Needs & Objectives

Educational Needs

Peripheral and central androgen therapies are used in the treatment of sexual arousal and desire disorders, although mostly off-label and without concrete knowledge of their mechanism(s) of action. Unfortunately, androgen therapies have been laden with misunderstanding and misinformation, making clinicians suspicious of their efficacy. Empirical studies of androgen actions in the brain and periphery on sexual functions will help dispel myths and show the promise of these agents for the treatment of sexual arousal, desire, and possibly orgasm disorders in both males and females.

There are still significant controversies about the diagnosis and etiology of male hypogonadism, leading to confusion by both patients and providers. It is challenging to make sense of the various assays used in making the diagnosis and to determine the appropriate workup. The signs and symptoms of hypogonadism can be non-specific, and the risks and benefits of testosterone therapy are still controversial.

Women are the traditional health brokers for children and men in the family. Men often delay medical attention until conditions become advanced. Many medical conditions can be treated at an earlier stage to prevent the onset of common urological/andrological conditions (e.g., hypogonadism, erectile dysfunction, and infertility) from progressing.

Men who are overweight or obese frequently have low serum testosterone concentrations, which are associated with increased risk of type 2 diabetes. In the absence of obesity, adverse lifestyle behaviors, and use of medication such as serum testosterone concentrations decrease by only a minimal amount at least until very advanced age in most men.

Anemia is very common especially in women and in elderly men. Often it is a finding of a routine blood examination. Beside causing anemia low T levels can also cause other diseases with a high impact on the quality of life of the subjects

The effect of TRT on QoL in cohort of patients who have both hypogonadism and T2DM is poorly understood. There are only a handful of RCTs who have looked at the effect of testosterone on sexual and constitutional symptoms in diabetes population. Our recent study will be the first study to show significant clinical improvement in the symptoms as measured by total AMS scores in a cohort with both hypogonadism and type 2 diabetes. This result will hence have significant clinical implication in patients with diabetes who have hypogonadism and makes an argument to actively diagnose and institute treatment in these patients to better their clinical symptoms.

Borderline low testosterone levels are commonly seen in older men and those with comorbidities such as overweight/obesity, diabetes and depression. Several contraindications to testosterone therapy have also been based upon limited data. Clinicians need to be aware of the potential clinical scenarios where testosterone therapy may be considered, potential benefits and potential adverse effects/risks.

Testosterone deficiency has been shown to occur in up to 74% of men taking long-action opioid medication for CNCP. We need to increase awareness of OPIAD and to educate physicians on strategies to identify and manage this syndrome effectively. Physicians need to be aware of how common a deficiency in testosterone and associated symptoms can be in patients using opioid medication for CNCP so that they can take appropriate steps to improve the care of these patients.

The accuracy and reliability of testosterone tests can differ among test manufacturers and laboratories. Urologists need to be aware of the analytical accuracy and reliability of these tests when using them together with clinical practice guidelines and recommendations.

There is confusion as to what serum level of testosterone is consistent with hypogonadism. Because the diagnosis of hypogonadism requires laboratory confirmation of a low level of testosterone, clinicians rely heavily on laboratory reference ranges to determine whether a patient may be a candidate for TRT. However, a wide variety of testosterone assays are in use with varying reference ranges. Healthcare providers need to be knowledgeable about how various testosterone blood tests are performed and how to apply results to clinical practice.

Hormone imbalance for men and women creates significant morbidity and mortality. There is clear evidence that T promotes well-being in both sexes. There is no other drug that does this. Because of a multitude of factors it is frequently ignored, leading many to suffer. Providers should be aware of the enormous amount of hormone data, leaving no single study to be the defining study.

A review of the biochemical evidence indicating that testosterone has immunological actions in the pathogenesis of Covid-19 through modification of SARS-CoV-2 infection pathways, inflammatory response and immune recovery is needed in the field of andrology.

