Mayo Clinic Archives

Primer on Testosterone Therapy for Women: Treatment of HSDD

Posted by Maria Uloko, MD | Jun 2023

Maria Uloko, MD, discusses testosterone therapy for women with hypoactive sexual desire disorder (HSDD). She explains that people with HSDD have higher rates of impaired body image, low self-confidence and self-worth, relationship stress, depression and anxiety, and increased healthcare costs.

Dr. Uloko shares the Basson Model of Sexual Motivation and emphasizes there is no “quick fix” for low libido. Dr. Uloko advocates a biopsychosocial approach that incorporates the biological, psychological, and social aspects that can affect HSDD. She explains the importance of patient education and therapy as well as medication treatments like flibanserin and testosterone.

Dr. Uloko emphasizes that testosterone is not FDA-approved for women, and it remains challenging to dose women appropriately. She cites studies that conclude testosterone, either alone or in concert with estrogen therapy, can be effective and safe for the treatment of HSDD. Dr. Uloko states that symptomatic improvement takes approximately 12 weeks, and treatment should be discontinued if no improvement occurs within six months.

Dr. Uloko then concludes that HSDD is a common but multifactorial condition for women with significant detriment to quality of life. She re-emphasizes the importance of a biopsychosocial approach to diagnosis and treatment that may include treatment with testosterone therapy.

Radioligand Therapy in Prostate Cancer

Posted by Geoffrey B. Johnson, MD, PhD | Jun 2023

Geoffrey B. Johnson, MD, PhD, Chair of the Division of Nuclear Medicine at the Mayo Clinic in Rochester, MN, discusses radioligand therapy in prostate cancer. Dr. Johnson briefly reviews the specific activity of this therapy, with a focus on Lutetium-177-PSMA-617.
Dr. Johnson highlights the benefits and tolerable side-effects of Lutetium-177-PSMA-617, and mentions the therapy is approved for patients with metastatic castrate-resistant prostate cancer who have been previously treated with androgen receptor pathway inhibition and taxane-based therapy.

The presentation further explores the process of patient selection for PSMA imaging, with the requirement of at least one lesion that shows higher PSMA expression than the liver. Dr. Johnson showcases post-therapy imaging examples, and discusses the potential of advanced scanning techniques, such as CZT-based scanners, which offer higher sensitivity and faster scans for accurate tracking of therapy response.

Dr. Johnson emphasizes the promising future of radionuclide therapy. He mentions the potential combinations of PSMA therapy with hormonal therapy, chemotherapy, immunotherapy, and external radiation. Additionally, he mentions ongoing trials exploring the use of alpha and beta emitters and the incorporation of different targets.

Point-Counterpoint: Erectile Dysfunction After Local Therapies: PDE5 Inhibitors and Early Penile Rehab Improves ED Recovery Following Radical Surgery – Con

Posted by Aditya Bagrodia, MD | Jun 2023

Aditya Bagrodia, MD, FACS, Associate Professor of Urology and Genitourinary Oncology Team Lead at the University of California, San Diego, presents the cons of using PDE5 inhibitors and early penile rehabilitation to treat erectile dysfunction post-radical prostatectomy. In this presentation, Dr. Bagrodia discusses, the known adverse effects of early use of PDE5is in patients, the failure of PDE5is to out-perform placebos, and the strengths and weaknesses of known treatment options for post-operative erectile dysfunction.

This lecture is part of a Point-Counterpoint debate. Its opposing lecture is “Point-Counterpoint: Erectile Dysfunction After Local Therapies: PDE5 Inhibitors and Early Penile Rehab Improves ED Recovery Following Radical Surgery – Pro.

Point-Counterpoint: Erectile Dysfunction After Local Therapies: PDE5 Inhibitors and Early Penile Rehab Improves ED Recovery Following Radical Surgery – Pro

Posted by T. Mike Hsiech, MD, MBA | Jun 2023

T. Mike Hsieh, MD, MBA, presents the pros of using PDE5 inhibitors and early penile rehabilitation to treat erectile dysfunction post-radical prostatectomy. In this presentation, Dr. Hsieh discusses, the role of tissue hypoxia in recovery failure, the changing ratios of collagen versus smooth muscle in the organ pre- and post-operation, and why Restoration of QoL, not Spontaneous Erection Recovery, should be the measure of success.

This lecture is part of a Point-Counterpoint debate. Its opposing lecture is “Point-Counterpoint: Erectile Dysfunction After Local Therapies: PDE5 Inhibitors and Early Penile Rehab Improves ED Recovery Following Radical Surgery–Con.”

Results From TRITON3

Posted by Alan H. Bryce, MD | Jun 2023

Alan H. Bryce, MD, presents results from the TRITON3 study comparing the efficacy of a PARP inhibitor (rucaparib) against docetaxel in mCRPC treatment. Dr. Bryce reviews the study design, emphasizing the options presented to the study participants in both treatment arms. The study yielded evidence that rucaparib might be superior to docetaxel-containing treatments.