Armor Men's Health Show

EP 586: Rethinking ED and Testosterone Treatment

June 15, 2022 Dr. Sandeep Mistry and Donna Lee
Armor Men's Health Show
EP 586: Rethinking ED and Testosterone Treatment
Show Notes Transcript

In this episode, Dr. Mistry and Donna Lee discuss the evolution of erectile dysfunction treatment within the field of urology. Only decades ago,  ED was almost entirely attributed to psychological causes. Today, urologists view ED as a complex condition with both physiological and psychological causes, but its psychological impacts remain under-diagnosed and under-treated. No matter their cause, ED symptoms are distressing and can lead to performance anxiety, sexual dysfunction, and isolation. Fortunately, Urology Specialists offers affordable, cutting edge treatments for ED, including psychological care. If you or someone you love is struggling with ED, please give us a call today!

Voted top Men's Health Podcast, Sex Therapy Podcast, and Prostate Cancer Podcast by FeedSpot

Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.

We enjoy hearing from you. Email us at armormenshealth@gmail.com and we’ll answer your question in an upcoming episode!

Phone: (512) 238-0762
Email: Armormenshealth@gmail.com
Website: Armormenshealth.com

Our Locations:

Round Rock Office
970 Hester’s Crossing Road
Suite 101
Round Rock, TX 78681

South Austin Office
6501 South Congress
Suite 1-103
Austin, TX 78745

Lakeline Office
12505 Hymeadow Drive
Suite 2C
Austin, TX 78750

Dripping Springs Office
170 Benney Lane 
Suite 202
Dripping Springs, TX 78620

Speaker 1:

Welcome back to the Armor Men's Health Hour with Dr. Mistry and Donna Lee.

Dr. Mistry:

Hello and welcome to the Armor Men's Health Hour. I'm Dr. Mistry, your host, here with my co-host Donna Lee.

Donna Lee:

Hi. Happy Saturday.

Dr. Mistry:

Happy Saturday, everyone. Welcome to our show. I am a board certified urologist. I treat a variety of health conditions, a lot of them related to men's health issues. We got a lot of men coming through our clinic, don't we?

Donna Lee:

We have a lot of men. We have some womens, but we got lots of mens.

Dr. Mistry:

What's the name of our urology clinic, Donna?

Donna Lee:

It is Urology Specialists.

Dr. Mistry:

That's right. Urology Specialists.

Donna Lee:

It used to be North Austin Urology, and now we are Urology Specialists.

Dr. Mistry:

And that's because we have gone, you know, big time.

Donna Lee:

All over. We're all over the place. We're in south Austin, Dripping Springs, north Austin, Round Rock. And you started this practice what? 13 years ago?

Dr. Mistry:

That's right. 13 years ago. We have four physician practitioners, three mid-level providers, so that's PAs and nurse practitioners. We have a pelvic floor physical therapist. We have...

Donna Lee:

She's been with us, Dr. Treadway, the whole time.

Dr. Mistry:

...a long time. A registered dietitian on staff. We don't manage, per se, but we do test for and have a program specifically designed for obstructive sleep apnea. And we also have a sex therapist.

Donna Lee:

We have a lot of things going on, a lot of balls in the air.

Dr. Mistry:

Yeah. You know...

Donna Lee:

As, as we say.

Dr. Mistry:

Yeah, as we say. We don't speak enough about the psychological aspects that we treat here, which is interesting, because years ago, when I was in training, before Viagra was a drug available, most books on erectile dysfunction or impotence would cite that psychological problems are the number one reason for erectile dysfunction. Well, it does not.

Donna Lee:

...to a degree.

Dr. Mistry:

And today we would never say that.

Donna Lee:

Back then, though. It makes sense.

Dr. Mistry:

Back then, maybe.

Donna Lee:

You're like,"It's all in your head."

Dr. Mistry:

Well, if you didn't have a hammer, then everything didn't look like, nothing looked like a nail, you know?

Donna Lee:

Right.

Dr. Mistry:

It was a really interesting wake up call for medicine and urologists to understand that surely, having erectile dysfunction causes psychological problems...

Donna Lee:

For sure.

