Men's Health Clinic Research Articles

Care You Can Trust: How the Black Men's Health Clinic Leverages Community Partnerships Charting a Course Where Health Care Struggles to Reach.

Black men in the United States have a lower life expectancy than Hispanic and White populations due to elevated morbidity and mortality from various health conditions. This is partially attributable to the experience of systemic racism and earned mistrust toward health professionals, the majority of whom are not Black. Despite recognition of this issue, limited progress has been made to improve Black men's health trajectories. Thus, there is an urgent need for health care organizations to reach more Black men and address existing health inequities through innovative means. Larry Wallace Sr., an experienced health care executive, recognized this issue in his community and created the Black Men's Health Clinic (BMHC) with his son, Larry Wallace Jr., to improve health care delivery to Black men in and around Austin, Texas. BMHC has successfully reached Black men in its catchment area through its strategic community engagement efforts and a unique financial model to increase health care accessibility for a population that has historically experienced poor health outcomes. Furthermore, they offer a comprehensive range of services that acknowledge the impact of social and structural determinants of health and address social needs to provide Black men with access to vetted, high-quality health care. Consequently, BMHC's health care model offers a useful framework for other health care organizations that are aiming to achieve health equity. The BMHC model is presented herein, highlighting strategies for other health care organizations to reach Black men and deliver trusted care. Implementing suggestions discussed in this work may lead to improved health outcomes for Black men in the United States.

Outcomes after chronic isolated epididymal pain A retrospective study.

Despite being a commonly encountered urologic condition, there remains a paucity of understanding and literature on the management and natural history of isolated epididymal pain. Typically, patients who do not respond to conservative management undergo an epididymectomy; however, the literature on its efficacy is also scarce, with success rates varying from 10-90%. Our goal was to better describe the etiology and natural history of isolated epididymal pain and to describe the rates of success associated with epididymectomy. A retrospective, case-control study was conducted at the Manitoba Men's Health Clinic, with the approval of the University of Manitoba Research Ethics Board. All patients presenting with chronic epididymitis, defined as discomfort or pain localized to the epididymis for at least three months, were identified. Information regarding patient demographics, past medical and surgical history, duration of pain, localization of pain, findings on previous ultrasounds, prior conservative therapies trialed, and response rates, as well as response rates to surgical therapy were collected. From April 2022 to April 2023, a total of 275 patients with chronic orchialgia were identified; among them, 74 patients presented with chronic isolated epididymal pain. On average, 22.9% of patients experienced symptoms for 3-6 months, 10% for 6-12 months, and 67.1% for over 12 months; 13.5% (n=10) had associated ejaculatory pain, 8.1% (n=6) had lower urinary tract symptoms, and 4.1% (n=3) had erectile dysfunction. Ultrasound findings were observed in 68.9% of patients, with 31.1% having an epididymal cyst, 27.1% having a varicocele, 5.4% having a spermatocele, and 4.1% having a hydrocele. Among those who underwent conservative therapy, only 36.2% of patients reported a positive response. Surgical intervention was performed on 23 patients, including 16 who underwent epididymectomy, three who underwent cord denervation, and two who underwent vasovasostomy and spermatocelectomy each. Most (81.3%, n=13) patients who underwent epididymectomy had a positive response to the surgical intervention, defined as no pain on followup, while all patients undergoing other surgical interventions experienced a positive response. Chronic epididymal pain is a condition with limited data surrounding its management. Prior to referral, a large proportion of patients did not undergo any conservative treatment, and of those that did, there was limited response. For those who underwent surgical intervention, all were pain-free on followup, except three patients who underwent epididymectomy.

(099) Intersection of Sexual and Mental Health: Prevalence of Anxiety and Depression in a Men's Health Clinic and Feasibility of Mental Health Surveys

