3rd Annual Jefferson Urology Symposium: Men’s Health Forum

© The Canadian Journal of Urology TM : International Supplement, August 2020 Sleep plays an important role in maintaining normal serum T levels. Greater degrees of nocturnal hypoxia, such as seen with conditions like obstructive sleep apnea (OSA), can result in lower serum T levels due to blunting of LH levels. Improving sleep apnea, either with the use of a CPAP machine, or surgically through uvulopalatopharyngoplasty, has been shown to improve serum T levels. 19 Finally, Leproult et al demonstrated that restricting sleep to 5 hours a night for 8 nights can decrease T levels by 10% to 15%. 20 Varicocele repair has also been shown to improve serum T values. Sathya et al conducted a prospective study of 200 men who received varicocelectomy or observation. 21 Serum T levels increased on average 80 mg/dL after varicocelectomy. Seventy-eight percent of the patients in the varicocelectomy group normalized their serum T levels compared to 16% in the control group. Ameta-analysis by Li et al evaluated 814 patients undergoing varicocele repair. 22 They found that serum T levels increased approximately 100 ng/dL after varicocelectomy. While varicocele repair may increase serumT levels, it appears that this increase is modest, and currently hypogonadism is not an established indication for vaicocelectomy. Conclusion Clinicians prescribing testosterone shouldbe aware of the current controversies associatedwithTTh. Controversies associatedwithTTh include potential risk of developing prostate cancer and worsening of LUTS. In addition, there are concerns of TTh potentially increasing CV risk. The current literature does not suggest that there is a significant risk with TTh and prostate cancer, LUTS, and CV events. However, more studies, including randomized placebo- controlled trials, are needed. Clinicians prescribing TTh should also be aware that the majority of hypogonadal patients currentlybeing treated with TTh are being treated off-label. Finally, lifestyle modification, such as weight loss and improvement in sleep, as well as varicocelectomy, can improve serum T values. Patients should be counseled appropriately regarding the indications for T therapy and the benefits of lifestyle modification prior to initiating TTh. 23 Controversies with testosterone therapy References 1. Maseroli E, Corona G, Rastrelli G et al. Prevalence of endocrine and metabolic disorders in subjects with erectile dysfunction: a comparative study. J Sex Med 2015;12(4):956-965. 2. Wu FC, Tajar A, Beynon JM et al. Identification of late-onset hypogonadism in middle-aged and elderly men. N Engl J Med 2010;363(2):123-135. 3. Burnett AL, NehraA, Breau RH et al. Erectile dysfunction: AUA guideline. J Urol 2018;200(3):633-641. 4. MorgentalerA, MinerMM, CaliberM, GuayAT, KheraM, Traish AM. Testosterone therapy and cardiovascular risk: advances and controversies. Mayo Clin Proc 2015;90(2):224-251. 5. Miner M, Morgentaler A, Khera M, Traish AM. 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