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Expert shares how he counsels patients on testosterone replacement therapy

Opinion
Video

"in general, we can use a simpler regimen [of testosterone replacement therapy] and achieve normal levels," says Peter N. Tsambarlis, MD.

In this video, Peter N. Tsambarlis, MD, discusses how he counsels patients who have received testosterone replacement therapy (TRT) from a previous provider. He also shares how the TRAVERSE data regarding TRT have affected how he counsels patients. Tsambarlis is a urologist with Northwestern Medicine in Chicago, Illinois.

Transcription:

How do you counsel patients who come to see you after receiving testosterone replacement therapy from another provider?

I think when people want testosterone therapy, there are places to get it. And you can get it without having to go through the standard process, the approval—they go outside of insurance. You can just get it. What I tell them when they come to me is, "We have to find out where you really are now. We're never going to know where you were before you started this. But where you are now means we really want to get a trough level. We're going to stop the testosterone therapy in the short term, and you may not feel great, but we have to find out what your levels are." And then usually, [I] simplify the regimen. I find that the regimens coming out of these other clinics tend to be pretty complex. Maybe they're on anastrozole and clomiphene and exogenous testosterone. And I don't know if they needed that. But in general, we can use a simpler regimen and achieve normal levels. Moving someone from low into normal has a lot of benefits. But moving someone from normal into higher up than normal or normal into supratherapeutic carries risk without the expectation of benefits.

Have the TRAVERSE data regarding testosterone replacement therapy affected how you counsel patients?

It hasn't changed what we offer. But it's given me the strongest foundation of data yet to maybe break some of these myths about testosterone. Was there an association with prostate cancer? No. Are we seeing cardiac events? Not at a higher rate. It is interesting that we saw some pulmonary emboli. That's something to be worried about. And if you're going to be transparent about the safety data, you have to be transparent about the risk data too. I don't have a good explanation for that one, for example, but I think all it does is it gives us tangible information at the highest quality that we've had so far, to give reasonable expectations of risk to our patients. Now, I don't think [the study] was perfect. There was some crossover; some of the inclusion/exclusion criteria weren't super strict when we see what the actual results showed, but it's the best data we have so far. I'm really glad that we have access to it. And I share it with my patients with those caveats.

This transcription was edited for clarity.

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