Latest news with #urology
Yahoo
15-07-2025
- Business
- Yahoo
Aquablation® Therapy's Assigned Category I Code in 2026 Medicare Proposed Physician Fee Schedule
SAN JOSE, Calif., July 14, 2025 (GLOBE NEWSWIRE) -- PROCEPT BioRobotics® Corporation (Nasdaq: PRCT) (the 'Company'), a surgical robotics company dedicated to advancing patient care through transformative urology solutions, today announced that Aquablation therapy was assigned a Category I code effective January 1, 2026. The 2026 Medicare Proposed Physician Fee Schedule (PFS) includes payment rates for a new Category I Current Procedural Terminology (CPT) code related to Aquablation therapy. Category I CPT code 52XX1 will replace Category III CPT code 0421T as the primary code for Aquablation therapy. 'Securing a Category I CPT Code marks a major milestone for PROCEPT, the urology community, and the patients we serve,' said Sham Shiblaq, chief commercial officer of PROCEPT BioRobotics. 'This transition recognizes the clinical value and widespread use of Aquablation therapy as we continue to make progress toward becoming the BPH surgical standard of care. The Category I code will further support surgeon adoption and broaden patient access to a treatment that delivers durable symptom relief with a low risk of sexual side effects.' The new CPT Category I Code 52XX1 was assigned a 2026 national Medicare physician proposed payment of 16.14 total RVUs which translates to an approximate national average of $540, under the 2026 proposed Medicare PFS. By comparison, TURP was assigned 15.82 total RVUs which translate to an approximate national average of $529. The PFS Proposed Rule was released on July 14, 2025, and updated payment policies and payment rates for services will be provided for Medicare beneficiaries on or after January 1, 2026. The Proposed Rule release is followed by a public comment period that will close in September 2025 and will culminate in CMS' release of the Final Rule, which is expected to be announced in November 2025 for implementation on January 1, 2026. The Proposed Rule is therefore subject to change. These 2026 proposed rule payment values and RVU assignments can be viewed on the CMS website at: About Aquablation TherapyAquablation therapy is the first and only ultrasound guided, robotic-assisted, heat-free waterjet for the treatment of BPH. The system's real-time ultrasound imaging provides the surgeon with a multi-dimensional view of the prostate enabling personalized treatment planning tailored to each patient's unique anatomy. The surgeon can specify which areas of the prostate to remove while preserving the anatomy that controls erectile function, ejaculatory function and continence. Once the treatment plan is mapped by the surgeon, the predictable robotic-assisted execution enables prostate tissue to be removed in a precise, targeted and controlled fashion. About PROCEPT BioRobotics CorporationPROCEPT BioRobotics is a surgical robotics company focused on advancing patient care by developing transformative solutions in urology. PROCEPT BioRobotics manufactures the AQUABEAM® and HYDROS™ Robotic Systems. The HYDROS Robotic System is the only AI-powered, robotic technology that delivers Aquablation therapy. PROCEPT BioRobotics designed Aquablation therapy to deliver effective, safe, and durable outcomes for males suffering from lower urinary tract symptoms or LUTS, due to BPH that are independent of prostate size and shape or surgeon experience. BPH is the most common prostate disease and impacts approximately 40 million men in the United States. The Company has developed a significant and growing body of clinical evidence with over 150 peer-reviewed publications, supporting the benefits and clinical advantages of Aquablation therapy. Forward-Looking StatementsThis press release may contain forward-looking statements within the meaning of federal securities laws. Forward-looking statements are subject to numerous risks and uncertainties that could cause actual results to differ materially from those anticipated or implied in such statements. PROCEPT BioRobotics undertakes no obligation to publicly update or revise any forward-looking statements. Important Safety InformationAll surgical treatments have inherent and associated side effects. For a list of potential side effects visit Investor Contact:Matt BacsoVP, Investor Relations and Business in to access your portfolio
CNA
12-07-2025
- Health
- CNA
Is going to the bathroom 'just in case' bad for you?
