Larry I Lipshultz

• M.D. - Professor of Urology
• Baylor College of Medicine

Background While the use of testosterone replacement therapy (TRT) in men undergoing active surveillance (AS) for prostate cancer (PCa) has been historically contraindicated, recent studies have contributed to a paradigm shift to this approach. Aim To examine the impact of testosterone on prostate-specific antigen (PSA) levels and prostate biopsy...

Introduction Emerging preclinical work has demonstrated the requisite role of the adaptive immune system in maintaining tolerance toward “foreign” spermatozoa. As seen in animal models, breaks in this system directly causes male factor infertility. Depletion of tolerogenic T lymphocytes induces severe autoimmune orchitis, immune cell infiltration,...

Introduction Emerging animal-based research highlights the requisite role of the immune system in maintaining tolerance to spermatozoa. Critically, however, there exists a paucity of studies investigating the role of the immune system in clinical male factor infertility. Current protocols investigating seminal fluid resident white blood cells (leuk...

Introduction Despite improvements in nerve-sparing techniques offered by Robotic Assisted Laparoscopic Radical Prostatectomy (RARP), nearly all patients undergoing this procedure will demonstrate some degree of erectile dysfunction (ED) thereafter. Emerging data indicate that older age and pre-surgical hypogonadism correlate with worsened post-surg...

Introduction Though a relatively new clinical science and subsequent field of investigation, andrology research has emerged to address male health issues, particularly male fertility and sexual dysfunction. These conditions are widespread and significantly impact quality of life, yet they remain highly stigmatized. This stigma often deters patients...

Introduction The average age for a vasectomy reversal is reported as 35.2 years in the 1980s and 36.0 in the 1990s. Objective We sought to quantify the vasectomy reversal patient profile over the subsequent decades so that urologists may be better informed to counsel patients regarding their current and future fertility options. Methods A retrosp...

Introduction Approximately half of couples with infertility will be found to have a male factor. However, historical data has revealed that infertility is preferentially attributed to the female partner. This often-wrong assumption may cause female partners to undergo invasive and expensive procedures and treatments when the couple’s lack of fertil...

Introduction Migration of an IPP reservoir into the bladder is a rare, but known complication of penile prosthesis surgery with few documented cases over the past 25 years. Management options include retrograde removal via a penoscrotal/infrapubic approach without cystotomy closure and prolonged foley placement, versus an antegrade, open approach v...

Introduction Physicians face significantly higher rates of infertility than the general public and over 50% of medical residents express concerns over their own fertility. This highlights a pressing issue within the medical community, particularly among those in surgical training programs. Addressing these concerns is crucial for the well-being and...

Introduction Men with Peyronie’s Disease (PD) are theorized to have an increased cancer risk. PD is characterized by infiltrative growth, proliferation, and decreased apoptosis- pathways shared by malignant neoplastic growth. Thus, one can hypothesize a genetic predisposition toward cancer as heralded by PD pathogenesis. Objective To investigate t...

Introduction Current AUA guidelines recommend proceeding to microTESE (mTESE) for patients with non-obstructive azoospermia (NOA). Herein, we propose that that conventional Testicular Sperm Extraction (cTESE) is an effective and preferred first-line technique for sperm retrieval in men with NOA who first undergo a diagnostic testicular core extract...

Introduction Infertility is a prevalent problem in the United States with male factor etiology in up to 50% of these cases. Varicoceles are present in up to 35% of men with primary infertility. However, surgical correction with varicocelectomy yields varying improvements in semen parameters. Objective To characterize semen parameter improvements f...

Introduction Outcomes with vasectomy reversal procedures for infertility have varied widely in the literature, with limited data available on long-term results. The current study objective was to provide data on long-term outcomes, including delayed stenosis rates using a multicenter dataset. Objective To evaluate the rate of long-term stenosis of...

Introduction Leukospermia is of poorly understood clinical significance. Culture-based assays have not consistently correlated leukospermia with bacteriospermia. DNA-based microbial detection has revealed a rich microbiome throughout the body, often in areas previously presumed sterile, and certain microbial populations have been linked to impaired...

