Learning about your patient’s preferences and values when it comes to tailoring testosterone replacement therapy (TRT) are important factors to keeping them at the center of care. And the multidisciplinary team can help do this. To learn more about strategies and approaches to TRT management, join Dr. Brian McDonough as he speaks with Dr. Wayne Hellstrom, Professor of Urology and Chief of Andrology in the Department of Urology at Tulane University School of Medicine.
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Approaches to Individualizing Testosterone Replacement Therapy
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Announcer Introduction
Welcome to Clinician’s Roundtable on ReachMD. Here’s your host, Dr. Charles Turck.
Dr. Turck
This is Clinician’s Roundtable on ReachMD. I'm Dr. Charles Turk, and joining me to discuss strategies for tailoring testosterone therapies for patients is Dr. Omar Raheem. Dr. Raheem is an Associate Professor of Urology at UChicago Medicine. Dr. Raheem, thanks for being here today.
Dr. Raheem
Thank you, Charles.
Dr. Turck
So let's jump right in, Dr. Raheem. How do you learn about your patient's preferences and values when it comes to testosterone replacement therapy, or TRT for short, and keep them at the forefront of care?
Dr. Raheem
Sure. It's an important question, Charles. I think when patients seek testosterone therapy, there are a couple of things we need to discuss with them, obviously, their needs, their preference, their desire to continue on this testosterone therapy. I think nowadays we have a plethora of products that can be provided to patients. They're all FDA-approved after the safety and efficacy trials on these products. I do acknowledge the patient’s preference in terms of if they are needing an oral pill, maybe they're taking a number of medications, we can add testosterone pill. That can be convenient for them if they prefer injectables. If they're traveling long distance and they don't take any daily medication, I think the injectables would be a good format. There's also the topical option, which can be also convenient for men who are used to daily use.
Dr. Turck
And as a follow-up to that, what approaches to shared decision-making do you use to select a TRT option?
Dr. Raheem
It's important to share with the patient the discussion about the TRT products. I think it comes down to the patient evaluation and the medical need. I think each patient is different, obviously, and we need to be acknowledging their underlying comorbidities and medical conditions when it comes down to the products that we have. So I think acknowledging also the side effects that could be caused by this medication as well, but it's minor, but I think it's important to acknowledge that when we decide with the patient their therapy plan.
Dr. Turck
And then once you select a TRT option, what best practices have you found helpful for managing your patients?
Dr. Raheem
As part of the American Neurological Association and in the Crohn Society guidelines, in the treatment of the testosterone therapy, I think these guidelines provided a roadmap for physicians, like myself to follow, which include regular checkups and evaluation physical examinations, as well as monitoring for side effects. This should be coupled with regular checkups or blood work, which includes C-B-C-P-S-A and testosterone and liver function test on a three to six-month basis to monitor for the biochemical response of TRT on those patients. Acknowledging the side effects is important as well. If a patient develops any hypertension or high blood counts, it needs to be addressed and treated to avoid any possible complications in the future.
Dr. Turck
For those, just joining us, this is Clinician’s Roundtable on ReachMD. I'm Dr. Charles Turk, and I'm speaking with Dr. Omar Raheem about best practices for collaborative testosterone replacement therapy, or TRT management.So now that we've discussed how we can keep patients at the forefront of care, let's switch gears and look at the multidisciplinary team. Dr. Raheem, who's involved in this team, and what are their respective roles in the team management?
Dr. Raheem
I'm urologist, as you know, Charles. So I see patients in my clinic, and I'll be the main point of contact with patients when they come in. Although patients will need to make an appointment first with my front desk when a patient comes and sees me. Oftentimes also, I have a physician assistant with me who can really provide assistance in managing the patient's care and treatment plans. Beyond that, obviously we have nurses and medical assistants who can execute the patient treatment after the drugs have been prescribed. Oftentimes the drugs need some follow-up from our end to ensure the patient receives the right prescriptions to ensure authorization is done, prescriptions are sent to the patients on a timely fashion.
Dr. Turck
And what are some best practices you employ when working with this multidisciplinary team so that the patient stays at the center of care?
Dr. Raheem
I think when it comes to testosterone therapy, I think the most important thing is follow-ups and monitoring of the treatment plans. Oftentimes, patients will have potential questions about the treatments ensuring patients receiving the drug, addressing all their concerns or messages regarding the treatment, if they have any side effects, for example. We need to know about that. And then also addressing the issues at hand that will maintain patients compliance with the drug treatment going forward. Oftentimes, if there's a question about low testosterone, and that is complex nature of the patient, often we refer them to endocrine as well. Endocrine specialists can be very helpful in also addressing some of these complex scenarios.
Dr. Turck
And as we close our discussion today, Dr. Raheem, from a global standpoint, would you recap the impact these patient-centric approaches could have on patients with low testosterone?
Dr. Raheem
Yeah, we know testosterone is a quite common condition. It affects a lot of men. As we age, the testosterone levels decline with time with age. So it really has been a rising problem. And there's other medical conditions that can lead to this problem, like metabolic problems, diabetes, obesity, other conditions can lower testosterone levels. So the impact of treatment when chosen correctly is huge. It'll improve their quality of life in terms of physical, sexual, and also mental health in those who need it.
Dr. Turck
Well, with those final comments in mind, I want to thank my guest, Dr. Omar Raheem, for joining me to discuss personalized approaches to testosterone replacement therapy. Dr. Raheem, it was great having you on the program.
Dr. Raheem
Thank you very much, Charles. Appreciate you.
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Overview
Learning about your patient’s preferences and values when it comes to tailoring testosterone replacement therapy (TRT) are important factors to keeping them at the center of care. And the multidisciplinary team can help do this. To learn more about strategies and approaches to TRT management, join Dr. Brian McDonough as he speaks with Dr. Wayne Hellstrom, Professor of Urology and Chief of Andrology in the Department of Urology at Tulane University School of Medicine.