As children, many of us were encouraged to pee before we left the house or whenever a bathroom was nearby. There was a good reason: Using the bathroom 'just in case' can help prevent accidents among children prone to 'holding it.' Urologists call this practice 'convenience' or 'proactive' voiding, and people of all ages do it, often before heading out the door or going to sleep. An occasional 'just in case' bathroom break won't do much harm, said Dr Ariana Smith, a professor of urology at the University of Pennsylvania Perelman School of Medicine. But doing it several times a day, she said, can increase the likelihood of bladder issues by disrupting the natural feedback loop between your bladder and your brain. HOW DOES PEEING "JUST IN CASE" AFFECT BLADDER HEALTH? To understand why proactive voiding can be harmful, it helps to know how the bladder works. As your kidneys filter blood to remove waste, they produce urine, which is carried to your bladder. Women can typically hold up to 500 ml of urine, or around two cups, in their bladders; men can store 700 ml, or nearly three cups. We generally feel the urge to use the bathroom well before we hit that limit, when our bladder contains between 150 and 250 ml of liquid. As the bladder fills up, it sends nerve signals to the brain, letting us know it's time to go. The experts we spoke with said that when you pee 'just in case,' your bladder starts alerting your brain too early, before having the standard amount of urine. This disruption can reduce 'the volume your bladder can hold over time,' said Siobhan Sutcliffe, an epidemiologist and professor of surgery at Washington University. As a result, you might experience discomfort when you are in a situation where you can't use the bathroom right away, Dr Smith said. Urinating before the need arises also makes you more likely to strain. Doing so puts extra pressure on the pelvic floor muscles – a muscle group that supports the bladder and other organs – and can potentially weaken them, said Kathryn Burgio, a behavioural psychologist and professor emerita of gerontology, geriatrics and palliative care at the University of Alabama at Birmingham School of Medicine. For these reasons, 'just in case' peeing may lead people to develop an overactive bladder, a condition marked by a strong and frequent urge to urinate, Dr Sutcliffe said. IS IT POSSIBLE TO BREAK THE HABIT? The short answer is yes. Researchers have found that the brain has more control than we might think, or as Dr Alayne Markland, chief of geriatrics at the University of Utah School of Medicine, likes to tell her patients: 'Mind over bladder.' If you want to reduce preventative bathroom breaks, try deep breathing, distraction or self-statements like 'I'm in control,' Dr Burgio said. A few small studies suggest that mindfulness techniques can reduce sudden, intense urges to pee. More research is needed, but experts believe that methods like these could help you retrain your bladder to send signals only when more liquid has accumulated. If you're already experiencing conditions like an overactive bladder or urinary incontinence, however, there are other things you can try: Work with a pelvic floor therapist. There's a growing body of research to suggest that physical therapy for pelvic floor muscles can help people have more control over when they pee, Dr Sutcliffe said. By working with a physical therapist, patients can learn to engage and strengthen those muscles to control the bladder. 'We teach people to wait, take a deep breath and contract the pelvic floor muscles repeatedly,' Dr Burgio said. That will 'help calm the bladder, so the urge goes away.' Monitor what you drink. Experts emphasised that lifestyle modifications like fluid management can also help. Caffeine, alcohol, drinks with high acidity and even some artificial ingredients, such as sweeteners, can irritate the bladder's lining and cause more frequent urges. Cutting back on caffeine, Dr Smith said, 'is something we've universally seen as helpful,' as doing so can decrease urges and leakage. Get checked out for other health conditions. Talk with a doctor about your overall health, as conditions like diabetes or sleep apnoea can cause more frequent urges. Other interventions, such as medication, may be options in cases like these. The goal is to tame the 'vicious cycle between the brain and the bladder,' said Dr Smith, who is optimistic that, in most cases, the effects of 'just in case' peeing can be remedied. 'Healthy bladders are resilient,' she said.
Medscape
11-07-2025
- Health
- Medscape
A Practical Toolbox for GSM: New Guidance From the AUA
This transcript has been edited for clarity. Rachel S. Rubin, MD: Welcome back to another episode of Sex Matters . I'm Dr Rachel Rubin. I'm a urologist and sexual medicine specialist, and I am honored and beyond thrilled to introduce you to my next two guests who were the co-chairs of the new guidelines for the genitourinary syndrome of menopause (GSM). Now, if you are a primary care clinician — really, if you are any clinician who takes care of women — you must know about these new, exciting, wonderful, multidisciplinary guidelines all about GSM. Dr Melissa Kaufman, why don't you begin with a short introduction? Melissa Kaufman, MD, PhD: I'm Melissa Kaufman. I'm really delighted to be here and spread this word to all my colleagues. I am a urologist and I work at Vanderbilt University in Nashville, Tennessee. Rubin: And Dr Una Lee? Una J. Lee, MD: I'm Una Lee. I'm a urologist and a female urology specialist at Virginia Mason Franciscan Health in Seattle, Washington. Rubin: All three of us were a part of this very multidisciplinary guideline that was endorsed not just by the American Urological Association (AUA); Dr Kaufman, who else endorsed this really important guideline that everyone needs to know about? Kaufman: It's pretty amazing. The American Urogynecologic Society; the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction; and the Sexual Medicine Society of North America also endorsed this guideline. It was created by the Patient-Centered Outcomes Research Institute, in collaboration with the Agency for Healthcare Research and Quality. Many stakeholders were engaged in order to create this guideline, including patient stakeholders. I'm so appreciative, Rachel, that you've had us here today. Millions of patients are going to benefit from this landmark endeavor, and getting this message out to all providers who treat women is critically important. So, accolades to everyone who's been involved. Rubin: What's so fabulous about this guideline is that it stemmed from the need of so many women who suffer with both the genital and urinary consequences that occur when they experience