In this special episode of Pearls & Perspectives, recorded live at the 26th Annual Fall Scientific Meeting of the Sexual Medicine Society of North America in Grapevine, Texas, host Amy Pearlman, MD, brings together an energetic cohort of researchers working with Mohit Khera, MD, MBA, MPH. Each trainee highlights cutting-edge work poised to reshape how clinicians diagnose, counsel, and treat patients in sexual and reproductive medicine. Key Research Highlights 1. The Androgen Receptor and Individualized Testosterone Therapy Nelson Mills (Rice University) Mills presents compelling early data showing that men with longer androgen receptor (AR) gene lengths may require much higher testosterone levels to feel symptomatically normal. These patients often appear “eugonadal” by labs but feel hypogonadal clinically. AR length testing (via simple PCR) could one day guide personalized TRT dosing. Why it matters: This may fundamentally shift T-therapy from lab-based to receptor-based decision-making. 2. Genetic Insights & Device Innovation in Peyronie Disease Arnaav Walia (Rutgers MS3) His work with Khera explores: • genetic predisposition to Peyronie disease and predictors of response to collagenase clostridium histolyticum (CCH, Xiaflex). • early-phase trials using radiofrequency energy to stimulate superficial tissue vasculature and improve curvature. Why it matters: Brings precision medicine and device-based therapy into earlier stages of Peyronie’s care. 3. Using CCH During the Active Phase of Peyronie Disease Peyton Coady (University of Tennessee, MS3) A retrospective cohort shows patients treated with CCH during the active phase achieve similar outcomes to those treated in the stable phase. Why it matters: This counters traditional guidelines urging clinicians to “wait for stabilization”—a recommendation patients understandably despise. 4. Rethinking Azoospermia: Finding Hidden Sperm With AI Blair Stocks, MD, PhD (Baylor College of Medicine [BCM] faculty) and Aidan Boyne (BCM MS3) Using high-speed flow cytometry imaging and a customized AI algorithm, the team identifies sperm in men previously diagnosed as azoospermic. Manual review of samples can take 8 hours—AI processes images in milliseconds. Early findings: 40% of men labeled azoospermic actually have viable sperm present. Why it matters: This could dramatically alter fertility counseling, offer hope to thousands, and reduce unnecessary invasive procedures. 5. High-Frequency Ultrasound for ED & Testicular Mapping Another project uses high-resolution testicular and penile ultrasound to: • identify micro-regions of sperm production for targeted retrieval • detect early vascular changes that may predict future erectile dysfunction—and potentially cardiovascular disease. Why it matters: May become a noninvasive screening tool for infertility and systemic vascular health. Why This Matters for Clinicians and Patients This vibrant research group is addressing persistent clinical frustrations: • Why do some men need “high-normal” T levels? • Can we intervene earlier in Peyronie disease? • Are we missing viable sperm in men told they have none? • Can imaging or genetics help us personalize therapy? Across the board, their work offers answers that could transform guidelines, reduce invasive procedures, improve diagnostic accuracy, and empower clinicians with more personalized tools.

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