Dr. Mistry:

...because you know, it causes performance anxiety and self-worth problems and decreased intimacy. To think that the psychological problem was the cause of it I think was really because we didn't have a solution for it.

Donna Lee:

Right.

Dr. Mistry:

And so it was easier to say,"Eh, it's in your mind."

Donna Lee:

"It's all in your head."

Dr. Mistry:

"It's all in your head." And I think the same thing happens to women. So a lot of times, women with sexual dysfunction will be told that,"Well, you just need to relax." For some reason, a lot of people give women the advice to drink a glass of wine.

Donna Lee:

I almost said,"Have a glass of wine. Relax. Stop thinking about the dishes."

Dr. Mistry:

Yep. Probably a new boyfriend. I've heard that one.

Donna Lee:

Maybe

Dr. Mistry:

From my wife. I would rather her not follow that advice.

Donna Lee:

No.

Dr. Mistry:

But I think that that is a mistake as well. I think it suggests that everything about sexuality in men and women are just in their mind, and that the body's physiologic responses to things doesn't play a big role. Since the beginning of our practice, we've had a very robust program for the treatment of women with sexual dysfunction. The way I think about it in my mind is that really, biologically what makes up a woman's genitalia and her sexual response is very little difference between that and a man. So when you're in medical school, actually, there's a whole test that you take just to compare what is the man organ and the woman organ, and what are their analogs? And everything has an analog. Even the uterus has an analog in a man. When you go with that and you think,"Well, the nerves are the same and the blood flow is the same and the receptors are the same," that's why in our practice, we treat men and women with sexual dysfunction very similarly. You just have to recognize what is the dysfunction? What does arousal difficulties, what is orgasmic difficulties? What is pain? And how would we treat it in a man, and then how can we translate some of that to a woman? And that's why we had to include sex therapy so early in our practice.

Donna Lee:

Right.

Dr. Mistry:

Because you couldn't separate the psychological aspects and the biological aspects, and so we've been very fortunate here. So if you're a man with performance anxiety, we get a lot of men who just, believe it or not, are unable to penetrate, just because of psychology--newly married men, people from Asia. We, I just see this all the time, and having this sex therapy kind of tool in our toolkit makes us, I think, very robust.

Donna Lee:

Totally. And then we have the most amazing group, the Center for Relationships is the sex therapy group that we've partnered with all this time.

Dr. Mistry:

That's right.

Donna Lee:

And they're amazing Dr. Vagdevi runs that show and she's incredible.

Dr. Mistry:

And if you're interested in kind of an approach that she takes, check out the podcast. A little plug for the podcast.

Donna Lee:

That's right. Her name is Vagdevi. V-A-G-D-E-V-I.

Dr. Mistry:

No way you spell that right.

Donna Lee:

It totally a hundred percent.

Dr. Mistry:

Oh, man.

Donna Lee:

She's my favorite person, so.

Dr. Mistry:

Well, she's awesome. And she did a couple shows with us. The, her shows are on the podcast. We talked about how to reignite the spark in your relationship, and we talked about...

Donna Lee:

That was fascinating.

Dr. Mistry:

It was a good...

Donna Lee:

She was talking about watching porn as a couple and getting aroused together. And for women to just drop the whole psychological...

Dr. Mistry:

You just started right up with the porn.

Donna Lee:

I did. And I just thought that was fascinating.

Dr. Mistry:

People...it's a Saturday show now.

Donna Lee:

Well, it, it is a men's wellness show, so I'm sure they've heard of porn.

Dr. Mistry:

No.

Donna Lee:

But I'm just saying, it was a really interesting open discussion that I think is worth Googling and finding.

Dr. Mistry:

Before the internet, we all just pretty much watched, you know, ads about bras.

Donna Lee:

You know, my dad handed down his entire Playboy collection to me.

Dr. Mistry:

You?

Donna Lee:

Yes. Well, I mean, I'm an only child.

Dr. Mistry:

Okay.

Donna Lee:

But he had the original, like, Marilyn Monroe ones, and all the ones from the very beginning, and I don't know what to do with them. So if you're a listener out there and you're interested in buying a...

Dr. Mistry:

Don't do this.