hormonal changes. So, Dr Lee, what is GSM? Why does it need a whole guideline? Lee: Great questions. Great introduction. I want to loop back, Dr Rubin, because you and I talked about this years ago. This has been years in the making. I think it was 2021 or 2022 when we proposed this to the AUA. It takes years for this kind of effort to be coordinated, for the evidence to be collated together, and to bring all these stakeholders together. So, thank you for being the spark and part of the inspiration. But full circle, GSM is a clinical syndrome and diagnosis where the levels of estrogen in the tissues decrease and it creates symptoms of discomfort, burning, urgency, frequency, vulnerability to UTIs, and pain with intercourse. It does not feel good. It feels like you have a UTI but you may not necessarily have a UTI. It feels like you have an overactive bladder, but you may or may not actually have one. There are signs and symptoms that you can see on exam, but it is a very encompassing, impactful, and treatable condition that affects a lot of women across the lifespan — particularly in menopause and beyond, but there are other women who suffer. Rubin: One of the amazing things Dr Lee didn't tell you is she published a paper that looked at about 1500 women, and nearly all participants had at least one symptom of GSM; you can have a urinary symptom, you can have a vaginal symptom, or you can have dryness. What is so landmark about these guidelines is that these symptoms don't just occur during menopause, right? That word "menopause" in the term "GSM" is a little confusing because these symptoms can happen in many different types of patient populations. It occurs in perimenopause. Dr Kaufman, what other conditions does GSM occur in? Kaufman: So many women and so many patients suffer from these symptoms, and it occurs across a very broad spectrum. We're talking about women who are taking oral contraceptives and women who are breastfeeding. They may have some of these symptoms but they're not in that traditional perimenopausal period. So, everyone needs to be screened when they're coming in with these signs and symptoms that, as Dr Lee mentioned, may really be detractors because they can be very complex in terms of the physical changes that go along with them. I think this guideline helps provide some very pragmatic statements to allow very rapid implementation, and it truly promises to be transformational. One of the things that we see in many patients who are in menopause and perimenopause is that these vasomotor symptoms that we typically assign to menopause (because of the changes in the estrogens and the androgens during this time period) will abate over time, but these genitourinary symptoms associated with GSM actually increase pretty dramatically over time. So, it's necessary — even if other systemic symptoms abate — that we look for these treatment solutions. Rubin: It's important to emphasize that this is not just a urology problem, right? This is a problem for your primary care clinician, for your gynecology clinicians, and even your orthopedic surgeons need to know about this. Why? Because if you're getting a hip replacement and you've got symptoms of urgency and frequency, you might get readmitted for a UTI. Or how about the hospital team that are always looking at catheter-associated urinary tract infections (CAUTIs) and all of these ICU-based urosepsis admissions? These are preventive tools that our patients can use to prevent UTIs and have really improved quality of life. That's what I love so much about these guidelines: They are an easy-to-read handful of statements — that can be implemented quickly — that describe the currently available treatments and why they're safe to use. So, let's get into it. Not only should we ask our patients if they have genital and urinary symptoms, but we also should ask about and encourage a multidisciplinary approach — which is, again, quite landmark. Tell us more about what the guidelines say about including our other colleagues in this space. Kaufman: We want to do what we would call "shared decision-making" across the spectrum for these patients. Some of that may include engaging primary care providers to help make these decisions, but what it really means is that it's a very patient-centered approach. It's a dynamic, collaborative process. It's a process that takes someone's value system into account, and sometimes that value system may include consideration of treatments for other conditions, such as other cancer treatments. We see many, many women who have undergone cancer treatments for breast cancer, for gynecologic cancers, and other systemic issues that may need us to use multidisciplinary decision-making in order to arrive at the best consensus opinion as to what path of therapy is going to be ideal for that individual patient. It is very preference-sensitive. When we talk about shared decision-making, this is a real living entity. It's not just words on paper that people utilize to say that they're trying to do something in the patient's best interest. We've explicitly put it in these guidelines to make it operational for the provider to help with patient care. Rubin: One of the things I love so much about this guideline is it truly is a toolbox that you can give to patients and use to offer treatments. The guideline no longer takes the approach of "this is the first-line therapy and you have to fail the first-line therapy to go to another option." It is a toolbox. If you need a pelvic floor physical therapist, you should find one. If you need a mental health professional, you should find one. You should use vaginal hormones because those are shown to prevent UTIs and can help with overactive bladder symptoms, dyspareunia, dryness, and quality-of-life issues. Of course, moisturizers and lubricants are great tools in your toolbox to help with symptom management, but they don't necessarily address the urinary symptoms. Dr Lee, why don't you talk to us about what the toolbox looks like when it comes to hormonal approaches to treating GSM? Lee: We have very compelling and accumulating data on the efficacy and safety of low-dose local vaginal estrogen for the treatment of GSM. I think that it comes with a conversation because people have a lot of misconceptions. First of all, local, low-dose vaginal estrogen is different from menopause replacement therapy — systemic therapy — which is for vasomotor symptoms, like hot flashes. You can actually be on both vaginal estrogen and systemic therapy safely, if needed and if appropriate, or you can be on one or the other. That would be the mainstay of treatment — vaginal estrogen in the form of creams, suppositories, or a local ring called Estring. They're