Phone: 512-238-0762

Fax: 512-341-7370

April 4, 2020

Add Some “Mistry” to Your Urology Care- Dr. Mistry and Donna Lee Answer a Listener Question About Decreased Sex Drive

Speaker 1: 

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

Dr. Mistry: 

Welcome back to the Armor Men’s Health Hour. I’m Dr. Mistry, your host, here with my cohost, Donna Lee.

Donna Lee: 

Hi, that’s your real name.

Dr. Mistry: 

It is.

Donna Lee: 

“M. I. S. T. R. Y.”

Dr. Mistry: 

That’s right. I think…

Donna Lee: 

We’ve had several people ask.

Dr. Mistry: 

All the time.

Donna Lee: 

Your whole life, I bet.

Dr. Mistry: 

You know it never even occurred to me that it was an issue until the radio show. People were like, we can’t believe that that’s your really name!” And we even had people say that they thought it was too gimmicky.

Donna Lee: 

Yeah, that it was fake and gimmicky and why do we pick that? So now that’s your real name. So you can Google him at Dr. Mistry: “M. I. S. T. R. Y.” But we do like to play your name off on things like the “Mistry Vasectomy.”

Dr. Mistry: 

That’s right.

Donna Lee: 

And the “Mistry Surgery.” We’re taking the mystery out of Mistry…It’s no mystery!

Dr. Mistry: 

Put the mystery back in your urologic care. We really appreciate everybody joining us and being really active and engaged in our show. We love your questions. It’s really what drives us in terms of giving you information that you’d like. We get a lot of questions on Peyronie’s disease, so if you have a penile curvature, definitely there’s 20 segments that you can get on the podcast.

Donna Lee: 

Oh, that’s right! Listen to the podcast. They’re free and they’re out there everywhere.

Dr. Mistry: 

If you don’t know how to do a podcast, please find a young person.

Donna Lee: 

You can Google our podcast, the Armor Men’s Health Hour podcast. You can type in things like “Peyronie’s disease” or “funny looking penis” or all sorts of things and you’ll find several of our podcasts.

Dr. Mistry: 

We love your questions. And Donna Lee, you’ve got a great question for us.

Donna Lee: 

I do. It’s a loaded one. It’s very simple and basic, but I thought, “Gosh, that’s just such a powerful question.” This particular patient sent in a question to armormenshealth@gmail.com. He’s had his prostate removed entirely. His question is, is there anything he can do about his libido because it’s diminished so greatly?

Dr. Mistry: 

That’s an excellent question. There’s several parts of that question. If you’ve been a listener of the show, you’ll know that I’m always trying to get at what really that question is asking and then try to broaden it so that I can address issues that may not specifically relate to you in that question, but you can get some information out of it. More than likely, this listener has had their prostate removed for prostate cancer. They’ve had a radical prostatectomy. Most often that’s done robotically nowadays. Depending on how your function is beforehand, the incidence of erectile dysfunction can be anywhere between 30% and, you know, 70% in some studies after the surgery. And that’s because the nerves that are responsible for encouraging your penis to engorge with blood, they live right next to the prostate gland. And they’re not marked. In a book, they look like they’re a different color. But when you’re operating…

Donna Lee: 

But in life…

Dr. Mistry: 

No, that’s not how it is. It’s all the same color. Your job as an experienced robotic urologist, or a cancer surgeon, is to try to find where those nerves usually lie and then carefully try to take them off the capsule of the prostate without getting into the prostate and leaving cancer behind. So it’s a game of millimeters, and you really only have one chance to get it right. If your cancer’s not amenable to a nerve-sparing prostatectomy or your erections weren’t that good to start with, you may end up with severe erectile dysfunction and not an ability to get an erection. This listener’s question says that their libido is low, which is sex drive, and I think that that concept of sex drive and an ability to get an erection, they get intermixed in people’s minds. So usually we consider libido to be more of a psychological urge, and we consider erectile dysfunction to be more of a biologic or physical manifestation of that urge. If you still have a strong sex drive, getting an erection is something that we can make happen in a number of different ways. We can use medications, we can use something called a vacuum erection device, which is an external appliance that you put over your penis.