Abstract Introduction Depression and general anxiety disorder (GAD) are the most prevalent mental health conditions in men, affecting 5% and 2%, respectively. 31% of men suffer depression in their lifetime and only 1/4 of men speak to a mental health professional about it. Suicide rates are 4 times higher in men and men are more likely to succeed at attempts. Men with high depression scores are nearly twice as likely to report erectile dysfunction (ED) than nondepressed men. Objective We aim to identify the prevalence of depression and GAD among patients presenting to a men's health clinic (MHC). Secondary objectives include demonstrating the feasibility of administering mental health surveys in a busy MHC to early identify men who may benefit from a referral to a mental health practitioner in order to improve overall men's health. Methods We retrospectively reviewed the records of patients presenting to a MHC during a three-month period in 2023 who completed all surveys. We measured ED and ejaculatory dysfunction severity with the Sexual Health Inventory for Men (SHIM) and Male Sexual Health Questionnaire (MSHQ-EJ), respectively. Screening for depression and anxiety was performed with the Patient Health Questionnaire (PHQ-7) and the General Anxiety Disorder (GAD-7) questionnaire. Both questionnaires rate disease severity as mild, moderate, or severe. Linear regression models were used to compare the severity of depression and anxiety to ED severity. Non-parametric statistics were used to analyze the prevalence of mental health disorders and the reason for the patient’s visit to the men’s health clinic. Referral to a mental health specialist was offered for any patients meeting scoring criteria. Results We identified 255 men (77% white, 18% black, 5% Asian, and 94% non-Hispanic) with a median age of 48 years (IQR: 33-64) and a BMI of 28 (IQR: 25-32). Overall, 63% of men had some ED, while 88% had some degree of ejaculatory dysfunction. Prevalence of depression and GAD was 15% and 11%, respectively. A linear regression model showed that as ED severity increases, so does depression severity (F [1, 244] = 13.53, p = .0001, coefficient: 0.15, R-squared: 0.05) and anxiety severity (F [1, 244] = 5.93, p=0.02, coefficient: 0.08, R-squared: 0.02). The study found no significant correlation between prevalence of depression and the reason for the patients' visits to the MHC: ED (17%, 20/117), hypogonadism (22%, 26/120), Peyronie's (28%, 7/25), fertility evaluation (33%, 5/15), varicocele (30%, 8/27), and vasectomy evaluation (5%, 1/21) (p=0.27). Conclusions The prevalence of depression and GAD among men attending a MHC is higher than that of the general male population. The degree of ED and its association with the severity of depression and anxiety emphasizes the importance of addressing both sexual and mental health in the context of men's healthcare. ED should be considered a multifactorial condition that requires a multidisciplinary approach to treatment, especially when depression is present. Patients reporting ED should be routinely screened for depression. Administration of mental health surveys in a MHC is feasible and helps guide early referral to a mental health specialist. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Coloplast and BK Ultrasound.

Extragenital Sexually Transmitted Infections Among High-Risk Men Who Have Sex With Men in Johannesburg, South Africa.

In South Africa, extragenital etiological sexually transmitted infection (STI) screening among men who have sex with men (MSM) is not routinely available. We aimed to determine the prevalence of STI pathogens at rectal and pharyngeal sites, syphilis seroprevalence, and associated risk factors among a selection of high-risk MSM without symptomatic urethritis attending a men's health clinic in Johannesburg, South Africa. A cross-sectional study was conducted in 2022. Enrolled clients self-reported demographic, sexual behavioral risks, and clinical information. Client or clinician-collected rectal and pharyngeal swabs were tested for Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, and Trichomonas vaginalis. C. trachomatis-positive rectal samples were reflex tested for lymphogranuloma venereum. Blood specimens were screened for syphilis. Univariate and multivariate regression models were used to determine factors independently associated with the presence of an extragenital STI or syphilis. Among the 97 participants (median age, 29 years), 24.7% had an extragenital STI and 9.4% had high nontreponemal antibody titers (rapid plasma reagin ≥1:16). Rectal STIs were detected in 26.4% participants: N. gonorrhoeae (14.3%), C. trachomatis (9.9%), and M. genitalium (5.5%). Pharyngeal STIs were less prevalent (4.1%). Overall, the prevalence of any STI was 41%. Sex under the influence of drugs (adjusted odds ratio, 4.94; 95% confidence interval, 1.56-15.69) and engaging in condomless receptive anal intercourse with a casual partner (adjusted odds ratio, 8.36; 95% confidence interval, 1.73-40.28) were independent risk factors for having an extragenital STI. The high burden of extragenital STIs and active syphilis in asymptomatic MSM underscores the importance of routine etiological screening in this key population, as the syndromic approach would not enable detection or treatment of these infections.

Outcomes and patient tolerability of radical inguinal orchiectomy under deep intravenous sedation.

Radical inguinal orchiectomy (RO ) is indicated for the management of testicular tumors and is universally performed under general anesthetic in the hospital. The need to perform radical orchiectomy in an expeditated fashion can result in logistical difficulties, often necessitating this procedure to happen after-hours on a semi-emergent basis. These logistical difficulties have been exacerbated by the backlog of cases from the COVID-19 pandemic. A similar procedure - inguinal hernia repair - is regularly performed under local anesthesia with minimal complications. Thus, we sought to evaluate the feasibility of performing radical orchiectomy under deep intravenous sedation in an ambulatory surgery center. We evaluated our single-surgeon (PP), prospective database of patients who underwent RO between September 2022 and February 2023 at the Men's Health Clinic Manitoba. Patients were given a combination of deep sedation, ilioinguinal nerve block, and local anesthetic. Tolerability was assessed both perioperatively and at 4-6 weeks' followup. We reviewed the medical records for any postoperative complications. Eight patients underwent RO under deep sedation during the study period. All patients tolerated the surgery well and were discharged shortly after surgery. Average operative time was 40 minutes and length of stay was 46 minutes. There were no perioperative complications. Our pilot study demonstrates that RO can be safely and effectively performed under deep sedation. This anesthetic combination can be used both in-hospital and out-of-hospital settings, thereby resulting in faster recovery, shorter length of stay, and favorable patient and provider satisfaction.