equally efficacious. It's a patient preference and an insurance coverage issue. I like to prescribe what is covered by their insurance as a starting point so that they initiate therapy as quickly as possible. Get the benefits at a reasonable cost. In the paper Dr Rubin quoted, this national sample of women reported their experience with and barriers associated with vaginal estrogen therapy. Two of the major barriers were financial barriers, because treatment can be costly, and concerns about medication side effects. So, I think we have to address those upfront and tell patients about the benefits so that they understand that the benefit is worth the out-of-pocket cost and that this treatment is safe. It does not cause cancer. It does not cause death. It actually helps quality of life, symptom control, and prevention. Once our patients understand this, they're much more likely to be adherent and receive those benefits. Rubin: Absolutely, and again, what I love is that it's all about education, which is really what we're great at. The guideline teaches you that there are no data to show that local low-dose vaginal estrogen causes breast cancer. There is no fear or risk of endometrial cancer with these very low-dose products. We must have these shared discussions, even with our patients with breast cancer, because the quality-of-life issues of GSM are so drastic that, for many of our patients, the benefits of therapy far outweigh the risks. This is where we give that toolbox. There are tables within the guidelines that outline doses and how to prescribe these products. In addition to vaginal estrogen, there are strong data on vaginal DHEA and a SERM — ospemifene — that can be used as well and has been shown to help with GSM symptoms. Now, a lot of people get all these ads on TV for lasers, right? They're being told to get vaginal rejuvenation laser therapy. Dr Kaufman, what was the guideline consensus on these fancy and expensive lasers? Are we there yet? Kaufman: Well, we're not quite there yet, although there are some data that would be supportive. There are certainly some randomized trials that would suggest it's useful. But when we looked at the data in their entirety, there really wasn't evidence to support the use of any lasers in the treatment of the GSM-related vaginal symptoms, like dryness, discomfort, dysuria, quality of life, or dyspareunia. Although you may consider these for certain patient populations that absolutely are not candidates for vaginal estrogen or prefer this as an alternative, the data are not compelling, and these were relatively high-level data that we use to make those opinions. Rubin: How do you follow up these patients with GSM? Are these treatments something they use for a weekend? Is it short-term? How do we talk to these patients about these therapies, Dr Lee? Lee: I smile because that is a common thing that happens. Patients come back and they say, "Well, I used the prescription and then it ran out, so I stopped." We need to counsel them on the ongoing use for the continued benefit. It sometimes takes a few weeks to a few months to get the full benefit, so we should set that expectation. Patients need to use it continuously. We do a lot of things for maintenance. I think about all the face creams I use on my face, and I'm okay with using that for the rest of my life. I'm also okay with counseling my patients on the use of vaginal estrogen to maintain vaginal health, bladder health, urinary health, and prevention of UTIs in patients with that treatment indication. I think we need to counsel them on the continued use, the risk benefit — high on the benefit, low on the risk — and the need for follow-up. They need follow-up because it's a prescription that could be refilled by all the amazing PCPs out there who see their patients for maintenance and medication refills. Rubin: I absolutely love that, and I think the guideline's very clear about how we would love for you to do exams. And we do go into full detail on how to do exams: how to look at the labia, how to look at the urethra, how to look at the pelvic floor — we go into full detail. But this is something you can prescribe through telemedicine after speaking with your patients. You will not cause harm. Using these vaginal hormone therapies will ultimately help the microbiome and acidify the vagina to make good, healthy, lactobacilli grow so that you fight infection, prevent UTI, and make sex not painful. It can help with lubrication and orgasm. I always joke, "Vaginal hormones are better than Viagra because they're like Viagra but they prevent UTIs." These products are usually inexpensive. There should be a product covered by insurance, but if not, some of these cash price options of coupon cards or online pharmacies offer a tube of estrogen cream for about $13. Get comfortable with the costs, because those should not be barriers anymore. Dr Kaufman, what would you say to a clinician who says, "Oh my gosh, my patient had bleeding after I gave her vaginal hormones. Did I cause harm? I'm a primary care doctor; what should I do?" Kaufman: Those are very common issues that may arise in some instances, and the guidelines certainly encourage clinicians to send their patient to an appropriate provider that can help if there are any questions. That is part of the collaborative nature. Some of it may be trauma from the way that the estrogen was applied, so there may be issues with application. Sometimes if patients experience bleeding, they do need to undergo an evaluation by a gynecologist or someone who can help, depending on their other status. It would be quite rare that some of these things may happen, but this is another aspect of that multidisciplinary care you spoke about earlier. Rubin: The guidelines are very clear that you don't need to routinely do endometrial surveillance, so if a patient is not bleeding, you don't need to follow it. If any postmenopausal patient does bleed, they should get a workup by a gynecologist, right? That's normal care that we're all used to anyway. Dr Kaufman and Dr Lee — as co-chairs of this project, this was your baby. You wrote this incredible, collaborative, beautiful document. What are the major takeaways you want people to know? Because it's not just about writing this document; it's also about getting it into the hands of all of the clinicians and all of the patients who truly need to see this beautiful work that you've all done. Kaufman: It's this increased knowledge and the awareness that it's going to manifestly transform women's health. This has remained a glaring deficiency for all the time we've been practicing medicine, and likely for thousands of years before this. These types of issues have been pushed off to