Precision Medicine Applications in Hypogonadism and Other Areas of Men's Health

Precision medicine—formerly called personalized medicine—is a national healthcare priority in the United States. In his remarks announcing a $215 million commitment to develop precision medicine in January 2015, President Obama used the example of doctors matching a blood transfusion to a blood type and said, “What if matching a cancer cure to our genetic code was just as easy? That’s the promise of precision medicine, delivering the right treatments at the right time, every time, to the right person.”

The American Journal of Men’s Health discusses this initiative with special attention to a patient group that is notoriously difficult to engage: men. With sections on prostate cancer, benign prostatic hyperplasia (BPH), infertility, hypogonadism, and erectile dysfunction, the authors give heavy emphasis to endocrine problems.

They report that more than 70 single nucleotide polymorphisms can predict prostate cancer risk when incorporated into polygenic risk scores, allowing screening for elevated risk. Once clinically assessable, these tests could tag patients for prostate-specific antigen screening and chemoprevention.

In BPH, medical therapy resistance has been linked to CAG repeats in the androgen receptor gene—response to testosterone therapy is inversely related to the number of repeats, and surgery may be a better option.

Erectile dysfunction appears to have a possible link to genetic polymorphisms, with some patients responding better to the PDE5 inhibitors. For example, Patients possessing polymorphisms in the gene that encodes the G-protein β3 subunit seem to have better outcomes when they take sildenafil than those lacking the mutation.

More precise diagnosis will advance infertility screening and treatment, identifying precise causes. The authors site the example of advising certain couples to avoid using the male partner’s sperm (that’s, avoid sperm extraction and in vitro fertilization) to prevent abnormalities in children.

Precision medicine’s role in the management of hypogonadism is still in its formative stages. Researchers suggest that identifying biomarkers associated with individual patients’ treatment responses is possible.

The authors stress that precision medicine will improve men’s healthcare. It will also provide many benefits to their planned and actual families.