Katherine M. Rodriguez

Testosterone therapy and prostate cancer

The use of exogenous testosterone to treat hypogonadism in the men with a history of prostate cancer (CaP) remains controversial due to fears of cancer recurrence or progression. Due to the detrimental impact of hypogonadism on patient quality of life, recent work has examined the safety of testosterone therapy (TTh) in men with a history of CaP. In this review, we evaluate the literature with regards to the safety of TTh in men with a history of CaP. TTh results in improvements in quality of life with little evidence of biochemical recurrence or progression in men with a history of CaP, or de novo cancer in unaffected men. An insufficient amount of evidence is currently available to truly demonstrate the safe use of TTh in men with low risk CaP. In men with high-risk cancer, more limited data suggest that TTh may be safe, but these findings remain inconclusive. Despite the historic avoidance of TTh in men with a history of CaP, the existing body of evidence largely supports the safe and effective use of testosterone in these men, although additional study is needed before unequivocal safety can be demonstrated.

Enclomiphene citrate for the treatment of secondary male hypogonadism.

ABSTRACT Introduction: Hypogonadism is a growing concern in an aging male population. Historically treated using exogenous testosterone, concerns about possible adverse effects of testosterone have led physicians to seek alternative treatment approaches. Areas covered: Enclomiphene citrate is the trans isomer of clomiphene citrate, a non-steroidal estrogen receptor antagonist that is FDA-approved for the treatment of ovarian dysfunction in women. Clomiphene citrate has also been used off-label for many years to treat secondary male hypogonadism, particularly in the setting of male infertility. Here we review the literature examining the efficacy and safety of enclomiphene citrate in the setting of androgen deficiency. Expert opinion: Initial results support the conclusion that enclomiphene citrate increases serum testosterone levels by raising luteinizing hormone (LH) and follicle stimulating hormone (FSH) levels, without negatively impacting semen parameters. The ability to treat testosterone deficiency in men while maintaining fertility supports a role for enclomiphene citrate in the treatment of men in whom testosterone therapy is not a suitable option.

Alternatives to Testosterone Therapy: A Review

INTRODUCTION Although testosterone therapy (TTh) is an effective treatment for hypogonadism, recent concerns regarding its safety have been raised. In 2015, the US Food and Drug Administration issued a warning about potential cardiovascular risks resulting from TTh. Fertility preservation is another reason to search for viable alternative therapies to conventional TTh, and in this review we evaluate the literature examining these alternatives. AIMS To review the role and limitations of non-testosterone treatments for hypogonadism. METHODS A literature search was conducted using PubMed to identify relevant studies examining medical and non-medical alternatives to TTh. Search terms included hypogonadism, testosterone replacement therapy, testosterone therapy, testosterone replacement alternatives, diet and exercise and testosterone, varicocele repair and testosterone, stress reduction and testosterone, and sleep apnea and testosterone. MAIN OUTCOME MEASURES Review of peer-reviewed literature. RESULTS Medical therapies examined include human chorionic gonadotropins, aromatase inhibitors, and selective estrogen receptor modulators. Non-drug therapies that are reviewed include lifestyle modifications including diet and exercise, improvements in sleep, decreasing stress, and varicocele repair. The high prevalence of obesity and metabolic syndrome in the United States suggests that disease modification could represent a viable treatment approach for affected men with hypogonadism. CONCLUSIONS These alternatives to TTh can increase testosterone levels and should be considered before TTh. Lo EM, Rodriguez KM, Pastuszak AW, Khera M. Alternatives to Testosterone Therapy: A Review. Sex Med Rev 2018;6:106-113.

Penile implants: a look into the future

Inflatable penile prosthesis (IPP) has been around since the 1970’s as a durable and one-time cure for erectile dysfunction (ED). For the past 40 years, many changes have been made to make the device better and currently IPP boasts a high percentage of long-term patient satisfaction. The next paradigm shift in IPP treatment for ED is upon us. Funding for ED related medications and devices has been a hot topic in health policy over the last 10 years. This suggests that the device must improve and patient advocacy and education must increase for IPP to remain as a viable solution for ED. In this paper, we conduct a literature search for innovations in IPP and argue that IPP must constantly improve to compete with oral, injectable, shockwave, and potentially gene therapies.

A history of penile implants

Erectile dysfunction (ED) has long been described by physicians and patients, with treatments for ED proposed starting in the 8th century BC. In the last 50 years, however, there have been many advances in medical and surgical management of ED, notably the introduction of the inflatable penile prosthesis (IPP) in 1973 and phosphodiesterase type 5 inhibitors (PDE5Is) in 1998. Here we review the evolution of the IPP from 1973 through the current day. The 3-piece device was first described in 1973 by Dr. F. Brantley Scott, who helped found American Medical Systems (AMS) to market and sell the device. In 1983, Mentor (now Coloplast) started marketing a competing device. AMS and Mentor have made multiple modifications to the device over the years, which have increased rigidity, durability and patient satisfaction, and have decreased surgical variability, post-operative infection and spontaneous inflation. Today, the IPP is a safe and effective option for many men who have failed medical therapies, with high satisfaction from both patients and partners.

