BackTable Urology Ep. 124 Testosterone and Hypogonadism: A Clinical Perspective with Dr. Mohit Khera
Oct 4, 2023
Dr. Mohit Khera, a Baylor professor and andrology researcher specializing in male reproductive medicine and testosterone therapy. He walks through diagnosing low testosterone and the key labs to check. He explores lifestyle drivers, fertility-preserving options versus replacement, new oral formulations, dosing strategies to avoid peaks, and safety monitoring including hematocrit and cardiovascular data.
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Receptor Sensitivity Changes Symptom Thresholds
- Individual androgen receptor sensitivity (CAG repeats) alters symptom thresholds for testosterone.
- Aim to raise patients into the upper quartile of normal to account for receptor variability.
Check Testosterone In Depressed Men
- Screen testosterone in men with depression because low T is common and therapy can improve depressive symptoms.
- Consider testosterone as adjunctive, not sole, treatment for mood when appropriate.
Manage Estrogen, Don't Eliminate It
- Measure estradiol before using aromatase inhibitors and only dose to bring levels into a 30–50 pg/mL range.
- Avoid aggressively shutting down estrogen to prevent sexual dysfunction and bone loss.