Donna Lee:

...giant collection.

Dr. Mistry:

Don't do this. Don't do this.

Donna Lee:

We can bring'em here.

Dr. Mistry:

Can I please have the Marilyn Monroe one?

Donna Lee:

I'll sell it to you for$12,000.

Dr. Mistry:

$12,000.

Donna Lee:

There you go.

Dr. Mistry:

But you know what I wanted to talk about today? I wanted to talk about shock wave therapy for erectile dysfunction. Just increasingly I've seen so many different types of practitioners say that they're gonna treat your erectile dysfunction.

Donna Lee:

And blankly. Like, with what?

Dr. Mistry:

And they have great logos and great ads.

Donna Lee:

...guaranteed.

Dr. Mistry:

And everything's guaranteed. And I'm thinking to myself, they must be successful, because those commercials are not cheap. Men must be seeking them out. And so what am I doing wrong? Why, why don't patients seek care from someone who actually treats erectile dysfunction?

Donna Lee:

Because, because we don't have as many ads.

Dr. Mistry:

...and knows how the penis works, and what happens, and biologically, and hormonally, and nervous system-wise. I'm convinced it's this, is that when, when men are seeking a quick answer to their problems, sometimes these type of organizations work better for them. I thought I'd give a little primer. Shock wave therapy for erectile dysfunction has been something that has come in the mainstream in the last, maybe three to five years. It uses very low intensity shock waves that, in effect, lead to a, a response within the erectile body of the penis to rejuvenate. Our, as a urologist, we have been very comfortable prescribing and utilizing shockwave therapy because we use it for kidney stones. And I actually use ultrasound to treat prostate cancer.

Donna Lee:

Right.

Dr. Mistry:

And so that's all an ultrasound is, or shockwave, is just ultrasound waves. And this low intensity shockwave is something that's delivered here in the office. I would say that for men with mild to moderate ED, you can probably see about a 75% to 80% response. It's done painlessly within about 30 minutes.

Donna Lee:

Yeah. The word shock is I think misleading.

Dr. Mistry:

That's correct. That's why a lot of people use something, some other term that you like.

Donna Lee:

Yeah. There's these all these...

Dr. Mistry:

Gentle massage.

Donna Lee:

That's another commercial.

Dr. Mistry:

That's a different commercial. That's a, that's a different place altogether.

Donna Lee:

Well, yikes.

Dr. Mistry:

Yeah, you may be half tie, but...But, but I think that doing shockwave therapy for erectile dysfunction, independent of another broader evaluation, is something that is going to set you up for failure. Because if it doesn't work, then you're gonna be even more discouraged and not know what to do.

Donna Lee:

Good point.

Dr. Mistry:

And so that, that's why, even if you're interested in specifically shockwave, we would ask you to reach out to us. We, our shockwave treatment prices are, I I'd have to guess, cheaper than almost anyone else's. It's$400 a treatment. Usually, people do five or six. And if you do, if you do buy a package of six treatments, the last one's free. You know, as a, as someone who takes medicine real seriously, I hate doing like promotions, you know? But, but, but you know, whatever it takes to get you in here. Because if you have erectile dysfunction and, and you're 52 years old, then we need to worry about more than just, you know, Jimmy John down there, we need to worry about...you think we can get sponsored by Jimmy John?

Donna Lee:

Yeah, I don't think so.

Dr. Mistry:

You need to worry a little bit more about that, about your overall cardiovascular health, because...

Donna Lee:

There's so much more to think about.

Dr. Mistry:

...underlying diabetes. I mean, that's, what we, what we tell patients is the arteries that feed your penis are the smallest important arteries in your body. The next biggest are the ones that go to your heart, and then the ones that go to your brain, and the ones that go to your legs. So, you rarely meet somebody with peripheral artery disease or with a history of carotid artery stenosis and stroke that, that's able to get an erection, because the, the first, the bellwether artery is gonna be your penile arteries. And so we'll do a hormonal evaluation. We'll make sure you're on the right meds. We'll make sure you're on the right supplements. I would certainly encourage you that if you have a erectile dysfunction to not take a shortcut. We will see you quickly. We'll make sure that you're treated well. And we'll, we're going to evaluate you from a hormonal standpoint, psychological standpoint, we're gonna look for your nervous system, and then your vascular system. So, you know what I thought we would do here?