The Role of Testosterone Therapy in the Setting of Prostate Cancer

Purpose of ReviewThe role of testosterone in the development of prostate cancer and the safety of testosterone therapy (TTh) after prostate cancer treatment, or in the setting of active surveillance, remains controversial. There are many concerns about using TTh in men, particularly those with a history of prostate cancer, ranging from a possible increased risk of cardiovascular disease to cancer progression or recurrence. With many prostate cancer patients living longer, and hypogonadism having significant morbidity, much care must go into the decision to treat. Here, we review the literature investigating the effects of testosterone on the prostate as well as the efficacy and safety of exogenous testosterone in men with a history of prostate cancer.Recent FindingsThe improvement in quality of life with TTh is well studied and understood, while the argument for significantly increased risk of cancer or other adverse effects is much less robust. Neither increased rates of prostate cancer, cancer recurrence, or cardiovascular risk have been well established. In men with high-risk prostate cancer, evidence in the setting of TTh is very limited, and TTh should be used with caution.SummaryThe fears of TTh causing or worsening prostate cancer do not appear to be well supported by available data. Though more studies are needed to definitively determine the safety of TTh in men with prostate cancer, consideration should be given to treatment of hypogonadal men with a history of CaP.

Post-finasteride Syndrome: A Review of Current Literature

Purpose of ReviewA constellation of persistent adverse effects—collectively termed post-finasteride syndrome (PFS)—after 5α-reductase inhibitor treatment for benign prostatic hyperplasia (BPH) and androgenic alopecia (AGA) has recently been described. The severity of these sexual, physical, neurological, and psychiatric side effects raises important concerns regarding the treatment of these conditions, especially given the prevalence of indications for these medications. Here we review the literature exploring the symptoms, proposed mechanisms, and potential disease modulating factors for PFS.Recent FindingsWhile the persistent sexual side effects associated with PFS are well documented, research on the physical, neurological, and psychiatric adverse effects is much less ubiquitous. Though the mechanisms leading to PFS have been proposed, a clear treatment plan for these patients has not been established. In the treatment of BPH and AGA with 5α-reductase inhibitors, the risks of PFS should be considered.SummaryThe occurrence of persistent adverse sexual, physical, neurological, and psychiatric side effects after 5α-reductase inhibitor is well supported by the existing data. While additional studies are needed to better evaluate the role of 5α-reductase inhibitors in the manifestation of the symptoms of PFS, the risks of PFS should be critically evaluated when treating patients with BPH or AGA.

MP35-09 SPERM ANEUPLOIDY IS ASSOCIATED WITH WORSE GENERAL HEALTH IN INFERTILE MEN

INTRODUCTION AND OBJECTIVES: The male factor is implicated in approximately 50% of couples undergoing Assisted Reproductive Technology. It has been known semen alterations could be responsible for chromosomal abnormalities, poor embryonic development and repeated miscarriage.The main objective of this study was to evaluate the possible impact of oligospermia on the aneuploidy embryonic rate, comparing oligo and normospermics patients. METHODS: This study compared 203 oligo and normospermics couples who underwent in vitro fertilization with subsequent embryo biopsy for preimplantation genetic screening (PGS) during the period from July 2014 to October 2016. The female mean age was 38.9. The seminal parameters were evaluated according to WHO 2010. Were biopsied 741 embryos. The biopsies were performed on either day 3 or day 5. The techniques used for the analysis were Array Comparative Genomic Hybridization (aCGH) or Next-Generation Sequencing (NGS). The results were analyzed by the T test (p <0.05). RESULTS: Of the 203 patients, 40 patients (19.7%) were considered oligospermic and obtained 160 biopsied embryos. Of these, 42 (26.2%) were considered euploid embryos. Normospermics patients obtained 581 biopsied embryos, and 151 (25.9%) were considered euploid. Therefore, when considering only the seminal concentration, there is no difference between the aneuploidy embryonic rate. CONCLUSIONS: This study showed no correlation between low seminal concentration and aneuploidy embryonic rate. Although low sperm quality is an indication for PGS, it has not yet been elucidated that there is a decrease in the rate of euploidy during in vitro fertilization as it is expected to occur with the natural conception. Therefore, it is advisable that further studies on the subject be carried out in order to corroborate these primary results.