the side. Conditions that are very easily treated have been marginalized. So, I really want to get across that these guidelines are operational. The solutions for GSM are simple, effective, safe, and generally very inexpensive. They are very easy for clinicians to implement. You are going to take care of several comorbid conditions like UTIs, overactive bladder — you may even take care of conditions that we don't recognize today, such as changing a patient's entire microbiome, which may in turn change their bowel symptoms. We don't know all the implications, but we do know that these guidelines are going to transform the way that you interact with your patients. These guidelines will not only improve quality of life, but they will also improve patients' overall medical morbidity and mortality. Rubin: I couldn't agree more. Dr Lee, as the co-chair for this incredible collaborative document, what do you really want people to take away? Lee: These guidelines are evidence-based, patient-centered, and are going to give clinicians around the world the confidence to put this into practice. One of the most rewarding things I do in my daily clinical practice is meeting women, diagnosing them with GSM, treating them, and then seeing how their quality of life and symptoms dramatically improve. When you incorporate the tools in this guideline, you'll be that partner for patients in this journey and help them along the way. The awareness of GSM is growing exponentially. It's in the media. It's in the news. Women are so grateful for this knowledge to be out there. Like Dr Kaufman said, I think this is going to be transformative and impactful, and this is just the beginning. Rubin: It's been so incredible to witness this whole process get carried out, and I'm so grateful to the AUA for investing in these guidelines — for caring about women's health in this very big way. It is so transformational and important. Spreading awareness about this guideline is going to spark even more research and even more knowledge, which we so desperately need in women's health. I'm so grateful to these incredible mentors of mine for joining me today. We hope you all read the AUA/SUFU/AUGS Guideline on Genitourinary Syndrome of Menopause and let us know what you think.
Yahoo
08-07-2025
- Health
- Yahoo
The testosterone trap: Why your problem might not be ‘low T'
Dr. Jamin Brahmbhatt is a urologist and robotic surgeon with Orlando Health and an assistant professor at the University of Central Florida's College of Medicine. You're feeling unusually tired and sad, and your interest in sex has dropped off. That's no fun. If you're a guy, you may be thinking you have low testosterone. Wait a minute. Don't we all experience some or all of these symptoms at one time or another? After a late night out, a stressful workweek or even just a bad night's sleep, it's common to feel tired, irritable or unmotivated. But I know my patients want to eliminate low testosterone as the source, so I often start with a survey called the Androgen Deficiency in the Aging Male, or ADAM, questionnaire. Take a minute to see how many 'yes' answers you collect. Do you have a decrease in your libido, or sex drive? Do you have a lack of energy? Do you have a decrease in strength and/or endurance? Have you lost height? Have you noticed a decreased enjoyment of life? Are you sad and/or grumpy? Are your erections less strong? Have you noticed a recent deterioration in your ability to play sports? Are you falling asleep after dinner? Has there been a recent deterioration in your work performance? If you answered 'yes' to question 1 or 7, or to more than three questions overall, you might have low testosterone, according to this questionnaire. Or maybe you don't. These questions and answers are the start of this journey, not the end. While these questions can be helpful, they're broad enough to describe common life experiences we all face. As a urologist specializing in men's health, I often see patients convinced they have low testosterone based solely on these symptoms, only to find their testosterone levels are perfectly within range (more on those levels below). Even as an expert in the field, I have also run to get my testosterone checked — only to realize my symptoms were due to poor sleep habits rather than a true hormone deficiency. A quick note before we dive deeper: I understand this can be a sensitive topic. The information provided here isn't truth for every man. Many patients come to my clinic frustrated and seeking clear answers. Even within the medical community, there's significant debate about how to diagnose and manage 'low T.' My intention isn't to discount or downplay your concerns but rather to provide perspective and education, and to help you make informed decisions with your health care provider. Diagnosing low testosterone can be tricky, even for urologists like me. That said, a total testosterone level below 300 ng/dL (nanograms per deciliter) is recommended as the cutoff for diagnosing testosterone deficiency, according to the latest American Urological Association guidelines. But here's the tricky part: Labs don't always agree on what they consider normal, leading to confusion for patients and medical professionals. Take two of the most popular labs in the United States — Quest Diagnostics and LabCorp — as examples. Quest lists a normal testosterone range of 250 to 1100 ng/dL, while LabCorp uses 264 to 916 ng/dL. This means a level of 260 ng/dL might be flagged as 'low' by one lab but 'normal' at another. That's why most American urologists rely on the AUA guidelines, bearing in mind that every patient's situation is different. To ensure accuracy, guidelines recommend checking testosterone levels twice — on two separate mornings, ideally between 7 a.m. and 10 a.m. Why so early? Because that's when your fluctuating testosterone is at its peak, making it the best time to gauge your true levels. The first peak occurs in the morning, and the second peak (not as high as the morning) occurs in the afternoon, with your testosterone level gradually dropping by the end of the day. Lab companies also base their 'normal' reference ranges on the assumption that your testosterone tests are done during these specific morning hours. Additionally, the clinical diagnosis of testosterone deficiency relies not only on lab numbers but also on the presentation of symptoms such as low energy, reduced libido, loss of muscle mass or mood changes. When we start testosterone therapy, the goal is typically to raise testosterone levels into the range of about 450 to 600 ng/dL, which is considered the 'middle tertile' for most laboratory reference ranges. That middle third is the 'sweet spot' in which most men experience