Donna Lee:

Question/answer session?

Dr. Mistry:

Really, I want you to ask me questions that you think are interesting about what's going on here in the clinic. And I'd love to hear some feedback that, that you've had from patients about some of the different treatments we've had. And we can just like put it all together in one show.

Donna Lee:

Well, that sounds fascinating.

Dr. Mistry:

So, I didn't give you any prep time. Tell...

Donna Lee:

You did not.

Dr. Mistry:

You start. Go ahead.

Donna Lee:

Thanks. On that note, my husband's always asking questions.

Dr. Mistry:

Let's see.

Donna Lee:

Because he's got all those cardiovascular issues and you know, his, his history since y'all are so close. I would like to announce though, that I came home one day and I told my husband that I, that you made me cry at work. And his response was,"Well, what did you do, Donna?"

Dr. Mistry:

That's right. And so from a lot of men out there, they're confused because that sounds really like a reasonable thing to ask. But...

Donna Lee:

Oh no.

Dr. Mistry:

Now that I've becoming more of a, a well aware person, I now realize it should have been,"What did he do?"

Donna Lee:

Yeah.

Dr. Mistry:

Right.

Donna Lee:

That's what I thought he was gonna say. But, you know, he takes your side and I don't understand. His questions are always as, are his friends,'cause they're all in the same age group, in their early to mid-fifties, is how healthy is it to be on testosterone if you've got cardiovascular issues? So he had a quadruple bypass. He's got a lot of friends in his position. A lot of them are overweight, they're not healthy, they're smoking, they're drinking. So I think he's scared as they are about taking testosterone. Because I think it's like a, you know, they're worried some sort of weird cardiovascular booster they're gonna get, that's gonna give'em a heart attack.

Dr. Mistry:

And I think that that's a great question, so...

Donna Lee:

Thank you.

Dr. Mistry:

There is some controversy because of some studies that came out several years ago that suggested that testosterone use might be dangerous for some men and make their cardiovascular disease worse. I can tell you, not only have those studies and the methods behind them been not supported, but for decades, we have known one thing for sure, without a doubt: having a low testosterone puts you at higher risk for death from cardiovascular disease.

Donna Lee:

Okay.

Dr. Mistry:

We know that.

Donna Lee:

Well, there you go.

Dr. Mistry:

We know that. We, that is, that is settled science. If you are walking around with a testosterone level of 185 or 210, and you go long enough, you are going to have a higher risk of heart attack and stroke than another, your neighbor, who has walking around with a testosterone of 500.

Donna Lee:

What's a normal range of testosterone?

Dr. Mistry:

350 to a thousand is what we use. The numbers from your insurance company, your lab may not be completely in line with those. I think a lot of men, they don't do testosterone therapy because they're scared that their insurance won't pay for, or somebody told'em it wouldn't.

Donna Lee:

Or it's expensive.

Dr. Mistry:

Or expensive. I mean, it's super cheap.

Donna Lee:

It's really cheap.

Dr. Mistry:

It's super cheap. Like of all the things we do to people...

Donna Lee:

I was shocked.

Dr. Mistry:

...it's super cheap.

Donna Lee:

When I came over here three years ago and found out the pricing, I was like,"Are we charging enough? Because it doesn't seem like it."

Dr. Mistry:

Yeah. I mean, if such, just somebody out there, whenever somebody tells me that,"Man, Dr. Mistry, that was a lot cheaper, whatever you recommend, it was a lot cheaper than I thought I was gonna be," that makes me so happy because I want people to know that that good healthcare is completely accessible. And if you just kind of...

Donna Lee:

And affordable.

Dr. Mistry:

...disassociate yourself a little bit from what you kind of think you're entitled to get paid for with your insurance, then you get to be the, the boss of your own treatment. So many guys buy testosterone, like, from some back alley gym or order it online or, you know, pick some extra up when they're across the border. And I'm like,"It's super cheap here. Just, just, just buy it here. Why are you through some craziness?"