Educational Objectives

At the conclusion of the Androgen Society’s 5th Annual Meeting, attendees will be able to:

1. Explain the role of androgens as signaling molecules for diverse biological functions.
2. Explain in detail the mechanisms of action of androgens on androgen receptors in brain and periphery.
3. Review androgen’s effects on sexual dysfunctions, particularly sexual arousal and desire disorders in both men and women.
4. Dispel the myth of androgens as “male” hormones.
5. Review how androgen affects in the periphery link up with those in the brain.
6. Identify issues relating to increased male mortality.
7. Identify gaps to improve male cardiometabolic health in the disease states of obesity and sleep.
8. Identify new treatments for obesity that improve ASCVD risk and lower renal disease.
9. Explain the actions and therapeutic benefits of Glucagon-Like Peptide Agonists (GLP! agonists) in the treatment of obesity.
10. Identify the improvements in mortality associated with the STEP studies of semaglutide.
11. Identify possible improvements of male mortality with the treatments for erectile dysfunction and the use of PDE5 inhibitors.
12. Identify improvements of ED with lifestyle therapies and the association of ED with ASCVD risk.
13. Discuss the myriad options of testosterone treatment and how to determine the optimal form for patients.
14. Review the various guidelines of key medical societies.
15. Discuss the similarities and differences across the various recommendations.
16. Discuss the importance of a more patient-oriented approach to the diagnosis of treatment of male hypogonadism.
17. Demonstrate that prevention measures and early treatment of many medical conditions can prevent the onset of common urological/andrological afflictions (e.g., sexual dysfunction, hypogonadism, male factor infertility).
18. Educate and transmit the concept that young men need to take charge of their medical care at an early age after leaving the family.
19. Identify common comorbidities and their respective treatments (e.g., diabetes, cardiovascular disease, hypertension, dyslipidemia, obesity, etc.) that in turn may prevent the onset of medical pathologies (hypogonadism, sexual dysfunction, infertility).
20. Discuss the T4DM study regarding testosterone and diabetes care.
21. Discuss new clinical developments in the field of androgens.
22. Review Andrology and relationship with other specialties.
23. Review symptoms and assess biochemical testing for male hypogonadism to determine the best course of treatment.
24. Discuss the advantages and disadvantages of routine blood analysis.
25. Discuss the indications and potential benefits of TRT in anemia patients.
26. List options for medical therapy of TRT and their potential long term side effects.
27. Discuss the new data regarding testosterone therapy and how it may affect hematocrit levels.
28. Discuss the effect of testosterone deficiency on quality of life in patients with hypogonadism and Type 2 Diabetes.
29. Discuss the effects of Testosterone replacement therapy on the symptom severity.
30. Review the results of the RCT (STRIDE STUDY) showing the positive effects of Testosterone therapy on QoL in patients with hypogonadism and type 2 diabetes.
31. Review the evidence around TRT and its safety.
32. Review the role of testosterone and PDE5 inhibitors for the reduction of acute and chronic complications.
33. Discuss controversial issues around acute COVID-19 infection with reference to personal near fatal experience.
34. Review the evidence base for the new 2023 BSSM Guidelines recently accepted by the World Journal of Men's Health.
35. Define functional hypogonadism.
36. Discuss potential benefits of testosterone therapy for male hypogonadism.
37. Discuss potential risks of testosterone therapy for male hypogonadism.
38. Describe testosterone's effect on prostate cancer growth.
39. Discuss Bipolar Androgen Therapy (BAT) and the latest trials using BAT to treat prostate cancer.
40. Explain the relationship between testosterone and cardiovascular risk.
41. Review the TRAVERSE Trial and the rationale behind initiating the trial.
42. Recognize the prevalence of CNCP and opioid use.
43. Discuss the history of opioids and opioid use and the prevalence of OPIAD.
44. Discuss the clinical consequences of OPIAD.
45. Identify strategies to effectively manage OPIAD.
46. Review the association of testosterone and estrogen in patients with acute COVID-19.
47. Review the association of male hypogonadism with risk of hospitalization from COVID-19.
48. Review the effect of testosterone therapy on risk of hospitalization from COVID-19.
49. Discuss the various methodologies being used for Total Testosterone testing.
50. Review methods and quality of the Free Testosterone Test.
51. Review methods and quality of the Bioavailable Testosterone Test.
52. Discuss the analytical performance of testosterone assays.
53. Describe the CDC Clinical Standardization Program for testosterone.
54. Discuss activities conducted by CDC to improve testosterone testing and data.
55. Discuss resources available to identify standardized testosterone tests and laboratories.
56. Discuss how various testosterone blood tests are performed and how to apply results to clinical practice.
57. Describe the workup to diagnose hypoactive sexual desire disorder.
58. Discuss proper dosing of testosterone in post-menopausal women.
59. Describe testosterone use for pelvic pain and vestibulodynia conditions.
60. Review the organ systems that are clinically most affected by T deficiency/insufficiency and discuss the clinical outcomes with adequate replacement.
61. Review the biochemical evidence indicating that testosterone has immunological actions in the pathogenesis of Covid-19 through modification of SARS-CoV-2 infection pathways, inflammatory response and immune recovery.