Increasing Role of the Advanced Practice Provider in Men's Health Clinics: An Analysis of Medicare and Commercial Claims in the United States.

As urologic care delivery in the U.S. continues to evolve to meet patient needs, we aim to clarify the role of Advanced Practice Providers (APPs) for publicly and privately insured patients in the treatment of male urologic conditions commonly encountered in men's health clinics. Medicare and commercial insurance claims from the Physician/Supplier Procedure Summary and Merative MarketScan Commercial Database, were queried for procedures submitted by APPs between 2010 and 2021. Common urologic conditions were identified using Current Procedural Terminology codes and grouped into 4 categories: testicular hypofunction, erectile dysfunction (ED) and Peyronie's disease (PD), benign prostatic hyperplasia (BPH), and scrotal pain. The proportion of procedures submitted by APPs was calculated for each year and category. From 2010 to 2021, the proportion of APP submitted service counts for each condition within the MarketScan group increased up to 5-fold, with BPH representing the greatest growth. The proportion of APP submitted service counts within the Medicare group increased up to 8-fold, with ED/PD representing the greatest fold change. The proportion of claims submitted by APPs treating all 4 conditions were higher in 2021 than 2010 in both publicly and privately insured groups. The role of APPs in men's urologic health is increasing for both privately and publicly insured patient populations. APPs play a critical role in urologic care and can help to improve access to men's health.

An Online Investigation Into Direct-to-Consumer Men's Health Clinics: The Who, What, and Where

ObjectiveTo characterize direct-to-consumer (DTC) men's health clinics by reviewing their online content. Increasing numbers of patients are seeking treatment for erectile dysfunction (ED) and hypogonadism from DTC “men's health” clinics. Treatments are often used off-label, with lack of transparency of provider credentials and qualifications. MethodsWe identified DTC Men's Health Clinics in the United States by internet search by state using the terms, “Men's Health Clinic,” and “Low T Center.” All stand-alone clinics were reviewed. ResultsTwo hundred and twenty-three clinics were reviewed, with 147 (65.9%) offered ED treatments and 196 (87.9%) offering testosterone replacement, and 120 (53.8%) offering both ED treatment and testosterone replacement. Of those clinics offering ED treatments, 93 (63.3%) advertised shockwave therapy and 84 (57.1%) PRP therapy. There were 56 (38%) who offered shockwave therapy and PRP. ICI was significantly more likely to be offered if there was a urologist on staff (p <.001).Clinic providers represented 20 different medical and alternative medicine specialties. Internal medicine was most common (17.4%), followed by family medicine (11.1%). A nonphysician (nurse practitioner or physician assistant) was listed as the primary provider in 10 clinics (4.5%) and 45 clinics (20.1%) did not list their providers. Urologists were listed as the primary provider in 10.3% of clinics. A naturopathic provider was listed as a staff member in 22 (11.6%) of clinics. ConclusionThere is significant heterogeneity and misinformation available to the public regarding men's health. Familiarity with and insight into practice patterns of “men's health” clinics will help provide informed patient care and counseling.

Predictive factors for efficacy of testosterone replacement therapy for late-onset hypogonadism in Japanese men: a preliminary report.

Although testosterone replacement therapy (TRT) is the first-choice method used worldwide for late-onset hypogonadism (LOH), clinical benefits are not seen in all cases. This study was conducted to determine the predictors of TRT efficacy for LOH. Fifty-six patients who visited our Men's Health Clinic (Kawanishi City Medical Center, Kawanishi and Hyogo Medical University, Nishinomiya, Hyogo, Japan) between November 2003 and June 2021 with data available before and after TRT were enrolled. They were divided into responders (Group 1; n = 45, accounting for 80.4%) and nonresponders (Group 2; n = 11, accounting for 19.6%) based on the clinical response to TRT, including patient satisfaction. Factors noted before TRT included age, body mass index, aging males' symptoms score, sexual health inventory for men, luteinizing hormone, follicular-stimulating hormone, testosterone, free testosterone, prolactin (PRL), estradiol (E2), and testosterone/estradiol (T/E2) ratio in serum. For statistical analysis, a multivariable logistic regression model was used. Univariate analysis revealed PRL (odds ratio [OR]: 0.9624; 95% confidence interval [CI]: 0.9316-0.9943, P < 0.05), E2 (OR: 0.8692; 95% CI: 0.7745-0.9754, P < 0.05), and T/E2 ratio (OR: 1.1312; 95% CI: 1.0106-1.2661, P < 0.05) to be predictive factors. Multivariate analyses showed that T/E2 ratio was an independent predictive factor (OR: 1.1593; 95% CI: 1.0438-1.2875, P < 0.01). The present results suggest that a low value for T/E2 ratio may predict a reduced response to TRT. The T/E2 ratio threshold to predict nonresponders based on receiver-operating characteristics (ROC) curve analysis was shown to be 17.3. Although additional studies with larger number of patients are necessary, we propose the determination of serum E2 level and testosterone level prior to performing TRT.

