Nelson Vergel from ExcelMale.com and DiscountedLabs.com interviews Dr. Mohit Khera, one of the world's top experts in urology and testosterone therapy with over 100 publications. He debunks myths about testosterone and prostate cancer, cardiovascular risks and DVT / blood clots. He discusses the use of hCG, clomiphene and other products. He also reviews data on natural ways to increase your own body's testosterone production. For more information visit: Testosterone Interviews on ExcelMale Transcript: Nelson Vergel: Hello everybody, Nelson Vergel here with excel male dot com and discounted labs dot com. I'm very honored today to introduce my urologist here in Houston. I'm very privileged to have doctor has published more than a hundred articles last time I Googled his name, and he's one of the experts in the field of men's health, urology, testosterone replacement, prostatic issues. I think you also treat, Doctor Khera, female sexual dysfunction, too. Very happy to have him, he's going to give today a lecture that I think everybody's going to find extremely interesting covering the controversies of testosterone therapy Dr. Khera: Thank you for the introduction. I appreciate it. As you mentioned, there have been significant controversies with the use of testosterone therapy over the past five years. Cardiovascular risk, DVT, prostate cancer, BPH, and today I'd like to discuss some of those controversies and give you some further insight into the diagnosis and treatment of hypogonadism. Dr. Khera: I always like to give you some of the statistics. I'm not sure if many of you know this, or are aware that in 2012 testosterone was one of the fastest growing medications in the United States. There wasn't a single medication that was selling faster than testosterone. The concern that while the testosterone sales were increasing, the testing in the United States during this time was also starting to decline. One interesting statistic was that roughly 27 percent of men who initiated testosterone did not have a blood test before taking the medication, and 21 percent of men who started testosterone didn't have a follow-up test. So clearly there was some abuse with testosterone and some concerns. Dr. Khera: When I talk about controversies today I'd like to give you three different perspectives. I want to give you the perspective of what the FDA label has to say, as well as what the guidelines have to say. We were very fortunate in 2018; two guidelines came out. The AUA, the American Urological Association, came out with their testosterone guidelines the same time the endocrine guidelines also came out with their testosterone guidelines, as well. So I'd like to share with you these three different perspectives as we go forward. Dr. Khera: The first is on the concept of venous thrombosis embolism or VTE, and so you should be aware that in the package insert of a testosterone products in 2005 in the adverse reactions section of the label, it was appended to note that one patient during the open-label extension trial did suffer from the DVT. Now in 2009, the label was changed again under the new medication guide that lists blood clots in the legs among the serious side effects. If you open the package insert for testosterone products, you will see, and this is just for Androgel, that they do put in the section warnings and precaution a concern for VTE. I'll read this. There have been postmarketing reports of VTE events including DVT, PE in patients using testosterone products, Androgel in this case. Evaluate patients who report symptoms of pain, edema, warmth, and erythema in the lower extremity for DVT and those who present with acute shortness of breath for PE. If a VTE is suspected, discontinue treatment with testosterone and initiate appropriate workup and management. Dr. Khera: So this is in the package insert, and you should be aware that patients will read this and they will ask you about this. We should be very careful because the guidelines slightly differ, and if you look at the American Urologic Association guidelines, it states that patients should be informed that there is no definitive evidence linking testosterone therapy to a higher instance of VTE. The entering guidelines don't have a guidelines statement on this, but they do have some comments that they've made. They do state that case-control and pharmacoepidemiological studies have not shown a consistent increase in the risk of VTE with testosterone treatment. However, there is two huge testosterone associated VTE events in randomized controlled trials to draw meaningful imprints. Dr. Khera: So ...
