KOL Video Debate
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CHAIRPERSON

Martin M. MinerMartin M. Miner, MD
Director, Men's Health Center
Miriam Hospital
Clinical Associate Professor
  of Family Medicine and Urology
Warren Alpert Medical School
  of Brown University
Providence, Rhode Island

Primary Care






FACULTY

Martin M. MinerAdrian S. Dobs, MD, MHS
Professor of Medicine and Oncology
Johns Hopkins University School of Medicine
Division of Endocrinology and Metabolism
Baltimore, Maryland

Endocrinology





Martin M. MinerRobert A. Kloner, MD, PhD
Professor of Medicine
Cardiovascular Division
Keck School of Medicine
University of Southern California
Los Angeles, California

Cardiology






Martin M. MinerAbraham Morgentaler, MD
Associate Clinical Professor
Urologic Surgery
Harvard Medical School
Boston, Massachusetts



Urology







Click a title below for suggested reading and to watch the video.
Hypogonadism Fundamentals: Diagnosis and Determining Who Is a Candidate for Treatment
In this clip, we review clinical practice guidelines on the diagnosis and treatment of hypogonadism and who is a candidate for treatment.


Suggested Reading
Bhasin S, Cunningham GR, Hayes SJ, et al; Task Force, Endocrine Society. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010;95(6):2536-2559.

Miner MM, Sadovsky R. Evolving issues in male hypogonadism: evaluation, management, and related comorbidities. Cleve Clin J Med. 2007;74(suppl 3):S38-S46.

Rhoden EL, Morgentaler A. Risks of testosterone-replacement therapy and recommendations for monitoring [review]. N Engl J Med. 2004;350(5):482-492.

Traish AM, Miner MM, Morgentaler A, Zitzmann M. Testosterone deficiency. Am J Med. 2011;124(7):578-587.

Wang C, Nieschlag E, Swerdloff RS, et al. ISA, ISSAM, EAU, EAA and ASA recommendations: investigation, treatment and monitoring of late-onset hypogonadism in males. Aging Male. 2009;12(1):5-12.
Primary Care and Specialist Approaches to Hypogonadism Treatment and Referral
Although the majority of hypogonadism cases can be managed by the primary care clinician, referral to a specialist is appropriate in specific instances.  The treatment of hypogonadism and men's health concerns ideally incorporates a multidisciplinary approach.  In this clip, we explore how the urologist, endocrinologist, cardiologist, and primary care clinician are each involved in the management of hypogonadism.


Suggested Reading
Dandona P, Rosenberg MT. A practical guide to male hypogonadism in the primary care setting [review]. Int J Clin Pract. 2010;64(6):682-696.

Katz DJ, Nabulsi O, Tal R, Mulhall JP. Outcomes of clomiphene citrate treatment in young hypogonadal men. BJU Int. 2011 Nov 1 [Epub ahead of print].

Miner M, Canty DJ, Shabsigh R. Testosterone replacement therapy in hypogonadal men: assessing benefits, risks, and best practices [review]. Postgrad Med. 2008;120(3):130-153.

Rice D, Brannigan RE, Campbell RK, et al. Men's health, low testosterone, and diabetes: individualized treatment and a multidisciplinary approach. Diabetes Educ. 2008;34(suppl 5):97S-112S.

Yin A, Swerdloff R. Treating hypogonadism in younger males. Expert Opin Pharmacother. 2010;11(9):1529-1540.
Defining the Associations Between Hypogonadism and Obesity, Type 2 Diabetes, and Cardiometabolic Disease and the Effect of Testosterone Therapy in the Population With These Comorbidities
A well-developed body of evidence suggests that male hypogonadism is associated with type 2 diabetes, obesity, and metabolic syndrome and its components that may increase the risk of cardiovascular morbidity and mortality. In this clip, we discuss the relationships between these conditions and the latest studies exploring the effect of testosterone therapy in the patient populations affected.


Suggested Reading
Jones TH, Arver S, Behre HM, et al; TIMES2 Investigators. Testosterone replacement in hypogonadal men with type 2 diabetes and/or metabolic syndrome (the TIMES2 study). Diabetes Care. 2011;34(4):828-837.

Traish AM, Guay A, Feeley R, Saad F. The dark side of testosterone deficiency: I. Metabolic syndrome and erectile dysfunction [review]. J Androl. 2009;30(1):10-22.

Traish AM, Saad F, Feeley RJ, Guay A. The dark side of testosterone deficiency: III. Cardiovascular disease [review]. J Androl. 2009;30(5):477-494.

Traish AM, Saad F, Guay A. The dark side of testosterone deficiency: II. Type 2 diabetes and insulin resistance [review]. J Androl. 2009;30(1):23-32.