Testosterone replacement therapy: Patient reported preferences

ABSTRACT Introduction Hypogonadism is common in the aging man, though it is often underdiagnosed and undertreated. Men with symptomatic hypogonadism can be treated with testosterone replacement therapy (TRT) in a wide variety of methods, such as intramuscular, transdermal, subcutaneous, intranasal, and oral. A number of factors including cost, efficacy, adverse effects, and mechanism and frequency of administration, must be considered when prescribing TRT to promote maximum patient satisfaction and clinical results. Objective This study seeks to determine the attitudes, opinions, and preferences of men regarding their testosterone replacement therapy and the factors that influence these preferences. Methods An anonymous online survey was distributed via REDcap, an online data collection engine, to 783 men currently on TRT in a single men's health clinic. Men answered questions relating to demographics, comorbidities, and social history, as well as validated questionnaires: Sexual Health Inventory for Men (SHIM) for erectile dysfunction and Androgen Deficiency in the Aging Male (ADAM) for hypogonadism. They were also asked about prior and current method of TRT and overall satisfaction with their current regimen. Patient preferences regarding administration, cost, effectiveness, and adverse side effects were assessed both qualitatively and in head-to-head comparisons. Results The average age of the 130 respondents was 64.3 years (32-87). The most commonly reported method of administration was injection (57.3%), followed by topical ointment (21.8%), under-the-skin autoinjector (9.7%), implantable pellet (7.3%), and swallowed pill (4.0%). Overall satisfaction with current therapy was reported as very satisfied (36.0%), somewhat satisfied (25.6%), neutral (22.4%), somewhat dissatisfied (8.8%), and very dissatisfied (7.2%). Submuscular injection was the most commonly preferred method of administration at 40.5%, followed by swallowed pill (32.5%), under-the-skin autoinjector (23.8%), topical ointment (23.0%), nasal spray (20.6%), implantable pellet (15.9%), and skin patch (10.3%). When asked about preferences regarding testosterone injection therapy, 66.4% preferred self-administration at home; only 17.6% of patients preferred longer lasting injections if they had to be administered in the clinic. Patients ranked the potential benefits of therapy from most to least important as: improved sexual function, increased muscle strength, increased libido, reduced fatigue, decreased fat mass, increased bone density, improvement in depression, reduced hair loss, improvement with other medical problems, and improvement in anemia. Patients ranked the potential side effects of therapy from most to least concerning as: heart problems, blood clots, liver problems, breast growth, difficulty urinating, testicular shrinkage, gastrointestinal irritation, acne, and skin irritation. In head-to-head comparisons, patients preferred an administration method with the most therapeutic efficacy, fewest side effects, most convenient administration, preferred method of administration, and preferred frequency of dosing over cost. Furthermore, patients preferred efficacy and fewer side effects to convenience, method, and frequency of dosing. Conclusions The majority of respondents were overall satisfied with their current therapy. The preferred TRT option was self-injection therapy at home. Treatment efficacy and fewer side effects were the most important considerations for patients on TRT. Patient preferences should be a strong consideration for providers when prescribing testosterone replacement therapy. Disclosure Work supported by industry: no.

What is a predictive factor of the efficacy of testosterone replacement for late-onset hypogonadism?

