Interviews with Icons: Abraham Morgentaler, MD, FACS, and Testosterone Therapy in Clinical Medicine
Neil H. Baum, MD, interviews Abraham Morgentaler, MD, FACS, on his clinical research treating men using testosterone therapy.
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Abraham Morgentaler
Testosterone Therapy in Men with Biochemical Recurrence and Metastatic Prostate Cancer
Abraham Morgentaler, MD, FACS, Associate Clinical Professor of Urologic Surgery at Harvard University, summarizes results from a recent study on testosterone (T) therapy for patients with biochemical recurrence and metastatic prostate cancer. He provides some background, explaining that physicians have been taught that raising testosterone in a man with prostate cancer is like “pouring gasoline on a fire,” even though approximately 20 years of evidence suggests that T therapy is safe after radical prostatectomy, after radiation therapy, in patients with prostatic intraepithelial neoplasia, and in patients on active surveillance. Dr. Morgentaler notes that his and his colleagues’ research indicates that T therapy is also safe for patients with advanced disease. He then goes over the makeup and design of the observational study, which featured 22 symptomatic men of a median age of 70.5. The median duration of T therapy was 12 months, and all patients reported symptomatic benefit from the treatment. The overall mortality was 13.6% with only one prostate cancer-specific death, and morbidity was fairly low, with no cases of pulmonary embolism, spinal cord compression or pathological fractures, and no observed rapid or precipitous progression of disease. Dr. Morgentaler highlights one 94-year-old patient’s experience, describing how this man wanted to be on testosterone because androgen deprivation made him too tired to do the things he enjoyed. After 6 weeks of T therapy, this patient’s brain was clearer, his appetite had improved, and he was exercising daily, and even though he died at age 95 after 11 months of therapy, Dr. Morgentaler emphasizes the importance of T therapy’s benefit to his quality of life in his final months. He concludes that there are men who prioritize quality of life over duration, that data contradict the idea that T therapy is dangerous for patients with prostate cancer, and that T therapy might in fact be a reasonable option for selected men with metastatic disease who refuse androgen deprivation.
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Androgen Society 3rd Annual Meeting Review (Day 3)
Abraham Morgentaler, MD, FACS, Associate Clinical Professor of Urologic Surgery at Harvard University, reviews day three of the 3rd annual meeting of the Androgen Society, an international organization consisting of healthcare professionals interested in testosterone deficiency and its treatment. The day began when Martin Miner, MD, and Jean-Paul Deslypere, MD, PhD, debated the correct threshold for diagnosing testosterone deficiency, ultimately concluding that the lower the T level, the better. Dr. Desylpere then discussed the role of active metabolites of testosterone in manhood, specifically the importance of testosterone in developing structural and functional characteristics of the sex. Hugh Jones, MD, followed with an analysis of androgen receptor sensitivity and its implications for clinical disorders and mortality. Abdulmaged Traish, PhD, then presented on whether or not age-related testosterone deficiency should be treated, respectfully disagreeing with the FDA’s position on not treating men with age-related hypogonadism. Martin Miner, MD, then looked at the relationship between testosterone and mood, depression, and dementia. Next, David Sullivan, MS, PhD, shared information about the preventative effect of androgens on dry eyes. Ernani Rhoden, MD, spoke on testosterone and gynecomastia before engaging in a debate on whether testosterone therapy may be used as monotherapy treatment of erectile dysfunction. The day concluded with a discussion by Dr. Morgentaler on testosterone, science, and human dignity that stemmed from his experiences with patients wanting testosterone therapy despite the impact on their life expectancies out of a desire to improve their quality of life.
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Androgen Society 3rd Annual Meeting Review (Day 2)
Abraham Morgentaler, MD, FACS, Associate Clinical Professor of Urologic Surgery at Harvard University, reviews the second day of the 3rd annual meeting of the Androgen Society, an international organization consisting of healthcare professionals interested in testosterone deficiency and its treatment. The day began with presentations on testosterone therapy and type 2 diabetes by Gary Wittert, MD, Hugh Jones, MD, and Farid Saad, MD. These presenters suggested that testosterone could lead to remission of diabetes mellitus, potentially prevent diabetes, and improve glycemic control. They were followed by a presentation on testosterone, anemia, and hematocrit by Sudarshan Ramachandran, PhD, one on COVID-19 and testosterone by Mary Samplaski, MD, and a panel discussion on testosterone’s impact on prostate cancer. Mohit Khera, MD, presented on the possibility of testosterone therapy performing a protective and/or therapeutic role against prostate cancer. Sharon Parish, MD, and Leah Millheiser, MD, presented on testosterone therapy for women and how it benefits sexual function. The day concluded with a presentation by Daniel Kelly, MD, on the complex, context-dependent relationship between testosterone and atherosclerosis.
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Androgen Society 3rd Annual Meeting Review (Day 1)
Abraham Morgentaler, MD, FACS, Associate Clinical Professor of Urologic Surgery at Harvard University, reviews the first day of the 3rd annual meeting of the Androgen Society, an international organization consisting of healthcare professionals interested in testosterone deficiency and its treatment. Dr. Morgentaler notes that the day began with a presentation on the history of testosterone by Dr. Nieschlag, followed by a presentation by Drs. Ethan D. Grober and Michael S. Irwig on transgender men and the physical impact of testosterone. Dr. Morgentaler then reviews a panel discussion that covered the use of free testosterone, erythrocytosis management, and the role of testosterone therapy and PDE5 inhibitors in men with erectile dysfunction and low testosterone. He goes on to summarize presentations by Drs. E. David Crawford and Omer Raheem which covered the use of androgen deprivation therapy (ADT) in local disease, biochemical failure, and advanced disease, as well as the sexual effects of testosterone. Dr. Crawford presented data showing that there is value in having a testosterone level below 20 nanograms per deciliter, and Dr. Raheem discussed a study that found that different forms of ADT should be used depending on patients’ cardiovascular issues. Dr. Morgentaler concludes by considering new testosterone formulations, including testosterone undecanoate, an oral soft gel, and injectables.
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