Introduction Although use of ejaculated sperm for Intracytoplasmic Sperm Injection (ICSI) in men with cryptozoopsermia obviates conventional testicular sperm extraction (cTESE) or micro testicular sperm extraction (mTESE), there exists an ongoing debate as to whether testicular sperm produce better ICSI outcomes. Objective To better understand thi...

Introduction Testosterone monotherapy impedes spermatogenesis and often renders the male user azo- or severely oligospermic. Prior studies have demonstrated that rescue Human Chorionic Gonadotropin (HCG) and Clomiphene Citrate therapy can restore semen parameters, but report that just under half of men will respond favorably. Objective In the pres...

Introduction Falls continue to be a prominent cause of injury and disability in the elderly. One in three adults 65 and older will fall each year. A significant number of these accidents are severe enough to result in an emergency room visit. Higher levels of endogenous testosterone are protective against falls in elderly men. Objective This study...

Introduction Placement of a penile prosthesis is a safe, reliable treatment for erectile dysfunction. Unfortunately, regardless of patient satisfaction, some prostheses must be removed for select indications. It is widely believed that after explant of a penile prosthesis, patients will have no chance of penetrative intercourse without another peni...

Introduction With ideas such as God’s command to “be fruitful and multiply” in both Jewish and Christian texts and the Vatican’s disapproval of the use of in vitro fertilization (IVF), religious identities of male-factor infertility patients may affect how patients engage in reproductive health care. Objective The goal of this study is to assess t...

Introduction When a couple seeks family planning information following a prior vasectomy, they are burdened with fertility restoring options with vastly different costs, insurance coverage options, success rates, and risks. The couple is tasked with making a personalized decision by attempting to prioritize these factors as well as taking into acco...

Background Both clomiphene citrate and its isomer, enclomiphene, have become widespread within urologic practice; thus, understanding these medications’ comparative benefits and risks is crucial for optimizing treatment and providing improved therapeutic options. We sought to investigate the longitudinal benefits and risks associated with enclomiph...

Physician infertility has become a growing concern because of the increasingly high rates of infertility physicians experience associated with their strenuous work schedules, environmental exposures, and delayed family planning due to their necessitated years of training. Fortunately, there has been an increase in awareness, advocacy, and urgency f...

Introduction Physician infertility has become a growing concern, documented by the high rates of infertility physicians experience as a result of their strenuous work schedules, environmental exposures, and delayed childbirth due to their extensive years of training. The implications in fertility extend beyond an individual's desire to have childre...

Introduction While erectile dysfunction (ED) in young men has traditionally been viewed as primarily psychogenic in etiology, a growing body of evidence supports a higher prevalence of organic etiology. Objective The aim of this study was to further characterize the etiology and treatment outcomes of ED in men under 40 years at a single institutio...

Introduction Depression of spermatogenesis is a significant concern for hypogonadal patients on testosterone therapy. Human chorionic gonadotropin (hCG) is commonly prescribed in these men to prevent testicular atrophy and to maintain some degree of spermatogenesis. Furthermore, hCG dosages are significantly increased when a pregnancy is desired. H...

Introduction Inflatable penile prosthesis (IPP) is seen as the gold standard for surgical treatment for ED, specifically for patients that are not amenable to lifestyle changes or oral medications. Objective This study aims to explore which patients progress to seeking treatment with an IPP along their journey with erectile dysfunction. Methods T...

Introduction Collagenase Clostridium histolyticum (CCH) is the only FDA-approved medication for Peyronie’s Disease (PD) in the United States. While treatment-related side effects are commonly considered mild or moderate in severity, including bruising, pain, and swelling, there is currently limited literature on how these side effects affect patien...

Introduction Historically, testosterone therapy (TTh) is not indicated in eugonadal men with erectile dysfunction (ED). Moreover, the 2018 AUA Guidelines state that TTh is not indicated as monotherapy for men suffering from ED but should be considered as combination therapy with PDE5i, as TTh may increase the efficacy of PDE5i therapy. Objective W...