ABSTRACT Introduction Testosterone replacement therapy (TRT) is a worldwide first-choice method of treatment for late-onset hypogonadism (LOH). In the diagnosis of LOH in Japan, we use 8.5 pg/mL of serum free-testosterone (FT) level measured by RIA as a lower limit. Objective The objective of this study is to determine the predictors of the TRT efficacy for LOH. Methods A total of 56 patients who attended our men's health clinic between August 2002 and June 2021 with the data available before and after TRT were enrolled into this study. These patients were divided into responders to TRT (Group 1, n=45, 80%) and non-responders to TRT (Group 2, n=11, 20%) according to clinical response including patient's satisfaction. Evaluated parameters obtained before TRT were following: age, BMI, aging males symptoms scale (AMS), sexual health inventory for men (SHIM), serum luteinizing hormone (LH), follicular stimulating hormone (FSH), testosterone (T), FT, prolactin (PRL), estradiol (E2) and T/E ratio. For statistical analysis, we used a multivariable logistic regression model. Results Univariate analysis revealed PRL (OR 0.96; 95% CI 0.93-0.99, P&amp;lt;0.03), E2 (OR 0.87; 95% CI 0.77-0.98, P&amp;lt;0.02), T/E (OR 1.13; 95% CI 1.01-1.27, P&amp;lt;0.04) as predictive factors. Then we carried out multivariate analyses of these factors and determined T/E ratio as an independent predictive factor (OR 1.16; 95% CI 1.04-1.29, P&amp;lt;0.01). Conclusion This study suggested that low value of T/E ratio might predict the low response to TRT. Although further study with a larger number of patients is necessary, we propose the measurement of serum E2 level as well as testosterone level before TRT. Disclosure Work supported by industry: no.

Osteoporosis knowledge, health beliefs, and self-efficacy in Hong Kong Chinese men.

Male osteoporosis had long been neglected despite one-third of fractures occurring in men. Lifestyle modification through education is the main tactic in osteoporosis prevention, but current programs and strategies are designed for postmenopausal women. Understanding men's knowledge, health belief, and self-efficacy in adopting osteoporosis prevention strategies can help to design a specific program for men. A prospective cohort study was conducted in three men's health clinics in Hong Kong from September to October 2020, recruiting 277 men aged ≥ 20years. They completed a questionnaire consisting of sociodemographic data, 14 general questions from the Facts on Osteoporosis Quiz (FOOQ), Male Osteoporosis Knowledge Quiz (MOKQ), Osteoporosis Health Belief Scale (OHBS), and Osteoporosis Self-Efficacy Scale (OSES). Scores from these scales and their association with sociodemographic data were reported. Correlations between age, knowledge, health beliefs, and self-efficacy were studied using the Health Belief Model. The mean age was 36.4years old, and 52% had university education. Their mean FOOQ + MOKQ score was 10.8 out of 20; mean OHBS score was 129.2 out of 210; and mean OSE-Exercise and OSE-Calcium scores were 66.4 and 68.9 out of 100 respectively. Self-efficacy of exercise was correlated with young age, perceived exercise benefits, and little barriers to exercise (p < 0.01). Self-efficacy of calcium intake was positively correlated with health motivation and self-efficacy of exercise and negatively correlated with barriers to calcium intake (p < 0.01). Male osteoporosis awareness programs should focus on improving knowledge, enhancing awareness on susceptibility, promoting benefits of lifestyle modification, and helping men overcome perceived barriers.

Testosterone Replacement Therapy: Patient Reported Preferences

ABSTRACT Introduction Hypogonadism is common in the aging man, though it is often underdiagnosed and undertreated. Men with symptomatic hypogonadism can be treated with testosterone replacement therapy (TRT) in a wide variety of methods, such as intramuscular, transdermal, subcutaneous, intranasal, and oral. A number of factors including cost, efficacy, adverse effects, and mechanism and frequency of administration, must be considered when prescribing TRT to promote maximum patient satisfaction and clinical results. Objective This study seeks to determine the attitudes, opinions, and preferences of men regarding their testosterone replacement therapy and the factors that influence these preferences. Methods An anonymous online survey was distributed via REDcap, an online data collection engine, to 783 men currently on TRT in a single men's health clinic. Men answered questions relating to demographics, comorbidities, and social history, as well as validated questionnaires: Sexual Health Inventory for Men (SHIM) for erectile dysfunction and Androgen Deficiency in the Aging Male (ADAM) for hypogonadism. They were also asked about prior and current method of TRT and overall satisfaction with their current regimen. Patient preferences regarding administration, cost, effectiveness, and adverse side effects were assessed both qualitatively and in head-to-head comparisons. Results The average age of the 130 respondents was 64.3 years (32-87). The most commonly reported method of administration was injection (57.3%), followed by topical ointment (21.8%), under-the-skin auto-injector (9.7%), implantable pellet (7.3%), and swallowed pill (4.0%). Overall satisfaction with current therapy was reported as very satisfied (36.0%), somewhat satisfied (25.6%), neutral (22.4%), somewhat dissatisfied (8.8%), and very dissatisfied (7.2%). Submuscular injection was the most commonly preferred method of administration at 40.5%, followed by swallowed pill (32.5%), under-the-skin auto-injector (23.8%), topical ointment (23.0%), nasal spray (20.6%), implantable pellet (15.9%), and skin patch (10.3%). When asked about preferences regarding testosterone injection therapy, 66.4% preferred self-administration at home; only 17.6% of patients preferred longer lasting injections if they had to be administered in the clinic. Patients ranked the potential benefits of therapy from most to least important as: improved sexual function, increased muscle strength, increased libido, reduced fatigue, decreased fat mass, increased bone density, improvement in depression, reduced hair loss, improvement with other medical problems, and improvement in anemia. Patients ranked the potential side effects of therapy from most to least concerning as: heart problems, blood clots, liver problems, breast growth, difficulty urinating, testicular shrinkage, gastrointestinal irritation, acne, and skin irritation. In head-to-head comparisons, patients preferred an administration method with the most therapeutic efficacy, fewest side effects, most convenient administration, preferred method of administration, and preferred frequency of dosing over cost. Furthermore, patients preferred efficacy and fewer side effects to convenience, method, and frequency of dosing. Conclusions The majority of respondents were overall satisfied with their current therapy. The preferred TRT option was self-injection therapy at home. Treatment efficacy and fewer side effects were the most important considerations for patients on TRT. Patient preferences should be a strong consideration for providers when prescribing testosterone replacement therapy. Disclosure No