Wang C, Jackson G, Jones TH, et al. Low testosterone associated with obesity and the metabolic syndrome contributes to sexual dysfunction and cardiovascular disease risk in men with type 2 diabetes. Diabetes Care. 2011;34(7):1669-1675.
Weighing Epidemiologic Evidence and Testosterone Trials With Cardiovascular Endpoints: Evaluating Whether Endogenous and Exogenous Testosterone Are Associated With Increased Mortality or Cardiovascular Risk
Some epidemiologic studies have shown that low endogenous testosterone levels are independently associated with cardiovascular risk factors, and it has been hypothesized that hypogonadism contributes to higher mortality via arterial stiffening, endothelial dysfunction, and increased atherosclerosis.  In this clip, we review some of the epidemiologic evidence and discuss what is currently known about the cardiovascular safety of testosterone therapy and what needs further investigation.


Suggested Reading
Araujo AB, Dixon JM, Suarez EA, Murad MH, Guey LT, Wittert GA. Endogenous testosterone and mortality in men: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2011;96(10):3007-3019.

Basaria S, Coviello AD, Travison TG, et al. Adverse events associated with testosterone administration. N Engl J Med. 2010;363(2):109-122.

Carson CC III, Rosano G. Exogenous testosterone, cardiovascular events, and cardiovascular risk factors in elderly men: a review of trial data. J Sex Med. 2011 Jun 15 [Epub ahead of print].

Fernández-Balsells MM, Murad MH, Lane M, et al. Adverse effects of testosterone therapy in adult men: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2010;95(6):2560-2575.

Haddad RM, Kennedy CC, Caples SM, et al. Testosterone and cardiovascular risk in men: a systematic review and meta-analysis of randomized placebo-controlled trials. Mayo Clin Proc. 2007;82(1):29-39.

Khaw KT, Dowsett M, Folkerd E, et al. Endogenous testosterone and mortality due to all causes, cardiovascular disease, and cancer in men: European Prospective Investigation Into Cancer in Norfolk (EPIC-Norfolk) prospective population study. Circulation. 2007;116(23):2694-2701.

Laughlin GA, Barrett-Connor E, Bergstrom J. Low serum testosterone and mortality in older men. J Clin Endocrinol Metab. 2008;93(1):68-75.

Shores MM, Matsumoto AM, Sloan KL, Kivlahan DR. Low serum testosterone and mortality in male veterans. Arch Intern Med. 2006;166(15):1660-1665.
Looking at the Proof: Investigating the Inverse Relationship Between Prostate Cancer Risk and Endogenous Testosterone Levels
As screening for prostate cancer increases, some clinicians have expressed concerns about an association between prostate cancer and testosterone therapy.  In this clip, we provide the historical context for these concerns, the latest research, and the implications for hypogonadism treatment.


Suggested Reading
Dobs AS, Morgentaler A. Does testosterone therapy increase the risk of prostate cancer? Endocr Pract. 2008;14(7):904-911.

Khera M, Bhattacharya RK, Blick G, Kushner H, Nguyen D, Miner MM. Changes in prostate specific antigen in hypogonadal men after 12 months of testosterone replacement therapy: support for the prostate saturation theory. J Urol. 2011;186(3):1005-1011.

Marks LS, Mazer NA, Mostaghel E, et al. Effect of testosterone replacement therapy on prostate tissue in men with late-onset hypogonadism: a randomized controlled trial. JAMA. 2006;296(19):2351-2361.

Morgentaler A, Lipshultz LI, Bennett R, Sweeney M, Avila D Jr, Khera M. Testosterone therapy in men with untreated prostate cancer. J Urol. 2011;185(4):1256-1260.

Morgentaler A, Schulman C. Testosterone and prostate safety. Front Horm Res. 2009;37:197-203.

Morgentaler A, Traish AM. Shifting the paradigm of testosterone and prostate cancer: the saturation model and the limits of androgen-dependent growth [review]. Eur Urol. 2009;55(2):310-320.

Rhoden EL, Morgentaler A. Risks of testosterone-replacement therapy and recommendations for monitoring [review]. N Engl J Med. 2004;350(5):482-492.

Shabsigh R, Crawford ED, Nehra A, Slawin KM. Testosterone therapy in hypogonadal men and potential prostate cancer risk: a systematic review [review]. Int J Impot Res. 2009;21(1):9-23.
Monitoring Treatment and Reviewing Therapeutic Options
In this clip, we discuss the array of treatment options for hypogonadism as well as suggestions for monitoring prior to and during testosterone therapy.


Suggested Reading
Bhasin S, Cunningham GR, Hayes SJ, et al; Task Force, Endocrine Society. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010;95(6):2536-2559.