Introduction Clomiphene is a selective estrogen receptor modulator used to induce ovulation by increasing luteinizing (LH) and follicle-stimulating hormone (FSH) levels. Since the 1970’s, it has been used in males with hypogonadism as an alternative to testosterone therapy as it does not suppress the hypothalamic-pituitary-gonadal axis. Objective...

Introduction Inflatable penile prostheses (IPP) are used in a multitude of urologic disorders including Peyronie’s disease and medication-refractory erectile dysfunction. The IPP procedure is performed by inserting a penile pump to help generate and maintain penile erections. Objective To analyze self-perceptions and body dysmorphia of patients wh...

Introduction Depression of spermatogenesis is a significant problem in the hypogonadal patient on testosterone therapy (TTh). We commonly prescribe human chorionic gonadotropin (hCG) concomitantly in these men to prevent testicular atrophy and to maintain some degree of spermatogenesis. When a pregnancy is desired, we increase the hCG to 3000 units...

Introduction Collagenase Clostridium histolyticum (CCH) is the only FDA-approved medication for Peyronie’s Disease (PD) in the United States. Roughly half of patients who received CCH experienced improvements in curvature by more than 20% in the IMPRESS I/II trials. Despite objective improvements in PD severity, some patients still report dissatisf...

Introduction The COVID-19 pandemic brought with it an increase of healthcare interactions on an electronic interface, but a return to in-person interactions has left many questions open regarding the future utility and viability thereof. Urologic care, and particularly sexual health, frequently involves sensitive issues and understanding patients’...

Introduction Traditionally, the use of testosterone replacement therapy (TRT) in hypogonadal men on active surveillance (AS) with prostate cancer (PC) has been controversial, and for many providers, contraindicated. However, studies suggesting a need to revisit the association between TRT and prostate cancer progression have contributed to a recent...

Introduction Roughly 52% of men over the age of 40 have ED. However, our understanding of ED risk factors is constantly evolving. Objective The aim of this study is to provide a contemporary update of risk factors and characteristics of men presenting with erectile dysfunction (ED). Methods A retrospective review identified 576 men presenting to...

Introduction Clomiphene, and its trans isomer enclomiphene, have been used off-label in recent years for hypogonadal men seeking to maintain fertility. Both drugs have become increasingly widespread within andrology clinics; thus, understanding the comparative benefits and risks of these medications are crucial for optimizing treatment decisions an...

Introduction A positively perceived body image is an important part of one’s conception of oneself and one’s own identity, abilities, and worth. Past research has shown an inverse relationship between testosterone concentration and one’s sense of self, as manifested by increased depression. We hypothesized, therefore, that a subjectively negative s...

Introduction Male hypogonadism impacts the production of hormone production, which plays a key role in masculine growth. It has also been shown to impair certain male reproductive functions or delay development. Objective The goal of this study is to describe the characteristics and treatment outcomes for patients with a diagnosis of Hypogonadism...

Introduction Sustained treatment with elevated levels of exogenous testosterone (T) has been linked to various adverse events, particularly concerning cardiovascular risks. However, there is currently a lack of sufficient literature that comprehensively describes the overall safety profile of supraphysiologic testosterone levels. Objective To comp...

Introduction Collagenase clostridium histolyticum (CCH) is the only FDA-approved medication for Peyronie’s Disease (PD) in the United States. Roughly half of patients who received CCH experience improvements in curvature by more than 20% in the IMPRESS I/II trials. Current literature reports varying satisfaction rates of 67-81% within one year of t...

Introduction Erectile dysfunction (ED) affects 52% of men in the US, with treatment modalities varying significantly in their degree of invasiveness. Low-intensity shockwave therapy (LI-SWT) is an emerging non-invasive therapy that uses acoustic waves to improve cavernosal arterial flow by inducing microtrauma and subsequent angiogenesis, in additi...

Approximately one in twenty men have sperm counts low enough to impair fertility but little progress has been made in answering fundamental questions in andrology or in developing new diagnostic tools or management strategies in infertile men. Many of these problems increase with age, leading to a growing population of men seeking help. To address...