Pre- and Post-Injection Needle Pain in Patients Undergoing First Intracavernosal Injection

BackgroundIntracavernosal injections (ICI) are a well-established treatment option for men with erectile dysfunction (ED); however, the anticipation of pain with injection remains a significant barrier to the use of ICI. AimTo evaluate the patient-anticipated degree of pain versus the experienced degree of pain pre- and post-ICI in men undergoing their first injection with an erectile agent. MethodsWe studied 51 patients who underwent their first ICI in our men's health clinic. Anticipated needle-associated pain was judged with a pre-injection score, and pain experienced during the injection was judged with a post-injection score. All patients graded their pre- and post-ICI pain using a standard 10-point scale (0–10). OutcomesPre- and post-ICI pain was defined with the visual analogue scale (0–10) in men undergoing their first penile injection. ResultsMedians and interquartile ranges (IQRs) of the patients' age [65 years (54.5–68.0)], pre-injection pain [5 (4–7)], and post-injection pain [1 (1–2)] were recorded. Most men in the study had erectile dysfunction (68.6%) and/or Peyronie's Disease (64.7%). The average pre-injection prediction pain score was 5.45 ± 2.15; the average post-injection perceived pain score was 1.20 ± 0.73. Thus, there was an average discrepancy of over 4 points in predicted pain vs perceived pain. A paired t-test was performed which showed a statistically significant difference between pre- and post-injection scores (P < .05). A Wilcoxson Signed Rank Test showed statistical significance in the difference between pre- and post-injection pain scores (P < .05). Clinical ImplicationsICI is a safe, effective treatment for patients with ED and is associated with significantly less pain than is anticipated by patients. Strengths & LimitationsThis is the first report to describe the discrepancy between pre-ICI anticipated pain and post-ICI experienced pain. Limitations include an overall small sample size. ConclusionPatients experience significantly less pain with ICI than they anticipate having. This represents an important factor to consider when counseling patients about available ED treatments.Baird B, Wajswol E, Ericson C et al. Pre- and Post-Injection Needle Pain in Patients Undergoing First Intracavernosal Injection. J Sex Med 2022;19:590–593.

Color Doppler ultrasound imaging in varicoceles: Is the difference in venous diameter encountered during Valsalva predictive of palpable varicocele grade?

ObjectiveThe clinical grading system for varicoceles is subjective and dependent on clinician experience. Color Doppler ultrasound (US) has not been standardized in the diagnosis of varicoceles. We aimed to determine if US measurement of varicocele could be predictive of World Health Organization (WHO) varicocele grade. MethodsMen who presented for either scrotal pain or infertility to a tertiary men's health clinic underwent physical examination, and varicoceles were graded following WHO criteria (0=subclinical, 1, 2, 3). US was used to measure largest venous diameter in the pampiniform plexus bilaterally at rest and during Valsalva maneuver. Receiver operator characteristic curve analysis was used to determine if resting diameter, diameter during Valsalva, or change in diameter between at rest and during Valsalva provided the highest sensitivity and specificity for determining clinical grade. Threshold values for diameter were determined from these receiver operator characteristic curves. ResultsA total of 102 men (50 with clinical varicocele and 52 with subclinical varicocele) were included. Diameter at rest was the best ultrasonographic discriminator between subclinical and clinical varicoceles (area under the curve [AUC]=0.67) with a diameter threshold of 3.0 mm (sensitivity 79%, specificity 42%). Diameter during Valsalva had the greatest AUC for determining clinical Grades 1 versus 2 (AUC=0.57) with diameter threshold of 5.7 mm (sensitivity 71%, specificity 33%). For differentiating between Grades 2 and 3, diameter at rest had the greatest AUC of 0.65 with a threshold of 3.6 mm (sensitivity 71%, specificity 58%). ConclusionOur results corroborate other studies that have shown a weak correlation between US and clinical grading. The use of diameter during Valsalva was less predictive than diameter at rest and was only clinically significant in differentiating between Grade 1 and 2 varicocele. A standardized method for determining clinically relevant varicoceles on US would allow for improved patient counseling and clinical decision-making.