Donna Lee:

Oh gosh, I had an angry patient once at my previous clinic. He was yelling and screaming and the staff brought me in. He was a manager and I had to deal with him, and he was yelling and screaming. And then we looked at his testosterone level and it was 3000, and I was like,"Oh." And he like owned a gym. He was very upset.

Dr. Mistry:

Well, I'm glad you brought that up because that's a common myth, in fact, that being overly testosteroned may cause you to have a bad attitude. Let me tell you something, that guy was probably a real jackass to start with.

Donna Lee:

He was.

Dr. Mistry:

He didn't need any help from the testosterone.

Donna Lee:

He was amazing.

Dr. Mistry:

He didn't need any help from the testosterone.

Donna Lee:

He physically got in my face as if we were about to go throw down out in the parking lot.

Dr. Mistry:

After, after more than a decade of treating patients, and because we do it in a, in a controlled way, I would say that incidences of roid-rage or incidences of greatly altered personality are extremely rare and uncommon. People often will say,"Well, what am I gonna turn into when my testosterone's normalized?" And I say,"Well, were you kind of a dick before? Because if you were, then you, you might turn back into that guy." It's not going to take an otherwise mild mannered, regular person and turn him into incredible Hulk.

Donna Lee:

Hulk Hogan.

Dr. Mistry:

Which would be awesome.

Donna Lee:

That would be kind of cool if you turned green.

Dr. Mistry:

It would be, it would be awesome.

Donna Lee:

That would be cool.

Dr. Mistry:

Yeah.

Donna Lee:

Well, I can tell you, I take testosterone through our clinic.

Dr. Mistry:

Yes.

Donna Lee:

I see Lenora Brown, one of our providers, and...

Dr. Mistry:

That's right.

Donna Lee:

...I feel amazing. And when I get that shot every two weeks on a Friday, did I tell you? I have the most amazing boss dream ever, like I'm the boss of the world.

Dr. Mistry:

Sweet.

Donna Lee:

Every two weeks I have the best dream.

Dr. Mistry:

I love it.

Donna Lee:

The staff thinks it's hysterical.

Dr. Mistry:

Well, you know, that's great because a lot of, if you are listening with your wife or, you know, my incredible cadre of women listeners are tuning in.

Donna Lee:

Two of them.

Dr. Mistry:

Yeah, all two of them. Both of you. Testosterone replacement therapy is something that is possible in women. We usually do that in conjunction with estrogen replacement therapy, but not always.

Donna Lee:

Right.

Dr. Mistry:

So for some reason, you are just not comfortable taking estrogen, or you're not a candidate for it, we have a lot of young patients with low libido who do get better libido with testosterone replacement. Topical creams are probably the most common way that we give testosterone, or pellets in women, but occasionally, like yourself, injections because they're so inexpensive tend to be the one. The volume is real low that, that we have to give. Sometimes it's hard to drop such a low volume, but, but we definitely have ways of replacing testosterone. It does help maintain muscle mass, it does have a role in bone health, and libido, and mood, you know? And, you know...

Donna Lee:

Yeah. We're still looking for my libido, but I feel amazing.

Dr. Mistry:

That's right. We're still looking for it. It's like a scavenger hunt around here.

Donna Lee:

I heard Dr. Wang on our show, not too long ago, talking about hot flashes in the menopause episode that I thought was super fascinating,'cause that's my age group.

Dr. Mistry:

Yes.

Donna Lee:

She said, what?"That's what she said." That's the segment that is called,"That's what she said." Women have hot flashes in this age group because their estrogen has dropped.

Dr. Mistry:

That's right.

Donna Lee:

So I went to Leonora, our provider here that I see. And she put me on estrogen, and guess what? My hot flashes are gone. I thought,"This is like magic." It's amazing.

Dr. Mistry:

That, that's nice.

Donna Lee:

I'm the best testimonial you're gonna have all day.

Dr. Mistry:

I guess. And, and you know, women are also gonna notice an improvement in their skin and hair texture, and really a return back to kind of...

Donna Lee:

Feeling good.

Dr. Mistry:

...feeling better. And so the same thing happens in men. In, in women it's called menopause in, in, in women it's called menopause, and in men we call it andropause.

