Donna Lee and Dustin Fontenot, PA Discuss Where and When To Start With Testosterone Supplements

Thanks for tuning in to the Armor Men’s Health Hour Podcast today, where we bring you the latest and greatest in urology care and the best urology humor out there.

In this segment, Donna Lee and NAU Urology Specialists' partner, Dustin Fontenot PA-C, discuss testosterone therapy options for a 61YO man with erectile dysfunction. While we touch on testosterone often, this episode is a good reminder that there are so many effective and affordable options for men experiencing low testosterone AND that having a talented team of men's health professionals carefully evaluate your needs and address them in a holistic manner increases the odds that you'll be satisfied with your treatment outcomes.

This episode was previously aired on 4.3.21. If you enjoyed today’s episode, don’t forget to like, subscribe, and share us with a friend! As always, be well!

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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.

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Transcript

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

Donna Lee: Welcome to the Armor Men's Health Hour with Dr. Mistry and Donna Lee. And guess what? Dr. Mistry is not here again because he's super busy. So we brought in Dustin Fontenot. Hello, Dustin.

Dustin Fontenot: Hi, how're you doing?

Donna Lee: I'm good. We haven't had you on in a minute. You're one of our fabulous physician assistants and you've been with us how many years?

Dustin Fontenot: Almost six now.

Donna Lee: That's like forever in urology years, in dog years . And speaking of dogs, I said earlier, "What do you want to talk about Dustin today?" And he said, " Kitties!" So let's talk about cats . Now we both have big, giant, 20-pound cats.

Dustin Fontenot: We do . Yeah .

Donna Lee: I love a manly man with a cat.

Dustin Fontenot: Yup . I got one.

Donna Lee: You know, my cat is now 22 pounds. And when I hold him around the house, every single time--Michael never misses a beat every single time--he says, "Hey lady, you sure got a fat *****, and your cat's really big!" So we'll get Sam to bleep that one word out.

Dustin Fontenot: That's a good one. That's a good one. Yeah, we just shaved ours.

Donna Lee: Oh. So it looks like a little lion, a little Simba. Something?

Dustin Fontenot: Yeah. Yeah. He's happy.

Donna Lee: Cute. We will talk about men's wellness stuff in a minute, I assume. We have four locations in the Austin area: Round Rock, North Austin, South Austin, and Dripping Springs. And you probably know that if you live here and you've heard our show, and for those of you on the other side of the world, it just doesn't matter. Our phone number is (512) 238-0762. For those of you who are in the Austin area, you're welcome to give us a call. You can check out our podcasts wherever you listen to podcasts. Hopefully we'll make a podcast about kitties. Maybe we'll make that section if they Google "men's health" and " cats."

Dustin Fontenot: I know. And then Joe Rogan would probably have us on.

Donna Lee: Oh, that'd be great!

Dustin Fontenot: He's so popular.

Donna Lee: Because he lives in our area, you know, in this area here. What else do we need to share? Our website is armormenshealth.com and you can send your amazing questions to armormenshealth@gmail.com. We'll get those answered as soon as possible. We had a really good one, I thought, for Dustin, since you're in charge of our armor men's health division. For those of you who don't know, we actually have a division, a department in our urology group called Armor Men's Health. It's more than likely you'll see Dustin as well. So Dustin, tell us a little bit about the program.

Dustin Fontenot: Yes . So the program is designed for testosterone replacement therapy patients. It kind of helps group them in our practice. It's a, it's a monthly membership program for guys that are interested in testosterone treatment.

Donna Lee: And don't sometimes have insurance...but it's so inexpensive that some of your patients have insurance, but they prefer this program.

Dustin Fontenot: Yeah. And great for guys that are, if you're out of the local Austin Metro area.
Donna Lee: But in Texas.

Dustin Fontenot: Yeah. But in Texas. It's a way for us to , we have kind of a remote treatment program for you.

Donna Lee: Gotcha. So you just get your labs done, have a phone call. So you're super easy breezy. We've had the program what, a few years now since you've started, I guess. So yeah, look into that. It's armormenshealth.com is our website. But I have a great question for you. This question came about a week and a half ago, so we're just now trying to catch up on the questions. "How is hormone therapy administered? A little about myself: I'm a 61 year old male." In January. he said he'll be 61. "Been married 39 years to an amazing woman." Oh, how sweet . "My desire for her has not diminished, but I struggle with my lack of erection. Is this kind of therapy possibly for me?"

Dustin Fontenot: Yeah. Well...

Donna Lee: There's a lot in there for you. Good luck.

Dustin Fontenot: So the first question was how is it administered? We've talked about that on the show before, but the main routes, traditional routes are either a topical preparation which you rub on the skin every day; an injection that's you can give yourself, or we give you once per week; or a pellet, which is a little sub little implant we implant underneath the skin and they last for six months.

Donna Lee: For men for six months? And it's a tiny little cut. Like it doesn't hurt.

Dustin Fontenot: Totally. Yeah. Easy, easy procedure. Takes about 10 minutes here in the office. There's a few more novel treatments out there now. They actually just , FDA just approved an oral method of administration. And there's also a nasal gel that you inject or spray into your nose rather...

Donna Lee: It depends on the person? You can't tell me, like one of them works the best of all?
Dustin Fontenot: That's right. Everybody's, yep. So, and when you come see us, those are the things that we go through. We kind of interview you and go through everything with you and try to figure out which option we think would be best.

Donna Lee: Lifestyle, and all that stuff?