Stretched penile length and its associations with testosterone and infertility.

BackgroundMale infertility can be associated with secondary sexual characteristics, hypogonadism, and several findings in the examination of external genitalia. We sought to identify if stretched penile length (SPL) is associated with infertility or baseline testosterone.MethodsWe performed a retrospective review of all males age 18–59 presenting to a Men’s health clinic from 2014 to 2017. SPL of patients with infertility were compared to patients with any other complaint. Patients with Peyronie’s disease, prior penile surgery, prostatectomy, on testosterone replacement, clomiphene or β-hCG were excluded from our study. Baseline characteristics were compared between the two groups (infertile vs. other). Linear regression was used to assess the association between infertility and testosterone with SPL after adjusting for patient age, BMI, and race. Scatterplot was used for correlation between testosterone and SPL.ResultsSix hundred and sixty-four men were included in our study (161 infertile, 503 other). The unadjusted mean SPL in the infertile group was 12.3 cm compared to 13.4 cm in the other group (P<0.001). The significance remained when adjusted for age, BMI, testosterone and race (12.4 vs. 13.3, P<0.001). Mean total testosterone in the infertile group was not significantly different than the other group (414 vs. 422, P=0.68). Infertile men were younger than the other group (33.2 vs. 42.1 years, P<0.001). BMI did not significantly differ (28.9 vs. 28.9 kg/m2, P=0.57). There was a weak positive correlation between testosterone and penile size in both the infertile group (r=0.20, P=0.01) and the other group (r=0.24, P<0.001).ConclusionsThough SPL differed amongst our groups, adult testosterone levels did not. If developmental levels of testosterone exposure accounted for some of the differences in SPL between our two groups, these variations did not persist into adulthood. It remains unknown if reduced length is a result of genetic or congenital factors associated with infertility. Further investigation is needed to better understand the association of shorter SPL with male infertility.

Organic Diet and Intermittent Fasting are Associated With Improved Erectile Function

ObjectiveTo explore associations between dietary habits and erectile dysfunction (ED) in a cohort of patients presenting to a high-volume men's health clinic. Materials and MethodsAll patients presenting to a high-volume men's health clinic between July 2018 and May 2019 were evaluated for their dietary habits and screened with the International Index of Erectile Function-5 (IIEF-5) and Androgen Deficiency in Aging Males (ADAM). The primary outcome measure was the impact of dietary habits on ED, defined as IIEF-5 <22. Stepwise logistic regressions were used to control for patient characteristics and relevant comorbidities. ResultsTwo hundred seventy-one patients were included. Primary reasons for visit were ED (110, 40.6%), hypogonadism (39, 14.4%), benign prostatic hyperplasia/lower urinary tract symptoms (80, 29.5%), and Peyronie's Disease (30, 11.1%). 176 (64.9%) followed no diet, while 11 (4.1%), 11 (4.1%), 8 (2.9%), and 11 (4.1%) were whole food only, low-carb/keto, vegetarian/pescatarian, and low-fat, respectively. Additionally, 105 (38.7%) reported organic foods consumption, while 51 (18.8%) had no processed food consumption, and 77 (28.4%) performed intermittent fasting. Patients reporting ED were more likely to be over the age of 65, had higher body mass index, more comorbidities, and less likely to report an organic diet or intermittent fasting. There were no correlations between diet and ADAM score. In adjusted analysis, patients reporting organic diet or intermittent fasting were significantly less likely to have ED. ConclusionThis is the first study suggesting organic diet and intermittent fasting to be protective against ED. These results are hypothesis-generating and warrant further exploration.

