Clinical Urologic Endocrinology: Principles for Men’s Health

Book Preface

Since the days of the nineteenth century, we have come a long way in our understanding of the importance of the male hormonal milieu and how the hypothalamicpituitary- gonadal axis functions, self-regulates, and the best treatments when it is not optimized. In 1889, before the Societe de Biologie in Paris, the neurologist/physiologist Charles-Edouard Brown-Sequard fi rst claimed to have improved his own physical strength and intellectual capacity by self-injecting “liquid testiculaire.” This was a formulation prepared from animal testicles, primarily canine and guinea pig. Although we have certainly refi ned our treatments since then and the field has signifi cantly advanced, especially over the last two decades largely due to the work of many of the contributors to this text, there are still unanswered questions and gaps in our knowledge.

We are advancing our understanding for the sake of our patients, and the largest step forward was recognizing the importance of the hormonal axis for men’s health. Low testosterone is the major focus, but this text will also discuss other hormonal interactions in the realm of urologic endocrinology, which spans in its relevance to multiple types of health care providers, in essence any providing care for men.

Drs. Butenandt and Ruzicka won the Nobel Prize in 1939 for isolating testosterone and the clinical impact of this hormone on our patients has carried no lesser importance since that time. With 481,000 new cases of low testosterone in American men between the ages of 40 and 69 each year and an estimation that less than 5 % of hypogonadal men in the United States are being treated, the task falls upon health care providers to educate our patients and the public on the importance of this hormonal defi ciency and the benefi ts of appropriate treatment. This means that providers caring for hypogonadal men must be well versed in the process, the evaluation, the treatment options, and the risks; which is the aim of this text. It is crucial to overcome the current barriers to treatment of men with low testosterone including the current lack of consensus in the defi nition of low testosterone, the lack of confi dence in diagnostic testing, the non-specifi city of the generalized and vague signs and symptoms of low testosterone, the perception that low testosterone is a diffi cult and time consuming health issue for providers to manage, and the powerful fear that treating low testosterone may induce prostate cancer, which continues to be disproved with multiple studies.