ESSM Newsletter # 38

4 ESSM Today Testosterone replacement treatment in USA: A short interview with Joseph Alukal by Ferdinando Fusco (FF) ESSM TODAY briefly interviewed Joe Alukal about the current attitude of urologists in USA to prescribe testos- terone replacement treatment in USA. FF: Professor Alukal, what kind of cardio- vascular test, if any, you consider important for a patient before starting a testosterone replacement therapy? A cardiac risk assessment (exercise tolerance, prior cardiac history including stents, history of chest pain) can be taken easily by a urologist or an andrologist. Certainly a cardiologist can be involved if any of these questions are answered “yes”. If the patient already has a cardiologist, simply discuss the decision to start testoster- one with the cardiologist in question. Reassure them that this is not inherently dangerous from a cardiac standpoint; the patient simply needs to be monitored. FF: In a large number of men, serum tes- tosterone progressively declines with the age, inducing sexual dysfunction and other symptoms of hypogonadism. What is the current approach in USA for this “late-onset hypogonadism?” There is real controversy regarding this condi- tion; the FDA no longer considers “late onset hypogonadism” as an indication for testoster- one replacement. Many patients continue this treatment regardless. It is important therefore to discuss risks with these patients. FF: Prostate cancer is a contraindication to testosterone treatment. However, many hy- pogonadal men who should receive testos- terone, although not affected with prostate cancer, might develop it during the treatment and testosterone therapy might be accused to have increased the risk. What is your opin- ion about the role of testosterone therapy on the risk of prostate cancer? Both myself and many other urologists in our department and around the country do not be- lieve that testosterone replacement in the hypo- gonadal male increases his risk of developing prostate cancer. That being said, a prospective study proving this would be ideal. This study does not yet exist, and will be difficult to perform because of the necessary patients and length of follow up required to determine this effect. FF: Testosterone is available in many differ- ent formulations. Is there a best formulation in general or, at least, can we use objective criteria in selecting the best formulation for the single patient? I do not believe any one formulation is better; there is simply a need to tailor treatment options to particular patients. For example, gel formu- lations are not ideal in men who have small children or are worried about transfer to their spouses. Cost is certainly a factor in the united states as well. FF: How do you suggest to follow-up hypo- gonadal men after testosterone prescription? Men should be monitored with a yearly digital rectal examination and physical exam, biannual PSA testing, and q 3–4 month testosterone lev- els as well as complete blood count testing. Joseph Alukal MD Clinical Associate Professor, Department of Urology, Department of Obstetrics and Gynecology, Director, Reproductive Health and Benign Disorders of Prostate NYU Langone Medical Center alukal@gmail.com Take your Chance – Become a Member of ESSM, now ! Seize the day, or in Latin Carpe diem and become a member of ESSM now, to take all the advantages and benefits of ESSM membership. There are two levels of ESSM members- hip available: ESSM/ISSM Membership A combined ESSM/ISSM membership (annual fee 160 EUR) for both Sexual Medicine Societies (ESSM/ISSM) inclu- ding all ESSM and ISSM membership related services, including a subscription to the Journal of Sexual Medicine which is the monthly journal of the ISSM (Inter- national) and ESSM (European), and is the leading Journal in the field of Sexual Medicine. In addition there are reduced registration fees for all ISSM/ESSM rela- ted congresses. ESSM only Membership ESSM only membership (annual fee 50 EUR – reduced to 25 EUR for resi- dents in training) which includes the ESSM official Scientific and Social perio- dical, the „ESSM Today“, full access to the new comprehensive ESSM website: www.essm.org (including regularly updated scientific material, monthly updated literature re- views, the most recent guidelines, lecture recordings and presentations from past ESSM congresses), the opportunity to participate in the ESSM educational pro- grams, and to apply for scientific and sup- port grants and a reduced fee for the ESSM annual congress. ESSM Annual Membership Fees (January to December) Combined ESSM/ISSM Fee incl. JSM Journal EUR 160 ESSM only Fee EUR 50* * A reduced fee EUR 25 is available for resi- dents in training against proof of evidence. See application form on page 19.