Treatment of Hypogonadism: Testosterone Therapy - Who, When, Why, and How? with Dr. T. Mike Hsieh

T. Mike Hsieh, MD, MBA, Professor of Urology and Director of the Men’s Health Center, University of California, San Diego, San Diego, California, presents a practical overview of testosterone therapy, focusing on why testosterone deficiency matters, how to diagnose it appropriately, and how to manage treatment safely. Dr. Hsieh reviews the prevalence of low testosterone in aging men and in patients with obesity, diabetes, metabolic syndrome, chronic opioid use, and erectile dysfunction. He emphasizes that symptoms of testosterone deficiency are often nonspecific and that diagnosis requires both clinical symptoms and low testosterone levels on laboratory testing. He outlines the appropriate workup, including morning testosterone testing on two occasions and additional evaluation with follicle-stimulating hormone, luteinizing hormone, prolactin, estradiol, complete blood count, and prostate-specific antigen when appropriate. Treatment options include topical gels, injections, implants, and oral formulations. Dr. Hsieh reviews formulation-specific considerations and discusses the importance of selecting therapy based on patient goals, cost, and side effect profile. The presentation highlights regular monitoring, with special attention to erythrocytosis, prostate-specific antigen, fertility suppression, gynecomastia, and sleep apnea. Dr. Hsieh also addresses common clinical questions, including treatment in obese men on GLP-1 therapy, management of borderline testosterone levels, and when referral is appropriate. Dr. Hsieh provides clinicians with a practical framework for evidence-based testosterone management. Don't forget to join the GRU Community: https://grandroundsinurology.com/regi... Follow us on Twitter/X: https://x.com/GRUrology And like and subscribe to us here on YouTube! #TestosteroneTherapy #MensHealth #Urology #Hypogonadism #TRT