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BackTable / Urology / Podcast / Episode #98

Testosterone Replacement in Prostate Cancer Survivors

with Dr. Rodrigo Valderrabano

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.

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Testosterone Replacement in Prostate Cancer Survivors with Dr. Rodrigo Valderrabano on the BackTable Urology Podcast)
Ep 98 Testosterone Replacement in Prostate Cancer Survivors with Dr. Rodrigo Valderrabano
00:00 / 01:04

BackTable, LLC (Producer). (2023, May 17). Ep. 98 – Testosterone Replacement in Prostate Cancer Survivors [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. Rodrigo Valderrabano discusses Testosterone Replacement in Prostate Cancer Survivors on the BackTable 98 Podcast

Dr. Rodrigo Valderrabano

Dr. Rodrigo Valderrabano is an endocrinologist with Brigham and Women's Hospital in Boston, Massachussetts.

Dr. Jose Silva discusses Testosterone Replacement in Prostate Cancer Survivors on the BackTable 98 Podcast

Dr. Jose Silva

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

Synopsis

First, Dr. Valderrabano explains the role of testosterone in the body, which is to create the male phenotype and to 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.

Transcript Preview

[Dr. Jose Silva]
Rodrigo, you went to Stanford to do your fellowship in endocrinology. How did this love for men's health develop?

[Dr. Rodrigo Valderrábano]
When I was at Stanford, I started focusing on bone health. I have always had a large interest in exercise and how that can affect health and how we can do exercise interventions as treatment. That's why I got into bone health. I was at the University of Miami for a while and directed their bone clinic. I was starting to see all of these older men, people with prostate cancer, how they weren't doing well. My interest there started through bone health because that's why people were referred to me.

It has really morphed into this interest in how do we promote function, especially in older individuals, by any means, which means andrology and testosterone. It also means exercise. It also means proper nutrition. That's really where my path intersected with men's health. It's an area that still needs a lot of attention. I think there's a lot of hype out there. People bring their own opinions to the fray a lot more than in other conditions I feel like. Some people just are all on board with testosterone and some people are completely against it.

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

Testosterone and Prostate Cancer: Testing & Treatment Modalities

Testosterone and Prostate Cancer: Testing & Treatment Modalities

Rethinking Testosterone Therapy in Prostate Cancer Survivors: An Early Look at Positive Clinical Trial Data

Rethinking Testosterone Therapy in Prostate Cancer Survivors: An Early Look at Positive Clinical Trial Data

Topics

Hypogonadism Condition Overview
Prostate Cancer Condition Overview

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