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    Henry Rosevear, MD
    Dr. Rosevear, a member of the Urology Times Clinical Practice Board, is in private practice at Pikes Peak Urology, Colorado Springs, CO.

    Clinical hypogonadism and the urologist’s role: Primum non nocere

     

    Henry Rosevear, MDHenry Rosevear, MD

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    Dr. Rosevear is in private practice at Pikes Peak Urology, Colorado Springs, CO

     

    I consider urology to be a very unique field, one that I am lucky to be part of. We deal with conditions and talk to patients about problems that are not often discussed in “polite” conversation.

    Professionally, we take this responsibility very seriously. We constantly push the field forward, taking full advantage of advances in both technology (ESWL, robotics, and ureteroscopy, for example) and pharmacology (PDE-5 inhibitors and beta-3 agonists, to name two), even when using them sometimes decreases our own surgical volume. Recently, though, I have begun to wonder whether the medical community (not necessarily the urology community) has been too quick to embrace the widespread use of testosterone replacement therapy.

    Testosterone replacement therapy is not new. Some of the early work came in 1889 from Brown-Sequard, when, at the age of 72, he injected himself with a combination of dog and guinea pig testicular extract and reported increased vigor. I’ve often wondered if Brindley had that article in mind during his famous 1983 AUA presentation on the effects of penile self-injection of phenoxybenzamine. (Click here if you’re not familiar with that bit of urology lore.) 

    Within 50 years, Butenandt (1931) had isolated androgen and Rizica (1935) had synthesized it. By the 1950s, injectable testosterone esters were available and oral testosterone undecanoate was on the market by the 1970s. Twenty years later, a transdermal patch was available, and the gels were introduced in 2000.

    The clinical use of testosterone, however, did not significantly increase until the last few years. According to data from Bloomberg, sales of Androgel increased from $874 million in 2011 to almost $1.14 billion in 2013, and Axiron sales increased from $24 million to $168 million over a similar time period). Another Bloomberg article shows that prescriptions for testosterone replacement have increased fivefold between 2000 and 2011 and forecasts that sales of testosterone should triple by 2017.

    The trend toward increased use of testosterone replacement is not confined to the United States. A graph in a recent article from the BBC shows that Sweden has also had a dramatic increase in testosterone use.

    Continue to next page for more.

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