead to azoospermia (zero sperm count), with partial recovery upon cessation but not always returning to baseline.
  • 46:56 HCG supplementation alongside testosterone therapy may help preserve intratesticular testosterone levels and potentially fertility.
  • 48:51 Age, duration of testosterone use, and dosage impact sperm count recovery after cessation of testosterone therapy.
  • 52:16 Lifestyle modifications including diet, exercise, sleep improvement, and stress reduction can naturally increase serum testosterone levels.
  • 55:37 Sleep quality significantly affects testosterone production, with obstructive sleep apnea negatively impacting levels.
  • 56:58 Chronic stress, such as work stress, can lower testosterone levels, emphasizing the importance of stress management for hormonal health.
  • 57:56 Varicocele repair may lead to a substantial improvement in serum testosterone levels, offering a potential non-pharmacological intervention for hypogonadism.
  • 59:20 Emerging technologies like nanotechnology and stem cell therapy hold promise for alternative methods of testosterone delivery and production, respectively.
  • 01:01:14 Switching from testosterone cypionate to enanthate and adjusting dosage can help manage edema or water retention in patients on testosterone therapy.
  • 01:02:13 Maintaining estradiol levels between 30 and 60 pg/mL is crucial for avoiding adverse effects while maximizing the benefits of testosterone therapy.
  • 01:02:43 Aromatase inhibitors should be used judiciously based on individual patient's estrogen levels to avoid negative impacts on libido and bone health.
  • 01:03:40 Interested individuals can reach out to Dr. Khera and his team at Baylor College of Medicine's urology department through their website for consultations and appointments.
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