American Urological Association

So let's start with how we actually identify testosterone deficiency, because this is where the clinical guidelines become particularly important.

The American Urological Association, or AUA, recommends using a total testosterone level below 300 ng per deciliter as a reasonable cutoff to support the diagnosis of testosterone deficiency.

but a number by itself isn't enough to make that diagnosis.

The AUA recommends that testosterone be measured on two separate occasions, with both measurements obtained in the early morning, and that the diagnosis be based on low testosterone levels in combination with symptoms or signs consistent with testosterone deficiency.

and more and more people now around the world.

In fact, there were at least five papers recently at the AUA convention in which people were doing clipless nerve preservation.

So I've been doing clipless nerve preservation now for eight years.

No clips for the last eight years, and the outcomes are very clear.

Let me tell you an interesting story.

So a patient came in the other day and they said, what is the normal range? What's the range you were trying to put me at? And I said, well, according to the AUA guidelines, we should have you between 450 and 600.

That's called the mid-range.

He said, okay, so you want me between 450 and 600? I said, yes.

And I feel, I've felt bad for a year or two, and they're dismissed.

And that to me is quite sad.

But don't you think that our focus has changed a little bit with that middle tertile thing that came out with the AUA guidelines? Because that's actually 450.

So now are you going to treat people who come in who are 400 with symptoms because they're not in that mid-range situation?

And if you think it does, it'll be gone a week later.

Or we go to the AUA and we think we're learning stuff, but it doesn't stick.

We're already getting CME from evidence.

And I think when we do this at the point of care, it was a wonderful way to learn.

And so I think there's a long way to go to sort of eliminate that stigma, but I do think this conversation and this sort of stuff helps because... um people need to know what's an option it's not perfect right nothing is perfect but it's great and it's it's reliable as you mentioned and it and it works well yeah so i do want to talk about regenerative therapies so in the last i don't know what 10 years or so we've seen a resurgence in these sort of regenerative therapies like shockwave prp stem cells to some degree um do you use them are they efficacious what are your thoughts on them

I'll look at, you know, typically when I see a patient, I like to go over AUA guidelines.

There's a reason why we have guidelines for guidance on what we think is appropriate for patients to understand what is an appropriate treatment, what is not.

And when we look at PRP, we look at stem cells, we look at shockwave, a lot of it is still in the investigational process.

you tell the patient who's been denied twice? You know, my doctor said, nope, nope, nope, nope, nope.

What would you, would you have her print out the AUA guidelines, which clearly

say we can treat breast cancer patients with this? So I would, yes, I would, I would, there are a number of studies that have been published and in the book, I list them all out.

And then we have guidelines and I would bring the studies with the guidelines, not just from- We