Donna Lee:

Right.

Dr. Mistry:

And that is a part of the natural decline in testosterone. So either you're gonna be a guy out there that says,"Well, this is natural and this is supposed to happen to me," or you're gonna say,"Well, this is happening to me, and I want to do something about it."

Donna Lee:

I have a question.

Dr. Mistry:

Yeah.

Donna Lee:

I wanted, well, my husband actually had another question. He wanted to know if there's something similar to women when they're on their monthly angry cycle?

Dr. Mistry:

Yes.

Donna Lee:

Is there something that men go through? Cause he feels like he has a monthly issue. He's just angry.

Dr. Mistry:

The answer, the answer's,"Probably not."

Donna Lee:

No?

Dr. Mistry:

But if he's like me, it's probably payroll for his employees, and...

Donna Lee:

That's every two weeks, though.

Dr. Mistry:

...and maybe, and maybe his wife is going through her time, and I'm just having my little response to it.

Donna Lee:

Maybe my boss made me cry and then I went home angry and I made my husband angry, but then he took your side.

Dr. Mistry:

Yes, because I was probably right.

Donna Lee:

It's true. I have to admit it. You're more rational. I get it.

Dr. Mistry:

Okay.

Donna Lee:

Anyway, what else do we have to talk about today? We have the shockwave of therapy that you wanted to talk about.

Dr. Mistry:

Well, I think it's great. You know, you, you get to be on the frontline with a lot of our patients. I, I'd love to hear what feedback you're getting on, on patients that undergo shockwave therapy for erectile dysfunction.

Donna Lee:

Oh my goodness. I, I knew we'd have positive feedback, but I didn't know it'd be this good. We've had patients, several patients, many patients, but by the fifth cycle, they get six treatments by, by the fifth treatment, the, the reactions were incredible. One guy said he has to, he stopped taking Viagra altogether by his fifth treatment of shock wave therapy. Another patient who's gone through chemotherapy...

Dr. Mistry:

And radiation.

Donna Lee:

...and radiation who thought he would never ever have a, an erection again, he started getting natural, organic erections after the fifth treatment.

Dr. Mistry:

Organic erections.

Donna Lee:

Was that good?

Dr. Mistry:

Yeah. That's...

Donna Lee:

Did that sound holistic?

Dr. Mistry:

And that's what we want you to have. An organic erection.

Donna Lee:

An organic erection. No, that's incredible. We have more, but we don't, I don't have time to go into all the details. But I was super impressed with that. We had one guy who on his first treatment said he didn't have to use Viagra when he went home to have relations with his wife. Now, our provider said some of that might have been psychological, but hey, I'll take it. Right? It was his first treatment.

Dr. Mistry:

That's right. That's right. You know, we're big believers in placebo around here. So, and if, if you're interested in getting a more thorough evaluation for your erectile dysfunction, or if you have it enlarged prostate, or you have prostate cancer and want a second opinion, we're big fans and second opinion, and we're about to be coming upon urology Christmas. You know what that is? That's the stone season.

Donna Lee:

That's right.

Dr. Mistry:

When temperatures go up, dehydration gets worse and then all these kidney stones starts start falling like snowflakes.

Donna Lee:

Oh. You're so happy this time of the year.

Dr. Mistry:

Well, I do like taking care of people.

Donna Lee:

That's true.

Dr. Mistry:

And so, if you end up having a kidney stone and you want to avoid the ER, give our office a call. Try to remember this, you know, this show. And if you get sent to the ER and you want to be seen quick and well and thoroughly, and then we're gonna find out why you have the stone and give you nutritional counseling, that's what we do. It's different than what you're gonna get elsewhere, and that's something that we really like to push.

Donna Lee:

Right. And we welcome all your questions and your comments to armormenshealth@gmail.com. Thanks for letting me chit chat with you.

Dr. Mistry:

Oh yes. And please let us know if you liked more Donna.

Donna Lee:

I like more Donna. I'm unhinged.

Speaker 1:

The Armor Men's Health Hour is brought to you by Urology Specialists of Austin. For questions, or to schedule an appointment, please call 512-238-0762 or online at armormenshealth@gmail.com.