Treatment-related Outcomes for Patients With Atypical Peyronie's Disease Using Xiaflex Injections

OBJECTIVETo evaluate the efficacy and safety of collagenase Clostridium histolyticum (CCH) for the management of penile deformities in patients presenting with different categories of atypical Peyronie's disease (PD). METHODSWe conducted a retrospective review of charts of patients who presented to a men's health clinic with atypical PD between October 2016 and June 2019. We included patients in the stable phase of the disease, had completed a penile duplex Doppler ultrasound before any intervention, and proceeded with CCH treatment. Gathered data included patient demographics, treatment details, outcomes, and complications. Outcomes collected were both quantitative (curvature assessments) and qualitative using the symptom bother domain (last 6 questions; Q10 to Q15) of the Peyronie's Disease Questionnaire. RESULTSTwenty-one men with stable PD underwent CCH inject therapy after penile duplex Doppler ultrasound. The mean number of injections was 8.4 (standard deviation [SD] = 3.3), and the mean follow-up was 20.5 months (SD = 5.9). The overall mean change in penile curvature was −19.2° ± 8.3°, which corresponded to a −39% ± 13% improvement in curvature (P = .0079). In men who presented with an indentation or hourglass deformity, 11 of 17 (64%) were satisfied and reported subjective improvement in narrowing/indentation after receiving CCH injections. The average composite symptom bother domain of the Peyronie's Disease Questionnaire decreased by 6.7 (P = .0029). CONCLUSIONOur results suggest that CCH appears to be safe and provide significant clinical improvements in men presenting with atypical PD.

Ejaculatory Dysfunction in Patients Presenting to a Men's Health Clinic: A Retrospective Cohort Study.

IntroductionPrevalence and bother of ejaculatory dysfunction (EjD) has yet to be evaluated in a men's health referral population.AimTo evaluate the prevalence and associated risk factors of EjD in men presenting to a men's health clinic.MethodsA retrospective review examined patients presenting to an outpatient men's health clinic who completed the Sexual Health Inventory for Men and the Male Sexual Health Questionnaire Ejaculatory Dysfunction (MSHQ-EjD) Short Form. Patient factors including demographics, comorbidities, and medication were examined. Descriptive statistics and multivariable logistic regression were used.Main Outcome MeasuresThe main outcomes of this study are Sexual Health Inventory for Men and MSHQ-EjD scores.ResultsA total of 63 (24%) of patients presenting to the urology clinic were characterized as having EjD based on questionnaire responses. The mean age for men with EjD was 53.8 years, while those without was 42.6 years (P < .001). Of men with EjD, 74.6% were at least moderately bothered (MSHQ-EjD ≥3). Men with EjD were more likely to have erectile dysfunction (77.8%) compared with those without (21%, P < .001) as well as a history of a pelvic cancer (20.6% vs 6%, P = .001). On multivariable regression, erectile dysfunction (odds ratio: 15.04, 95% confidence interval: 6.76–35.92, P < .0001) and alpha inhibitor prescription (odds ratio: 6.82, 95% confidence interval: 1.57–30.16, P = .01) were associated with a higher odds of EjD. ED was found to be a mediator of the relationship between EjD and age, as the age association was lost in the ED population on multivariable regression compared with the non-ED population where it remained significant.ConclusionsEjD is common among patients presenting to a men's health clinic and may present at varying ages, though it is more common in those aged 50 years or older; it is independent of age and race. EjD is associated with erectile dysfunction, pelvic cancer history, and use of alpha inhibitors, presenting a population that could be considered for screening.Kasman AM, Bhambhvani HP, Eisenberg ML. Ejaculatory Dysfunction in Patients Presenting to a Men's Health Clinic: A Retrospective Cohort Study. J Sex Med 2020;8:454–460.

HP-3-1 Platelet Rich Plasma and Low-Intensity Pulsed Ultrasound Combination in Erectile Dysfunction Treatment

In order to evaluate the efficacy and safety of therapeutic model of combined application of platelet rich plasma (PRP) intracavernous injections and low-intensity pulsed ultrasound (LIPUS) for erectile dysfunction of vascular origin (arterial and corporal veno-occlusive) a prospective clinical study on 64 outpatients with diagnosis of erectile dysfunction of vascular genesis (ICD-10: N48.4) moderate and mild grade (according to IIEF-5) in Men's health Clinic (Kiev, Ukraine), was conducted. Clinical questionnaire “International Index of Erectile Function 5” (IIEF-5), “Erectile Hardness Score” (EHS), ultrasonic cavernous bodies scanning and pharmacodoppler-sonography were used as instruments of clinical data gathering. To data statistical processing used chi-square test. Contingent of a study was randomized in two symmetrical groups of 32 patients. Main group underwent treatment protocol of 6 sessions of PRP intracavernous injections (6 focuses by 1,0 ml, 1 session weekly) and 12 sessions of local penile LIPUS (2 sessions weekly, each 1-st session simultaneously with injections). Control group underwent 12 sessions of local penile LIPUS (2 sessions weekly) only.

Men's health clinics: a real need or a marketing strategy.

Globally, the life expectancy for men is 5.1 years less than for women. This gender gap in mortality is intrinsically linked to a higher proportion of premature male mortality and is a significant economic, social and healthcare issue. We explore the main causes for premature male death and also discuss the need for a dedicated men's health clinic, especially in the context of potential commercial exploitation.