relief or resolution of their symptoms, without exceeding levels that could cause unwanted risks or side effects. It can take months to find the right and safe dose for a patient. Further adding to our dilemma as doctors, testosterone sensitivity varies from man to man. This variation may relate to genetic factors, according to research, including the sensitivity of your testosterone receptors. That's why a man with a testosterone level of 400 ng/dL may feel great, while another at the same level may experience countless symptoms. Currently, testing testosterone sensitivity isn't something readily available. The hope, however, is to someday have a routine test that helps us better personalize testosterone replacement therapy. Diagnosing and treating low testosterone is still very much a work in progress, with ongoing debates among experts. However, other medical issues that mimic low testosterone symptoms are more straightforward, backed by strong research. Many men whose testosterone lab results are completely normal still experience persistent symptoms. Often, these issues have more to do with lifestyle or other medical factors rather than testosterone itself. In 2025, many medical professionals, including myself, have become more open to testosterone replacement therapy as newer research has disproven some of the significant risks previously feared, such as concerns over prostate cancer or cardiovascular disease. Still, testosterone replacement isn't the right choice for everyone, and there could be other medical conditions that mimic the same symptoms that should be the primary focus of your (and your doctor's) investigation. In my own experience, poor sleep has frequently been the reason behind feeling tired and irritable. Sleep is essential for hormone regulation, mood stability and overall health. Chronic sleep deprivation can lead to fatigue, mood swings, low libido and difficulty concentrating, according to the National Institutes of Health. Those are all symptoms that mimic what we see with low testosterone. A common cause of poor sleep is obstructive sleep apnea, a condition where breathing repeatedly stops and starts when you're trying to get a good night's rest. Sleep apnea can dysregulate your hormonal balance and lower your testosterone levels. The use of continuous positive airway pressure, or CPAP, machines has been shown to improve sleep quality, improve testosterone and alleviate symptoms. I started using an activity tracker 24/7, which quickly identified my own sleep issues. Eliminating late-afternoon caffeine and swapping evening screen time for reading before bed significantly boosted my sleep quality, energy levels and overall mood — without any hormone therapy. My own small changes led to big improvements. Chronic stress may make you feel like your testosterone is low. Elevated cortisol, your body's primary stress hormone, can temporarily suppress testosterone production, causing symptoms identical to testosterone deficiency, especially reduced libido and fatigue. Diet and exercise also play crucial roles. Studies have shown that testosterone levels in men have significantly declined over recent decades. Experts believe this decline is closely linked to rising obesity rates, chronic stress and increasingly sedentary lifestyles. Many of my own patients report dramatic improvements in energy, mood and libido simply by losing weight, eating healthier and staying physically active. Several medical conditions can mimic symptoms attributed to low testosterone. Low thyroid or vitamin deficiencies (vitamin D or vitamin B12) can cause fatigue, mood changes and low libido. Diabetes or heart disease commonly cause fatigue and sexual dysfunction. Many patients initially thinking they have testosterone deficiency improve significantly after addressing these (and other) medical conditions without any need for hormonal treatment. Another common scenario involves erectile dysfunction. Many patients mistakenly attribute their decreased libido or lack of sexual interest to low testosterone. In most cases, frustration and anxiety about sexual performance led to psychological withdrawal, decreasing sexual desire and confidence. There is a small percentage of men whose erectile dysfunction genuinely stems from low testosterone levels. In these cases, testosterone replacement therapy might help. However, in my personal experience, replacing testosterone alone often leads to more frustration: Men may experience higher libido, yet still face difficulty achieving or maintaining an erection. That's why it's usually better to treat ED directly — often with affordable generic medications like tadalafil or sildenafil — to restore sexual confidence and performance. These medications, once costing nearly $40 per pill, are now often as affordable as $40 for a three-month supply, providing a practical and reliable solution for most men. The number of men receiving testosterone tests and prescriptions has nearly tripled in recent years, according to the 2024 American Urological Association guidelines. Up to 25% of men starting testosterone therapy were never tested before starting treatment, the AUA noted. Nearly half never have their testosterone rechecked after initiating treatment. Up to a third of men receiving testosterone therapy don't meet the official clinical criteria for testosterone deficiency. Meanwhile, many men who would benefit from testosterone replacement therapy remain untreated because of lingering concerns among health care providers about potential prostate cancer or cardiovascular risks — concerns not strongly supported by current evidence found in the AUA guidelines and recent research published in the New England Journal of Medicine. Additionally, men who skip routine screenings or simply don't feel comfortable openly discussing their symptoms also miss out on the treatment and relief they could experience. This all feels like a 'chicken or egg' scenario: Will starting testosterone therapy motivate men to exercise more and manage their health better, or should we first address lifestyle and health issues before considering hormone therapy? These complexities highlight the importance of personalized conversations between you and your health care provider. In my practice, I always focus first on lifestyle: Are you getting quality sleep? How high are your stress levels? Are you physically active? How healthy are your personal relationships? By tackling these areas first, many of my patients see noticeable improvement without falling into the testosterone trap. Get inspired by a weekly roundup on living well, made simple. Sign up for CNN's Life, But Better newsletter for information and tools designed to improve your well-being.
