The role of testosterone replacement therapy following radical prostatectomy.

Hypogonadism is associated with a decreased serum testosterone level and numerous signs and symptoms, such as decreased libido, erectile dysfunction, decreased muscle mass, increased fat deposition, decreased ability to concentrate, and decreased bone mineral density Unlike women, who have a sudden loss of estrogen during menopause, men experience a gradual 1% to 2% decline in testosterone every year starting at age 30. There are several reasons for decreasing testosterone levels with age. As men age, they have a decline in Leydig cell numbers (primary failure), a decrease in gonadotropin-releasing hormone pulse amplitude (secondary failure), and an increase in sex hormone-binding globulin, all of which result in the reduction of available free or total testosterone Testosterone replacement therapy (TRT) is effective in treating the signs and symptoms of hypogonadism. These benefits include improvements in sexual function, muscle mass and strength, fat distribution, bone density, cognition, and mood Hypogonadism occurs frequently among men who have prostate cancer. Yamamoto and colleagues The association between testosterone replacement therapy and the development of prostate cancer In 1941, Huggins and Hodges [14] first demonstrated that a reduction in testosterone by castration caused metastatic prostate cancer to regress and that administration of exogenous testosterone promoted prostate cancer growth; however, current data have demonstrated that low testosterone levels are more likely to be associated with prostate cance

Changes in the Effects of Peyronie's Disease After Treatment With Collagenase Clostridium histolyticum: Male Patients and Their Female Partners

Introduction: Collagenase Clostridium histolyticum (CCH) intralesional injection was efficacious for the management of Peyronie's disease (PD) in the double-blinded, randomized, placebo-controlled Investigation for Maximal Peyronie's Reduction Efficacy and Safety Studies I and II (IMPRESS I and II). Little is known about the consequences of PD or treatment on the sexual partners of affected men. Aim: To assess the safety and efficacy of CCH treatment in men who received placebo in the IMPRESS I or II study and to evaluate the men's PD symptoms and partner bother as reported by female sexual partners. Methods: In this phase 3, open-label study (NCT01685437), men (n = 189) received up to eight injections of CCH (0.58 mg/injection). Female sexual partners who provided informed consent at screening (n = 30) participated in the study. Main Outcome Measures: Co-primary end points were change or percentage of change in penile curvature deformity and change in PD symptom bother domain score of the Peyronie's Disease Questionnaire (PDQ) from baseline to week 36. Participating women completed the PDQ for female sexual partners (PDQ-FSP) and the Female Sexual Function Index (FSFI). Results: Statistically significant mean improvements were observed in penile curvature deformity (36.3% decrease; 95% CI = −41.6 to −30.9) and PDQ symptom bother score (2.4-point decrease; 95% CI = −3.0 to −1.8) from baseline to week 36. Most treatment-emergent adverse events were mild or moderate. After CCH treatment of their male partners, female sexual partners reported improvement (using the PDQ-FSP) in their male partner's PD symptoms and female bother regarding their partner's PD. The percentage of female sexual partners with sexual dysfunction (FSFI total score ≤ 26.55) also decreased after male partner treatment, from 75.0% at baseline to 33.3%. Conclusions: These results support the safety and efficacy of CCH in the management of appropriate patients with PD and the potential benefits for patients' partners. Goldstein I, Knoll LD, Lipshultz LI, et al. Changes in the Effects of Peyronie's Disease After Treatment With Collagenase Clostridium histolyticum: Male Partners and Their Female Partners. Sex Med 2017;5:e124–e130

Cabergoline in the Treatment of Male Orgasmic Disorder—A Retrospective Pilot Analysis

Introduction: Male orgasmic disorder is common, with few treatment options. Cabergoline is a dopamine agonist that acts centrally to normalize serum prolactin that could improve orgasmic dysfunction. Aims: To determine whether cabergoline increases the potential for orgasm in men with orgasmic disorder. Methods: A retrospective chart review of men treated in a single andrology clinic for delayed orgasm or anorgasmia in a pilot study using cabergoline 0.5 mg twice weekly was performed. Duration of treatment and response were noted. Medical records were examined for other factors including history of prostatectomy and concomitant androgen supplementation. Main Outcome Measures: Subjective improvement in orgasmic function resulting from cabergoline treatment. Results: Of 131 men treated with cabergoline for orgasmic disorder, 87 (66.4%) reported subjective improvement in orgasm and 44 (33.6%) reported no change in orgasm. Duration of therapy (P = .03) and concomitant testosterone therapy (P = .02) were associated with a significant positive response to cabergoline treatment. No differences were found between injectable and non-injectable testosterone formulations (P = .90), and neither age (P = .90) nor prior prostatectomy (P = .41) influenced the outcome of cabergoline treatment. Serum testosterone levels before (P = .26) and after (P = .81) treatment were not significantly different in responders vs non-responders. Conclusion: Cabergoline is a potentially effective and easy-to-administer treatment for male orgasmic disorder, the efficacy of which appears to be independent of patient age or orgasmic disorder etiology. Prospective randomized trials are needed to determine the true role of cabergoline in the treatment of this disorder