Changing Paradigm in Testosterone Therapy Treatment Options

Posted by Mohit Khera, MD, MBA, MPH | Jan 2022

Mohit Khera, MD, MBA, MPH, presented “Changing Paradigm in Testosterone Therapy Treatment Options” during the 25th Innovations in Urologic Practice conference on September 25, 2021, in Santa Fe, New Mexico.

How to cite: Khera, Mohit. “Changing Paradigm in Testosterone Therapy Treatment Options.” September 25th, 2021. Accessed Apr 2024. https://grandroundsinurology.com/changing-paradigm-in-testosterone-therapy-treatment-options/

Changing Paradigm in Testosterone Therapy Treatment Options – Summary

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.

About The 25th Annual Innovations in Urologic Practice:

Presented by co-chairs Mohit Khera, MD, MBA, MPH, and Michael Coburn, MD, FACS, the Innovations in Urologic Practice conference provides a detailed review and commentary on multiple genitourinary and urologic diseases. Among the featured oncological topics are bladder cancer and immunotherapies, as well as upper tract cancer management, prostate cancer, including state-of-the-art imaging, focal therapy, and MRI. Experts also discuss new tools and techniques for nephrectomy and treating advanced renal cell carcinoma. In terms of general urological approaches, the conference also includes pelvic reconstruction and trauma, men’s health topics like male infertility and sexual dysfunction, and ways to diagnose and treat infections in the urology patient. Dr. Khera presented this talk at the 2021 conference.

For further educational activities from this conference, visit our collection page.

About The Author

Mohit Khera, MD, MBA, MPH

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.

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