CNN
08-07-2025
- Health
- CNN
The testosterone trap: Why your problem might not be ‘low T'
Winding downFacebookTweetLink Follow Dr. Jamin Brahmbhatt is a urologist and robotic surgeon with Orlando Health and an assistant professor at the University of Central Florida's College of Medicine. You're feeling unusually tired and sad, and your interest in sex has dropped off. That's no fun. If you're a guy, you may be thinking you have low testosterone. Wait a minute. Don't we all experience some or all of these symptoms at one time or another? After a late night out, a stressful workweek or even just a bad night's sleep, it's common to feel tired, irritable or unmotivated. But I know my patients want to eliminate low testosterone as the source, so I often start with a survey called the Androgen Deficiency in the Aging Male, or ADAM, questionnaire. Take a minute to see how many 'yes' answers you collect. Do you have a decrease in your libido, or sex drive? Do you have a lack of energy? Do you have a decrease in strength and/or endurance? Have you lost height? Have you noticed a decreased enjoyment of life? Are you sad and/or grumpy? Are your erections less strong? Have you noticed a recent deterioration in your ability to play sports? Are you falling asleep after dinner? Has there been a recent deterioration in your work performance? If you answered 'yes' to question 1 or 7, or to more than three questions overall, you might have low testosterone, according to this questionnaire. Or maybe you don't. These questions and answers are the start of this journey, not the end. While these questions can be helpful, they're broad enough to describe common life experiences we all face. As a urologist specializing in men's health, I often see patients convinced they have low testosterone based solely on these symptoms, only to find their testosterone levels are perfectly within range (more on those levels below). Even as an expert in the field, I have also run to get my testosterone checked — only to realize my symptoms were due to poor sleep habits rather than a true hormone deficiency. A quick note before we dive deeper: I understand this can be a sensitive topic. The information provided here isn't truth for every man. Many patients come to my clinic frustrated and seeking clear answers. Even within the medical community, there's significant debate about how to diagnose and manage 'low T.' My intention isn't to discount or downplay your concerns but rather to provide perspective and education, and to help you make informed decisions with your health care provider. Diagnosing low testosterone can be tricky, even for urologists like me. That said, a total testosterone level below 300 ng/dL (nanograms per deciliter) is recommended as the cutoff for diagnosing testosterone deficiency, according to the latest American Urological Association guidelines. But here's the tricky part: Labs don't always agree on what they consider normal, leading to confusion for patients and medical professionals. Take two of the most popular labs in the United States — Quest Diagnostics and LabCorp — as examples. Quest lists a normal testosterone range of 250 to 1100 ng/dL, while LabCorp uses 264 to 916 ng/dL. This means a level of 260 ng/dL might be flagged as 'low' by one lab but 'normal' at another. That's why most American urologists rely on the AUA guidelines, bearing in mind that every patient's situation is different. To ensure accuracy, guidelines recommend checking testosterone levels twice — on two separate mornings, ideally between 7 a.m. and 10 a.m. Why so early? Because that's when your fluctuating testosterone is at its peak, making it the best time to gauge your true levels. The first peak occurs in the morning, and the second peak (not as high as the morning) occurs in the afternoon, with your testosterone level gradually dropping by the end of the day. Lab companies also base their 'normal' reference ranges on the assumption that your testosterone tests are done during these specific morning hours. Additionally, the clinical diagnosis of testosterone deficiency relies not only on lab numbers but also on the presentation of symptoms such as low energy, reduced libido, loss of muscle mass or mood changes. When we start testosterone therapy, the goal is typically to raise testosterone levels into the range of about 450 to 600 ng/dL, which is considered the 'middle tertile' for most laboratory reference ranges. That middle third is the 'sweet spot' in which most men experience relief or resolution of their symptoms, without exceeding levels that could cause unwanted risks or side effects. It can take months to find the right and safe dose for a patient. Further adding to our dilemma as doctors, testosterone sensitivity varies from man to man. This variation may relate to genetic factors, according to research, including the sensitivity of your testosterone receptors. That's why a man with a testosterone level of 400 ng/dL may feel great, while another at the same level may experience countless symptoms. Currently, testing testosterone sensitivity isn't something readily available. The hope, however, is to someday have a routine test that helps us better personalize testosterone replacement therapy. Diagnosing and treating low testosterone is still very much a work in progress, with ongoing debates among experts. However, other medical issues that mimic low testosterone symptoms are more straightforward, backed by strong research. Many men whose testosterone lab results are completely normal still experience persistent symptoms. Often, these