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BackTable / Urology / Podcast / Episode #124

Testosterone & Hypogonadism: A Clinical Perspective

with Dr. Mohit Khera

In this episode of BackTable Urology, Dr. Jose Silva interviews Dr. Mohit Khera, professor of Urology at Baylor College of Medicine, about hypogonadism and testosterone replacement therapy.

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Testosterone & Hypogonadism: A Clinical Perspective with Dr. Mohit Khera on the BackTable Urology Podcast)
Ep 124 Testosterone & Hypogonadism: A Clinical Perspective with Dr. Mohit Khera
00:00 / 01:04

BackTable, LLC (Producer). (2023, October 4). Ep. 124 – Testosterone & Hypogonadism: A Clinical Perspective [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. Mohit Khera discusses Testosterone & Hypogonadism: A Clinical Perspective on the BackTable 124 Podcast

Dr. Mohit Khera

Dr. Mohit Khera is a professor of urology at Baylor College of Medicine in Houston, Texas.

Dr. Jose Silva discusses Testosterone & Hypogonadism: A Clinical Perspective on the BackTable 124 Podcast

Dr. Jose Silva

Dr. Jose Silva is a board certified urologist practicing in Central Florida.

Synopsis

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.

Resources

Miner MM, Khera M, Bhattacharya RK, Blick G, Kushner H. Baseline data from the TRiUS registry: symptoms and comorbidities of testosterone deficiency. Postgrad Med. 2011 May;123(3):17-27. doi: 10.3810/pgm.2011.05.2280. PMID: 21566412.
https://pubmed.ncbi.nlm.nih.gov/21566412/

KYZATREX™ by Marius Pharmaceuticals
https://www.kyzatrex.com/

Transcript Preview

[Dr. Jose Silva]
Today, we're going to talk mainly about testosterone: low testosterone, hypogonadism, the pathophysiology of those patients, and what to look for when we're seeing those patients in the office. Mo, can you define hypogonadism?

[Dr. Mohit Khera]
Yes. Hypogonadism essentially means a man having a low serum testosterone value. The number you want to remember that we use is 300 nanograms per deciliter. I have a little problem using that number. I think that it's not really fair that we pick one number for everyone in the world, and if you're below that number, you feel bad and above that number, you feel good, but the number we use is 300. We were involved in some international guidelines that pushed that number to 350 and we can get into that. If a man has a low testosterone and he has signs and symptoms of low testosterone, then that patient suffers from hypogonadism.

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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Articles

Optimizing Testosterone Treatment: Clinician Perspectives & Therapeutic Innovations

Optimizing Testosterone Treatment: Clinician Perspectives & Therapeutic Innovations

The Role of Testosterone in Hypogonadism

The Role of Testosterone in Hypogonadism

Topics

Hypogonadism Condition Overview

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