Dustin Fontenot: Yep. So, what your testosterone level is, how low you are, kind of what you can tolerate. So, lots of options, lots of options. Now, in his particular case, it sounded like he was mostly interested in maintaining his erections. So testosterone therapy can be a great avenue for that, I mean it can definitely help improve erections in a lot of guys. But, you know, a lot of times we'll also focus on erectile dysfunction treatment in conjunction with the testosterone replacement therapy. So he many need both. Yeah, he many need both.

Donna Lee: Hmm . Interesting. So he's 61. Where does he start? Like he just, I mean, I guess he just starts with lab work.

Dustin Fontenot: Yeah. So start with being an initial evaluation , you know, and he can do that with us and we'll kind of run him through the paces, get some blood work done, talk to him , kind of see what his goals are, what he's really looking to improve on. And then we'll revisit after we have the lab work and talk about where the deficiencies are and kind of what his best treatment plan would be.

Donna Lee: Is it always the fact that if a man gets testosterone, he's going to have more, his libido is going to be better or more engaged or is that just kind of a myth?

Dustin Fontenot: No. It's definitely not a myth. It , you know, I can't say it's always a fact because there's really no guarantees in medicine ever, but I would say that's one of the most common things that guys will tell us after they've been on treatment is that their libido has increased. And it's also one of the quickest things. Some of the other things take a little bit more time once you're on therapy, but the libido and the sex drive generally come back the quickest.

Donna Lee: Gotcha. And what else would he want to look into for erectile dysfunction? I know there's a million things, but...

Dustin Fontenot: Yeah. So same kind of thing. Right. So several options there. And that kind of goes back to the interview--you know, how bad is his erectile dysfunction? Is he, is he not able to get any erection on his own, you know, and has it not had one for a years? Or is he able to get a partial erection, but not enough to penetrate? Is he able to penetrate but just not maintain? So those are all the kinds of questions that we'll go through, and then based on that, we'll decide on a starting point. Those treatment options can be oral medications, they can be injections that are delivered into the penis before they want to have an erection. We also, which we've also talked about on the show before, the low intensity shockwave therapy , that can be a great option for these guys, too .

Donna Lee: Gotcha. And you're doing a lot--well, you're not doing--but you're , you have a lot of patients doing the shockwave therapy.

Dustin Fontenot: Yeah. The shockwave has been great. We've had excellent results with it. It's a series of six sessions. They're all done about a week apart. Last about 10 minutes. It's painless, no side effects, no restrictions. Basically helps build new vasculature in the penis to help improve blood flow.

Donna Lee: The only thing that's kind of off putting about the shock wave is that it's just loud. It's a little noisy. Right?

Dustin Fontenot: Yeah. It's a little noisy.

Donna Lee: It's just like a clicking, aloud clicking.

Dustin Fontenot: Earplugs, if you want.

Donna Lee: Oh, that's true. But it's like more of a , like a pulsing, right? Cause it's, it's...

Dustin Fontenot: Yeah, we deliver four shocks a second.

Donna Lee: But there's no actual shocking.

Dustin Fontenot: You don't , it's painless.

Donna Lee: Yeah, I always want to remind people of that....

Dustin Fontenot: That's the "low intensity" part of it.

Donna Lee: I always want to call it "penile pulsing," but Dr . Mistry is like, "Hmm, probably not a good idea." But it sure sounds better than "shock wave." But our particular machines called "spark wave ." So you'll get that spark back. I just came up with that. When I'm talking about testosterone really quickly, if he comes in, what's a low number? Because we, we always have patients who just look at their number and they're like, "Nope, my number needs to be 500." But give us a range of what's low-to-normal and high normal.

Dustin Fontenot: So that, that's kind of a question that varies depending on who you ask. In general, though, we consider somewhere in the realm of 400 or below low. But then there's another kind of caveat to that, and that has to do with a free testosterone level, which is a different lab that we look at. It shows that how much of your testosterone your body actually use. So that can come into play too with those people that are kind of low/normal-ish. But like you said, kind of have to take into consideration symptoms, too. So , where one man may feel low at this particular number, another one may feel low at a higher number. So we take everything into the equation. It's not as black and white as if it's, "If it's this number you're normal, but if you're one below, you're low." It's, it's more of a spectrum.

Donna Lee: Gotcha. And you used to work at a, previously at a men's wellness, like a testosterone clinic? Was that philosophy the same or how does that vary with what we do?

Dustin Fontenot: No, they pretty much have strict cutoffs. It kind of, you know, these are the numbers where you're at and you either meet it or you don't. So what we do is a bit different just simply because we take a lot more things into consideration and we also offer a lot more options, treatment options.

Donna Lee: Right. Well, and testosterone's so inexpensive. Don't we have patients who are paying like $25, $30 bucks a month? Or something in that range? And then you can, like you said, you can get your injections with us at our clinic or you can be self-taught to go home.

Dustin Fontenot: Right. Yeah.

Donna Lee: Gotcha. Well, that was really interesting. I think that patient has some , um, options out there and I'll get that podcast to him . If you need to reach us it's (512) 238-0762. And our email address is armormenshealth@gmail.com. You can send Dustin a question if you'd like, directly. You can give us a call as well and ask for me. Check out our podcasts where you listen to podcasts and visit our website: armormenshealth.com. Thank you so much, Dustin , for being here.

Dustin Fontenot: Absolutely.

The Armor Men's Health Hour will be right back. If you have questions for Dr. Mistry, email him at a armormenshealth@gmail.com.