Approximately one in twenty men have sperm counts low enough to impair fertility but little progress has been made in answering fundamental questions in andrology or in developing new diagnostic tools or management strategies in infertile men. Many of these problems increase with age, leading to a growing population of men seeking help. To address...

Introduction Hyperbaric oxygen therapy (HBOT) is a medical treatment in which the patient is exposed to 100% oxygen at a higher than atmospheric pressure. Over the past few decades, HBOT has been used to treat a variety of medical conditions. In recent times, there has been a rising curiosity regarding the potential therapeutic benefits of HBOT in...

This gold standard text has kept its readers abreast of rapid advancements in reproductive medicine and surgery since 1983. Continuing this tradition, this fifth edition has been fully updated and revised to provide clear, didactic advice on best practice for a variety of clinical situations faced by practitioners across many specialties - includin...

The clinical landscape of Peyronie’s disease is everchanging. There has been growing interest in non-invasive therapeutic options that could assist patients with achieving a meaningful reduction in penile curvature without surgical intervention. These therapies are wide-ranging in terms of their mechanisms of action, efficacies, and short- and long...

Objectives: To assess the value of preliminary testicular core extraction (TCE) as a tool for determining whether to pursue cTESE versus mTESE to minimize both financial burden and procedural complexity. Methods: All men with non-obstructive azoospermia (NOA) from 2018 to 2022 who underwent clinic TCE were analyzed. Patients who were found to ha...

Testosterone undecanoate injections (TU), an oil-based depot, is a universal hormonal-based treatment which has been associated with pulmonary oil microembolism (POME). However, the rate of POME during routine intramuscular (IM) TU injection is unknown. Here, we conduct a peer-reviewed literature review investigating POME incidents in the setting o...

Male solid organ transplant patients are at increased risk of hypogonadism and the safety of treating these patients for hypogonadism is unknown. We sought to evaluate the safety of treating hypogonadism in the solid organ transplant recipient. To accomplish this, we performed a retrospective review between 2009 and 2017 of patients treated at a si...

Male infertility is a common disease. Male infertility is also a core competency of urology training and clinical practice. In this white paper from the Society for the Study of Male Reproduction and Society for Male Reproduction and Urology, we identify and define different physician productivity plans. We then describe the advantages and disadvan...

Purpose of Review Approximately half a million men each year facing infertility in the USA are not properly evaluated by a dedicated male infertility specialist. Prior research has examined barriers to male infertility care from epidemiologic, geographic, financial, socioeconomic, and health policy perspectives. This article aims to describe barrie...

Purpose of Review What is the goal of your paper? What questions did you seek to answer? Digital health is an emerging discipline that utilizes hardware and software tools to improve healthcare delivery efficiency and accessibility. Technologies that fall under the digital health umbrella include mobile phone applications, telemedicine, and social...

Recent data suggest that cystic fibrosis transmembrane conductance regulator (CFTR) gene alterations negatively impact male fertility beyond obstruction. We sought to compare gene alterations, sperm retrieval rates, and intracytoplasmic sperm injection (ICSI) outcomes among men with cystic fibrosis (CF) disease and congenital bilateral absence of t...

Introduction There is persistent speculation that testosterone therapy (TTh) may induce worsening of obstructive sleep apnea (OSA). As both the incidence of OSA and the use of TTh grow more prevalent, it is important to review the current evidence that supports or refutes this relationship. Objectives To review the current literature regarding the...

Objectives Here we examine the association between shift work sleep disorder (SWSD) and erectile dysfunction (ED) in shift workers. Methods Men presenting to a single andrology clinic between January 2014 and July 2017 completed validated questionnaires: International Index of Erectile Function (IIEF), Patient Health Questionnaire-9 (PHQ-9), and t...

This study evaluates YouTube videos (YTVs) focused on male infertility to assess information quality and identify high-quality content that can reliably facilitate care. Top 50 YTVs based on relevance were identified using the keyword “male infertility.” A checklist, adapted from American Urological Association guidelines addressing male infertilit...