issues have more to do with lifestyle or other medical factors rather than testosterone itself. In 2025, many medical professionals, including myself, have become more open to testosterone replacement therapy as newer research has disproven some of the significant risks previously feared, such as concerns over prostate cancer or cardiovascular disease. Still, testosterone replacement isn't the right choice for everyone, and there could be other medical conditions that mimic the same symptoms that should be the primary focus of your (and your doctor's) investigation. In my own experience, poor sleep has frequently been the reason behind feeling tired and irritable. Sleep is essential for hormone regulation, mood stability and overall health. Chronic sleep deprivation can lead to fatigue, mood swings, low libido and difficulty concentrating, according to the National Institutes of Health. Those are all symptoms that mimic what we see with low testosterone. A common cause of poor sleep is obstructive sleep apnea, a condition where breathing repeatedly stops and starts when you're trying to get a good night's rest. Sleep apnea can dysregulate your hormonal balance and lower your testosterone levels. The use of continuous positive airway pressure, or CPAP, machines has been shown to improve sleep quality, improve testosterone and alleviate symptoms. I started using an activity tracker 24/7, which quickly identified my own sleep issues. Eliminating late-afternoon caffeine and swapping evening screen time for reading before bed significantly boosted my sleep quality, energy levels and overall mood — without any hormone therapy. My own small changes led to big improvements. Chronic stress may make you feel like your testosterone is low. Elevated cortisol, your body's primary stress hormone, can temporarily suppress testosterone production, causing symptoms identical to testosterone deficiency, especially reduced libido and fatigue. Diet and exercise also play crucial roles. Studies have shown that testosterone levels in men have significantly declined over recent decades. Experts believe this decline is closely linked to rising obesity rates, chronic stress and increasingly sedentary lifestyles. Many of my own patients report dramatic improvements in energy, mood and libido simply by losing weight, eating healthier and staying physically active. Several medical conditions can mimic symptoms attributed to low testosterone. Low thyroid or vitamin deficiencies (vitamin D or vitamin B12) can cause fatigue, mood changes and low libido. Diabetes or heart disease commonly cause fatigue and sexual dysfunction. Many patients initially thinking they have testosterone deficiency improve significantly after addressing these (and other) medical conditions without any need for hormonal treatment. Another common scenario involves erectile dysfunction. Many patients mistakenly attribute their decreased libido or lack of sexual interest to low testosterone. In most cases, frustration and anxiety about sexual performance led to psychological withdrawal, decreasing sexual desire and confidence. There is a small percentage of men whose erectile dysfunction genuinely stems from low testosterone levels. In these cases, testosterone replacement therapy might help. However, in my personal experience, replacing testosterone alone often leads to more frustration: Men may experience higher libido, yet still face difficulty achieving or maintaining an erection. That's why it's usually better to treat ED directly — often with affordable generic medications like tadalafil or sildenafil — to restore sexual confidence and performance. These medications, once costing nearly $40 per pill, are now often as affordable as $40 for a three-month supply, providing a practical and reliable solution for most men. The number of men receiving testosterone tests and prescriptions has nearly tripled in recent years, according to the 2024 American Urological Association guidelines. Up to 25% of men starting testosterone therapy were never tested before starting treatment, the AUA noted. Nearly half never have their testosterone rechecked after initiating treatment. Up to a third of men receiving testosterone therapy don't meet the official clinical criteria for testosterone deficiency. Meanwhile, many men who would benefit from testosterone replacement therapy remain untreated because of lingering concerns among health care providers about potential prostate cancer or cardiovascular risks — concerns not strongly supported by current evidence found in the AUA guidelines and recent research published in the New England Journal of Medicine. Additionally, men who skip routine screenings or simply don't feel comfortable openly discussing their symptoms also miss out on the treatment and relief they could experience. This all feels like a 'chicken or egg' scenario: Will starting testosterone therapy motivate men to exercise more and manage their health better, or should we first address lifestyle and health issues before considering hormone therapy? These complexities highlight the importance of personalized conversations between you and your health care provider. In my practice, I always focus first on lifestyle: Are you getting quality sleep? How high are your stress levels? Are you physically active? How healthy are your personal relationships? By tackling these areas first, many of my patients see noticeable improvement without falling into the testosterone trap. Get inspired by a weekly roundup on living well, made simple. 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