Dr. Pearlman on urologists’ role in the treatment of men on GLP-1 medications

In this interview, Amy Pearlman, MD, discusses a case study that she presented at the SNSMA section of the 2024 American Urological Association Annual Meeting in San Antonio, Texas on the role of urologists in preserving muscle mass for patients on GLP-1 medications. Pearlman is the co-founder and urologist at Prime Institute in South Florida.

Video Transcript:

During the SMSNA section of the AUA, I was presenting a bizarre, interesting, or nightmarish case. As I was thinking about all the cases I've been involved with, I decided, "let me go with interesting." I have my practice with my twin sister, who's my business partner and also a gastroenterologist. A lot of people ask, "how does a urologist and a gastroenterologist even end up in the same clinic together?" It's been really fun, because we actually now have a lot of mutual patients. I want to tell you about a mutual patient that I have with my twin sister. This guy is 47. He previously was a runner, but he had gained a significant amount of weight and really wasn't doing much exercise at all. When he saw my sister, he had fatigue, lethargy, felt sluggish, [had] reduced libido, and all the typical symptoms that are very characteristic for someone who is obese, but also who might have low testosterone. But he's seeing her for weight loss. When he sees her, she puts him on one of the GLP-1 agonist medications. Those medications [are a] huge industry now; everyone's talking about it, and they're very effective. What's so great about these new medications is that people are now able to lose more weight than they've ever been able to lose before. We see that in the headlines. In the news, media, headlines, we don't always want to hear about the good stuff, people are publishing the bad stuff. So now, there are a lot of headlines coming out about significant muscle loss associated with these medications.

As part of my sister's practice, she'll get her patients on a bioimpedance scale. We're not guessing; we can get real objective data in real time. When she gets her patients on that scale at baseline, she's looking at the skeletal muscle mass, because the number on a typical scale, or someone's BMI, actually means nothing when it comes to their cardiometabolic health. What is relevant? Well, it's their visceral adipose tissue, the weight around the gut, it's going to be skeletal muscle mass. Those are the more relevant factors that we're measuring. So, in this guy, he started off in the red. He had very low muscle mass. So, as he's starting to lose weight, most of these patients, they also lose muscle. She checks his testosterone level and it's in the high 200s on 2 occasions. She sends the patient to me, I put him on testosterone, and that's where he says things started changing for him. This is a year later–in the setting of him losing 44 pounds on a typical scale, he lost 10 inches in his waist circumference. He has more muscle mass today than when he started his weight management journey. That needs to be a viral headline. It's interesting, because a lot of these pharma companies are trying are coming up with these novel therapeutics to preserve muscle. But in the presentation that I gave during the conference, I asked the group of urologists, what if we already had a solution to this problem? What if it's already something that so many of us are already doing: replacing testosterone? We have a space in the weight management [arena] in medicine.

This transcription has been edited for clarity.