Testosterone Update

FACULTY
Allen D. Seftel, MD
Chief, Division of Urology
Cooper University Hospital
Professor of Urology
Cooper Medical School of Rowan University
Adjunct Professor of Urology
Robert Wood Johnson School of Medicine
Camden, New Jersey

INTENDED AUDIENCE
Urologists, endocrinologists, primary care physicians, cardiologists, and specialists interested in the management and treatment of hypogonadism.

NEEDS ASSESSMENT
Hypogonadism and erectile dysfunction (ED) are underdiagnosed and therefore undertreated conditions that can be associated with serious comorbid conditions, including metabolic and cardiovascular disease (CVD). Appropriate screening for comorbidities and treatment by any provider seeing men who are at risk should be encouraged. Mounting evidence indicates that ED and hypogonadism are associated with premature CVD, cardiovascular events, and cardiac death, as well as increased all-cause mortality. Despite compelling evidence, many clinicians are not aware of the connections between ED, hypoogonadism, comorbid conditions, and overall health.

The third Princeton Consensus Conference assembled to expand upon the panel's previous recommendations on sexual activity and CVD risk. The focus was on assessing the predictive value of vasculogenic ED in assigning cardiovascular risk in all men and to develop an approach to assess and manage cardiovascular risk in younger men with ED but no known CVD. The role of testosterone and usefulness of testosterone therapy in ED and CVD management were also examined. Clinicians should carefully consider how to integrate these recommendations into their clinical practice to improve overall health outcomes. Future research to discover the mechanisms involved in the pathogenesis of endothelial dysfunction as related to ED and hypogonadism may help improve treatment and management strategies.

EDUCATIONAL OBJECTIVES
At the conclusion of this activity, participants should be better able to:

Recognize that, because erectile dysfunction (ED) and hypogonadism are markers for latent cardiometabolic disease, sexual function should be incorporated into cardiovascular disease (CVD) risk assessment for all men, as ED may identify those at higher risk who require further cardiovascular workup
Integrate the third Princeton Consensus Panel recommendations into clinical practice
Review with patients that lifestyle improvements will not only improve erectile function but also lower cardiovascular risk and confer other benefits
Employ current data on the relationship between ED, CVD, endogenous testosterone levels, and endothelial function when discussing management strategies and treatment decisions with the patient
Measure testosterone levels and consider testosterone therapy as appropriate for any low-risk patient with ED or refer a high-risk patient to a cardiologist
Initiate phosphodiesterase type 5 inhibitor therapy and testosterone therapy when they may be safely utilized and refer to a cardiologist when appropriate

ACCREDITATION AND CERTIFICATION
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Dannemiller and CogniMed Inc. Dannemiller is accredited by the ACCME to provide continuing medical education for physicians.

Dannemiller designates this enduring material for a maximum of 0.50 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

There is no charge for this activity. Statements of Credit will be provided by e-mail following activity participation and upon completion and electronic submission of the posttest and evaluation to Dannemiller. A link to the evaluation form is provided upon completion of the activity. If you have any questions about your certificate, please e-mail cme@dannemiller.com.

CONTENT REVIEW STATEMENT
To resolve identified/potential conflicts of interest, the education content was fully reviewed by a physician member of the Dannemiller Clinical Content Review Committee who have no financial relationships with commercial interests. The resulting certified activity was found to provide educational content that is current, evidence based and commercially balanced.

DISCLOSURE STATEMENT
It is the policy of Dannemiller to ensure fair balance, independence, objectivity, and scientific rigor in all programming. All faculty participating in sponsored programs are expected to identify and reference off-label product use and disclose any significant relationships with those supporting the activity or any others whose products or services are discussed. The faculty for this activity have disclosed that there will not be discussion about the use of products for non–FDA-approved indications.

In accordance with the Accreditation Council for Continuing Medical Education standards, parallel documents from other accrediting bodies, and Dannemiller policy, the following disclosures have been made:

Dannemiller Staff
Mark T. Nadeau, MD, MBA, FAAFP, Clinical Content Reviewer, has nothing to disclose.
Gordon Ringler, Project Manager, has nothing to disclose.

CogniMed Inc. Staff
Estelle Perera, Senior Director, Scientific Affairs and Program Design, and Medical Writer, has nothing to disclose.
Elizabeth Varga Stanton, Editor, has nothing to disclose.

Faculty
Allen D. Seftel, MD, is a consultant to AbbVie Inc.; Actient Pharmaceuticals; Auxilium Pharmaceuticals, Inc.; Endo Pharmaceuticals; and Lilly USA, LLC.

The ideas and opinions presented in this educational activity are those of the faculty and do not necessarily reflect the views of Dannemiller and/or its agents. As in all educational activities, we encourage the practitioners to use their own judgment in treating and addressing the needs of each individual patient, taking into account that patient's unique clinical situation. Dannemiller disclaims all liability and cannot be held responsible for any problems that may arise from participating in this activity or following treatment recommendations presented.

This activity is supported by independent educational grants provided by Endo Pharmaceuticals, Inc. and Lilly USA, LLC.

This activity is an enduring material and consists of an audio recording and a written piece. Successful completion is achieved by listening to the audio or reading the piece, reflecting on the content's implications in your practice, and completing the assessment component.

The estimated time to complete this activity is 0.50 hour.

This activity was originally released June 28, 2013, and is eligible for credit through June 30, 2014.

This activity was reviewed by an impartial content reviewer and by faculty. Faculty have final editorial control over the piece.