Mohit Khera, MD, MBA, MPH

Mohit Khera, MD, MBA, MPH

Baylor College of Medicine

Houston, Texas

Mohit Khera, MD, MBA, MPH, is the Professor and F. Brantley Scott Chair in Urology, and Director of the Laboratory for Andrology Research at the McNair Medical Institute at Baylor College of Medicine. He is also the Medical Director of the Executive Health Program at Baylor. Dr. Khera earned his undergraduate degree at Vanderbilt University. He subsequently earned his Masters in Business Administration and his Masters in Public Health from Boston University. He received his MD from The University of Texas Medical School at San Antonio and completed his residency training in the Scott Department of Urology at Baylor College of Medicine. He then went on to complete a one-year Fellowship in Male Reproductive Medicine and Surgery with Dr. Larry I. Lipshultz, also at Baylor. Dr. Khera specializes in male infertility, male and female sexual dysfunction, and declining testosterone levels in aging men. Dr. Khera’s research focuses on the efficacy of botulinum toxin type A in treating Peyronie’s disease, as well as genetic and epigenetic studies on post-finasteride syndrome patients and testosterone replacement therapy. Dr. Khera is a widely published writer. He has co-authored numerous book chapters, including those for the acclaimed Campbell-Walsh Urology textbook, for Clinical Gynecology, and for the fourth edition of Infertility in the Male. He also co-edited the third edition of the popular book Urology and the Primary Care Practitioner. In 2014, he published his second book Recoupling: A Couple’s 4 Step Guide to Greater Intimacy and Better Sex. Dr. Khera has published over 90 articles in scientific journals and has given numerous lectures throughout the world on testosterone replacement therapy and sexual dysfunction. He is a member of the Sexual Medicine Society of North America, the American Urological Association, and the American Medical Association, among others.


Talks by Mohit Khera, MD, MBA, MPH

Testosterone to Improve the Diagnosis and Treatment of Prostate Cancer

Mohit Khera, MD, MBA, MPH, explores how testosterone can help diagnose and treat prostate cancer. He explains that low testosterone is a biomarker for prostate cancer, a predictor of who will progress on active surveillance (AS), and a risk factor for biochemical recurrence after prostatectomy. Further, testosterone therapy can be a treatment for metastatic prostate cancer. 

Dr. Khera argues that while testosterone should not be considered a monotherapy, it can augment treatment. He explains PSA has poor sensitivity and addresses biomarker tests that seek to improve sensitivity and specificity. Dr. Khera asserts the ratio of testosterone to PSA has sensitivity of 82 percent and specificity of 62 percent, with lower costs than biomarker tests. He cites data explaining for men with low testosterone, PSA alone may not be accurate. Dr. Khera cites another study on testosterone as a predictor of upstaging and upgrading in low-risk AS patients. It concludes testosterone should be a selection criterion for inclusion of low-risk prostate cancer patients in AS programs.

Dr. Khera explains lower preoperative testosterone levels increase the risk for prostate cancer recurrence. Dr. Khera turns to treatment options, looking at bipolar androgen therapy (BAT) that includes patients with advanced disease receiving high doses of testosterone which results in a 50 percent reduction in both PSA and metastatic disease. Dr. Khera cites a study on BAT for asymptomatic men with castration-resistant prostate cancer; the BAT was well-tolerated and resulted in high response rates. 

Dr. Khera cites the TRANSFORMER study comparing BAT vs. enzalutamide. Data show no difference in survival; however, patients who switched from BAT to enzalutamide had the highest survival rates. Dr. Khera concludes that testosterone can improve prostate cancer diagnosis and counseling for patients on biochemical recurrence; it comes with significantly less cost and offers greater quality of life.

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Results from the TRAVERSE Trial

Mohit Khera, MD, MBA, MPH, provides an update on the results of the landmark TRAVERSE Trial, which examined the potential cardiovascular effects of testosterone therapy in men. After reviewing the complex recent history and controversies surrounding testosterone therapy, Dr. Khera walks through the TRAVERSE Trial, a randomized, double-blind, placebo-controlled study of over 5,000 hypogonadal men who either had cardiovascular disease (CVD), or were at increased risk for CVD over 5 years.

Dr. Khera highlights the thoroughness of the trial’s design, giving special focus to the primary, secondary, and tertiary endpoints relating to any MACE events for the trial participants. He concludes by presenting the results of the trial; testosterone therapy, for a mean duration of 22 months, did not increase the risk of major cardiovascular events in hypogonadal men over 40 years old with previous CVD or elevated risk for CVD.

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Changing Paradigm in Testosterone Therapy Treatment Options

Mohit Khera, MD, MBA, MPH, Professor of Urology and Director of the Laboratory for Andrology Research at the McNair Medical Institute at Baylor College of Medicine in Houston, Texas, discusses testosterone therapy, focusing on four key topics: oral testosterone, testosterone and COVID-19, testosterone and prostate cancer, and lifestyle modification. Dr. Khera provides a historical context for oral testosterone treatments, noting that the US has only recently seen expansion of this option. He describes the inTUne study which showed that 7% of patients may increase or start hypertension medication while on a testosterone oral therapy, but that overall patients experience a lower rate of erythrocytosis when compared with those receiving injectable and topical forms of testosterone. Dr. Khera then reviews several studies examining the relationship between COVID-19 and testosterone. Early studies showed men were more severely affected by COVID-19 than women. Paradoxically, low serum testosterone may be protective against acquiring COVID-19, but the same low serum testosterone can also result in a more severe outcome if that same patient acquires COVID-19. Additionally, COVID-19 also directly impacts the testicles in that serum testosterone levels significantly decrease from their pre-COVID-19 levels. Transitioning to prostate cancer, Dr. Khera describes the paradigm shift over the past 15 years, with physicians previously viewing testosterone as dangerous to now seeing it as protective. He illustrates the point with a prostate saturation model that shows the non-linear relationship between testosterone, PSA, and prostate size. Dr. Khera then considers treatment options with high levels of testosterone, such as bipolar androgen therapy, that have shown promising results. He concludes with a review of lifestyle modifications that can also improve testosterone levels, such as weight loss, sleep, and varicocele.

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