In this episode of Pearls and Perspectives, host Amy Pearlman, MD sits down with Andrew Y. Sun, MD, during the American Urological Association's (AUA) 2025 Annual Meeting in Las Vegas, NV to explore contemporary, practical approaches to testosterone therapy. Sun, a urologist specializing in male sexual health at a large urology group in Dallas-Fort Worth, shares how his clinical practice has evolved with the growing use of oral testosterone therapies. Together, they discuss the "art" behind managing testosterone deficiency, moving beyond standard injections and pellets to creative strategies that prioritize both symptom relief and long-term patient goals like fertility preservation. Sun explains how oral testosterone formulations—thanks to their short-acting pharmacokinetics—can preserve some endogenous testosterone production, unlike traditional injections that often completely suppress it. He details how he customizes treatment plans by blending oral testosterone with agents like Clomiphene to boost hormonal levels without fully shutting down the body's own system, offering a more physiologically balanced solution for men who may want children in the future. Later, they delve into combination therapy strategies, including using oral testosterone alongside injectable TRT to better manage SHBG levels and mitigate side effects like polycythemia and acne—an approach that is gaining traction but rarely discussed in traditional guidelines or research. Throughout the conversation, Sun challenges outdated perceptions about oral testosterone, emphasizing that modern formulations avoid the liver toxicity concerns associated with older agents like methyl testosterone. He encourages providers to consider oral testosterone as a first-line option for many patients, citing its convenience, patient preference, and physiological advantages.

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