madman
Super Moderator
On this episode of BackTable Urology, Dr. Jose Silva invites endocrinologist Dr. Rodrigo Valderrabano onto the show to discuss the impact of testosterone replacement therapy on hypogonadic patients and prostate cancer survivors.
First, Dr. Valderrabano explains the role of testosterone in the body, which is to create the male phenotype and maintain sexual function and muscular strength. There is a strong relationship between bone building and testosterone, as testosterone is converted to estrogen to maintain bone density. He then explains what constitutes low testosterone, which is difficult to define due to testing imprecision, fluctuating hormone levels throughout the day, and other comorbidities, like obesity. To be diagnosed with hypogonadism, patients will need at least 2 lab tests and display clinical symptoms as well. For all patients who are interested in starting testosterone replacement therapy (TRT), Dr. Valderrabano measures total and free testosterone, sex hormone binding globulin, and LH and FSH to determine if the patient has primary hypogonadism or secondary hypogonadism.
Next, the doctors discuss different methods of testosterone delivery, such as injections, gels, patches, pellets, pills, and intranasal sprays. Dr. Valderrabano prefers to use gel, as it mimics the natural daily release of the hormone and results in less pituitary interference. However, he notes that the patient must be careful not to transfer the gel onto household contacts. Dr. Silva prefers to give testosterone injections. Then, the doctors discuss how recent literature disproves the claim that testosterone replacement therapy causes BPH/LUTS symptoms.
Finally, Dr. Valderrabano speaks about his research trial focused on giving TRT to prostate cancer survivors who have hypogonadism. His patient cohort includes prostate cancer patients who have a low risk of disease recurrence are at least 2 years into remission, have normal PSA levels, and are on no other hormone therapy treatments. His main outcomes are physical and sexual health. He also explains his data collection methods and collaboration with other institutions. Lastly, he emphasizes that physicians must collaborate with their patients to balance the risk of disease recurrence and their quality of life to determine if TRT is a good option for them.
