Advanced practice providers (APPs) play an important role in urology, particularly in the sphere of men’s sexual health. An ageing workforce and patient population, a shortage of practicing urologists, the expansion of the Medicare pool, and the increased incidence of urologic conditions all contribute to a gap in urologic care that APPs can help bridge.
One common urological condition that APPs frequently help diagnose and treat is male hypogonadism. Male hypogonadism is a condition in which the testicles do not produce enough testosterone, which can result in symptoms such as fatigue, reduced sex drive, depression, and erectile dysfunction (ED).
There are two types of male hypogonadism: primary and secondary. Primary hypogonadism (also known as primary testicular failure) is the result of a problem in the testicles that hinders or prohibits testosterone production.
Secondary hypogonadism occurs when there is an issue with the parts of the brain (i.e., the hypothalamus or the pituitary gland) that signal testosterone production via the production of follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
Men can be born with primary or secondary hypogonadism or develop it later in life due to an injury or infection. In some cases, men can have both primary and secondary hypogonadism, which is known as mixed hypogonadism.
Treatment for male hypogonadism is aimed at raising a man’s testosterone levels back into the normal range. This can be accomplished through testosterone replacement therapy (TRT). There are several types of TRT including:
- Topical gels, which are absorbed through the skin and can provide longer-lasting increases in serum testosterone than some of the other TRT options.
- Testosterone injections that have been around for many years andare typically self-administered at home by the patient. Testosterone can be injected intramuscularly (into the gluteus or quadricep muscles) or subcutaneously into the abdominal fat. There are now long-acting testosterone injections that last up to 10 weeks. In addition, there are now autoinjectors for testosterone injections for men who are needle phobic.
- Buccal tablets release testosterone to the buccal cavity (where the gums meet a person’s upper lip). While generally well-tolerated, some patients complain of gum irritation with buccal tablets.
- Implantable pellets are surgically implanted under the skin and supply the body with supplemental testosterone for three to six months.
- Oral testosterone tablets are a recent development in the field of TRT. Previously, oral testosterone was avoided due to concerns about potential liver damage, but new formulations avoid this pitfall.
- Nasal testosterone is a gel that is administered to the nose three times per day using a pump dispenser.
Patients may prefer one type of TRT over another, but it is important to discuss the benefits and potential side effects of each type during the medical consult so they have a clear understanding of their options before deciding on a treatment plan.
References:
“AUA consensus statement on advanced practice providers: executive summary.” Urology Practice 2, no. 5 (2015): 219-222. https://doi.org/10.1016/j.urpr.2015.05.001
Kumar, P., Kumar, N., Thakur, D. S., & Patidar, A. (2010). Male hypogonadism: Symptoms and treatment. Journal of advanced pharmaceutical technology & research, 1(3), 297. DOI: 10.4103/0110-5558.72420
Mayo Clinic. (2021, September 29). Male hypogonadism. https://www.mayoclinic.org/diseases-conditions/male-hypogonadism/symptoms-causes/syc-20354881
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