A male factor is a contributor in 50% of cases of infertility. Although assisted reproductive techniques can often bypass the need to improve semen parameters, the evaluation of the infertile man remains critical. Current methods for evaluating the infertile man are discussed, beginning with the basic workup that all suspected infertile men should...

Introduction Erectile dysfunction (ED) is the inability to attain or sustain an erection for sexual intercourse. Affected men endorse difficulties with intimacy and feelings of guilt and shame. Although medical treatments are available, patients are reluctant to discuss ED with physicians and often use dietary supplements to attempt to treat their...

Internet adoption continues to increase as broadband access and mobile connectivity penetrate developing global markets. Alongside increasing adoption, the Internet continues to evolve and usher in new modes of user interaction. Social media and search engines have facilitated the emergence of the participatory web, in which users are able to contr...

Testosterone is an archetypal androgenic-anabolic steroid (AAS), while its exogenous administration is considered to be the gold standard for the treatment of male hypogonadism. The benefits are not due to its intrinsic nature alone but are due to the result of its interactions with the androgen receptor (AR). As the management of hypogonadism cont...

Male hypogonadism is an increasingly prevalent clinical condition that affects patients' quality of life and overall health. Obesity and metabolic syndrome can both cause and result from hypogonadism. Although testosterone remains the gold standard for hypogonadism management, its benefits are not always conserved across different populations, espe...

Sleep has increasingly been found to play a role in the overall health of an individual, but sleep quality has also been decreasing with the invasion of technology into the bedroom, "always-on" lifestyles, and increasing demands on one's time when awake. We have herein reviewed the literature to assess the impact of sleep on erectile dysfunction, l...

Selective androgen receptor modulators (SARMs) are small molecule drugs that function as either androgen receptor (AR) agonists or antagonists. Variability in AR regulatory proteins in target tissues permits SARMs to selectively elicit anabolic benefits while eschewing the pitfalls of traditional androgen therapy. SARMs have few side effects and ex...

Objective: To assess the variability in management of estrogen levels in men treated with testosterone therapy (TTh). With the significant increase in the last two decades in the treatment of hypogonadism and the use of TTh, detailed guidelines for the management of estrogen levels are necessary. (1) MATERIALS AND METHODS: An anonymous survey was...

Objective: To examine the association between shift work sleep disorder (SWSD), a primary circadian rhythm disorder characterized by excessive daytime sleepiness associated with shift work, and hypogonadal symptoms in shift workers . Methods: Men presenting to an andrology clinic between July 2014 and June 2017 completed questionnaires assessing...

Purpose of Review As the prevalence of diabetes mellitus grows worldwide, it is increasingly important to understand the commonly comorbid urologic conditions, hypogonadism and erectile dysfunction, in the setting of the diabetic man. The relationship between the diabetes, hypogonadism, and erectile dysfunction is complex with significant interplay...

Introduction: Erectile dysfunction (ED) is a prevalent and under-recognized complaint among male solid organ transplant recipients. Most research on this topic has focused on kidney transplant recipients alone. In this review, we integrate current research on ED across all types of solid organ transplant recipients and assess the success of curren...

Background: Vasectomy reversal (VR) is a specialized procedure currently offered by an increasing number of medical practitioners. One method of VR, vasoepididymostomy (VE), is considered the most challenging microsurgical technique within the field of reproductive urology. We surveyed reproductive urologists to assess current practice patterns re...

Varicocele treatment has existed for over a century, and numerous surgical and radiographic treatment options exist. All available treatments provide reasonable improvements in clinical outcomes for the infertile male, although certain treatment choices may be preferred in unique patient populations or specific clinical situations. However, a clear...

Background: Men with Peyronie's disease (PD) may have an increased prevalence of certain comorbidities, including malignancy. We sought to examine the clinical relationship between PD and subsequent diagnosis of malignancy. Methods: Using data from the IBM Health MarketScan claims database from 2007 to 2013, we compared men with PD to a control...