T. Mike Hsiech, MD, MBA, Author at Grand Rounds in Urology

T. Mike Hsiech, MD, MBA

University of California, San Diego

La Jolla, California

Disclosures:

T. Mike Hsieh, MD is a professor in the Department of Urology at the University of California (UC), San Diego School of Medicine where he is involved in the teaching of medical students and training of surgical residents. Dr. Hsieh also serves as Director of the Men's Health Center at UC San Diego Health. Dr. Hseih earned his MD from The Robert Larner, M.D. College of Medicine at the University of Vermont. Dr. Hsieh completed his training in urology at George Washington University Hospital in Washington, DC and additional fellowship training in male reproductive medicine and microsurgery at Baylor College of Medicine in Houston. Dr. Hsieh earned an MBA from UC San Diego.

Dr. Hsieh is a board-certified urologist specializing in male fertility and men's health. He treats men with sexual dysfunction including low testosterone, erectile dysfunction, and Peyronie's disease. He also treats male infertility including men with ejaculatory disorder, hormone imbalance, sperm production impairment, cancer, and genetic causes of infertility. Dr. Hsieh has expertise in providing gender-affirming care to transgender and nonbinary patients.

Dr. Hsieh is an expert in microsurgical vasectomy reversal, varicocele repair, sperm retrieval procedure, reconstruction for Peyronie's disease and erectile disorder. He also performs the UroLift ® System treatment (an incisionless surgical procedure) to treat men with benign prostate hyperplasia, a noncancerous condition in which the prostate gland is enlarged and causes urge incontinence and changes in urinary flow.

As director of the Men's Health Center at UC San Diego Health, Dr. Hsieh's practice also includes general urology for men with kidney stones, and treating conditions such as benign prostatic hyperplasia (BPH); elevated PSA; enlarged PSA; male urinary retention; male urinary tract infections; any masses for prostate, bladder, testis, kidney; and testicular pain.

In collaboration with doctors at Moores Cancer Center, Dr. Hseih focuses on enabling male patients with cancer to preserve their fertility options before cancer therapy. He also helps cancer survivors preserve or regain their sexual function after they receive cancer treatment that has sexual side effects.

Dr. Hsieh also sees patients for conditions related to male infertility at Reproductive Partners - San Diego, where he often treats the partners of women who are undergoing IVF or other advanced reproductive technology.

Dr. Hsieh is conducting multiple research projects on stem cell maturation for male fertility, testicular functional imaging, outcomes of penile prosthetic surgery, and testosterone therapy in chronic pain patients.

Talks by T. Mike Hsiech, MD, MBA

Update on Testosterone and Treatment for Diabetes Mellitus: T2DM Australian Study

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

T. Mike Hsieh, MD, MBA, provides an update on a study examining the use of testosterone therapy (TT) to treat type 2 diabetes mellitus (T2DM) in men. He describes the Testosterone Trials and summarizes findings in men treated with TT, including a significant increase in testosterone (T) levels and subsequent improvement of symptoms.

Dr. Hsieh discusses T and diabetes, and explains that obesity with or without diabetes is associated with lower T and an increased risk of T2DM. He explains that lifestyle intervention and metformin were shown to prevent progression of prediabetes to T2DM without TT. He discusses TT and cardiovascular disease (CVD), explaining T deficiency is associated with CVD. Though there is conflicting data on the benefit of TT on CVD, the 2018 American Urological Association (AUA) Testosterone Deficiency guideline cites no definitive evidence linking TT to a higher incidence of venous thromboembolism (VTE).

Dr. Hsieh discusses an Australian double-blind, randomized, controlled trial that aimed to determine whether TT combined with lifestyle intervention vs. lifestyle intervention alone reduced T2DM incidence and improved glucose tolerance at two years, while closely monitoring for signs of CVD. The study supported that, while TT plus lifestyle modification can prevent or revert T2DM in men without hypogonadism, hematocrit (HCT) levels must be closely monitored in men undergoing TT, and long-term safety and cardiovascular outcomes of TT remains to be determined. Finally, Dr. Hsieh cites the ongoing TRAVERSE study, examining the complications of TT in older men.

Testosterone Update on Oral Products

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

T. Mike Hsieh, MD, MBA, provides an update on available oral testosterone treatments, beginning by explaining that oral testosterone is a large and growing market and outlining the development testosterone therapy over recent decades. Dr. Hsieh hones in on the three therapies most recently approved by the U.S. Food and Drug Administration (FDA), all of which are oral testosterone therapies (Jatenzo, Tlando, and Kyzatrex).

He cites a study of Oral Testosterone Undecanoate in Hypogonadal Men, which led to the approval of Jatenzo. Dr. Hsieh then addresses Tlando, and explains the study behind its approval, which found the treatment’s efficacy was 80 percent, exceeding the FDA threshold of 75 percent. He then addresses Kyzatrex, a gelatin capsule that uses a SEDDS formulation (phytosterol esters that form microemulsions in gastrointestinal fluids, allowing oral dosing of poorly-soluble drugs). As far as clinical efficacy, Kyzatrex well exceeded the FDA threshold, with 96 percent of patients achieving testosterone levels in the therapeutic range after 90 days of treatment.

Dr. Hsieh explains that, unlike Jatenzo, Tlando and Kyzatrex do not need to be taken with a high-fat meal. With all three medications, blood pressure increase is a possible side effect (though the data on hypertension was more favorable in the Kyzatrex study), and all these treatments carry FDA warnings to that effect.

Dr. Hsieh concludes that there is a wide variety of commercially available testosterone options on the market, with new oral formulations with favorable safety profiles representing exciting new options for patients. He reiterates that blood pressure should always be monitored in patients on oral testosterone.

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.”