Mohit Khera, MD, MBA, MPH presented “Update on 2018 AUA Testosterone and ED Guidelines” during the 23rd Annual Innovations in Urologic Practice on September 14, 2018 in Santa Fe, New Mexico.

How to cite: Khera, Mohit. “Update on 2018 AUA Testosterone and ED Guidelines” September 14, 2018. Accessed Dec 2018. https://grandroundsinurology.com/update-on-2018-aua-testosterone-and-ed-guidelines/

Update on 2018 AUA Testosterone and ED Guidelines – Summary:

Mohit Khera, MD, MBA, MPH, introduces the 2018 American Urological Association (AUA) guidelines for testosterone therapy and erectile dysfunction. He also describes inconsistencies between these guidelines and various institutions’ statements regarding these clinical areas.

Abstract:

In 2018, the AUA released their first testosterone therapy (TTh) guidelines, as well as for erectile dysfunction as a third iteration. Notably, the TTh guidelines recommend not to measure patients’ serum testosterone without signs and symptoms of hypogonadism, but with exceptions for select populations. The guidelines also recommend annual PSA testing for individuals over 40 and a normal testosterone level range of 450-600. For natural testosterone boosters, clinicians may use aromatase inhibitors, human chorionic gonadotropin, selective estrogen receptor modulators, or a combination for men desiring to maintain fertility.

There are controversies associated with the release of the 2018 guidelines due to differing perspectives from other organizations. Specifically, the FDA, the Endocrine Society, and AUA have contradicting statements regarding venous thromboembolism and cardiovascular disease (CVD). However, a review of all articles from 1940-2014 relating to testosterone and CVD and a similar study reviewing articles from 2014 to 2017 corroborate the AUA statements. In 2015, the FDA label eliminated idiopathic hypogonadism from its indications for TTh, contradicting with AUA and Endocrine Society guidelines. Additionally, there are similar controversies involving testosterone and its impact on BPH and prostate cancer.

The 2018 AUA guidelines concerning erectile dysfunction have a strong emphasis on shared decision making. Past guidelines have recommended that clinicians prescribe first- and second-line therapies before considering surgical interventions. Conversely, the new guidelines recommend counseling patients and basing treatment decisions on their values and priorities. The new guidelines also account for emerging techniques in this setting. In this regard, the AUA defines stem cell therapy, low-intensity shock wave therapy, and platelet rich plasma are experimental.

About Innovations in Urologic Practice

Innovations in Urologic Practice (IUP) is an annual CME-accredited conference devoted to updating urologists on the rapidly changing healthcare environment. Topics focus on innovative diagnostic and treatment strategies, controversies, new and currently developing technologies, and challenges in today’s urologic practice. Dr. Khera presented this lecture during the 23rd IUP in 2018. Please visit this page in order to learn more about future IUP meetings.