Donna Lee: 

My husband’s still waiting on that. He keeps thinking I’m bringing it home. I don’t know why.

Dr. Mistry: 

And you know if you saw the Austin Powers movie, he talked about the Swedish penile enlargement device, but it was really a vacuum erection device. In our program here, if you get a radical prostatectomy for cancer, you’re going to leave our office with a vacuum erection device always, because I think it maintains blood flow, penile health, and helps you return to sexual function sooner after your radical prostatectomy. And then we have something called an inflatable penile prosthesis. It is, it is a marvel of science if you asked me.

Donna Lee: 

It’s fascinating.

Dr. Mistry: 

It is fascinating.

Donna Lee: 

I walked past the model in South Austin, I’m like, “Wow, that is big.”

Dr. Mistry: 

It was invented at Baylor college of medicine.

Donna Lee: 

…where you happen to have…

Dr. Mistry: 

…where I may or may not have gone to school.

Donna Lee: 

Are you trying to take credit for this penile…?

Dr. Mistry: 

I am not. I’m just saying that fixing erections is in my urologic DNA. That inflatable penile prosthesis is a 3 piece silicone device completely inserted inside your body. When you want to have an erection, you just pump it up. There you go. You’re able to function well.

Donna Lee: 

Play your theme song while you’re pumping it up.

Dr. Mistry: 

You get a great orgasm.

Donna Lee: 

“Eye of the Tiger.”

Dr. Mistry: 

It maintains length and girth and rigidity of your penis. You know, I trained at Baylor and I’ve done many penile prostheses. One of our partners here, Dr. Christopher Yang, he did an entire year fellowship.

Donna Lee: 

Yeah, he’s the man.

Dr. Mistry: 

He’s done hundreds and hundreds and hundreds of penile prostheses, and he’s dealt with complicated ones, and complicated people, and redos and all these things. So if getting an erection and maintaining your sex life after a radical prostatectomy is something important to you, note that the penile prosthesis is covered by insurance.

Donna Lee: 

Shocking, every time. Breasts are not covered, but the penile implant is.

Dr. Mistry: 

Well, I’m telling you…

Donna Lee: 

Fascinating.

Dr. Mistry: 

You know, as long as, you know…

Donna Lee: 

Men are in charge?

Dr. Mistry: 

Men are in charge.

Donna Lee: 

Alright.

Dr. Mistry: 

I think that we’ll continue to get that covered. And so, it’s, you know, take advantage. It’s covered. And if you’re not getting any erection on your own, you’ve got nothing to lose. I did skip over one option that you have, which is called the intracavernosal injection. It’s an injection of medicine that’s right into the side of the penis. It can only be done before a penile prosthesis is done. So once the penile prosthesis is in, you can’t use this, option. The intracavernosal injection can give you a very robust, very satisfying erection.

Donna Lee: 

For four hours or more?

Dr. Mistry: 

Please call somebody if it lasts that long. And it is the kind of thing that, although off putting when you first hear about it, this idea of having to inject medicine into your penis, but the needle is super tiny. Most people don’t complain that the discomfort of the injection itself and it’s the kind of thing that can give you spontaneity and a robust direction back into your life.

Donna Lee: 

We get really good feedback. Patients love it.

Dr. Mistry: 

…very good feedback. And it’s about $7 to $8 a dose. Usually not covered by insurance. But we have a wonderful partner called Pharmalabs out of Florida. They do an amazing job. They send it right to your house. And then they have a whole panel of pharmacists that will talk you through dosing adjustments and things like that, because there’s a little bit of a titration and a little bit of trial and error that goes into making that perfect.

Donna Lee: 

Training.

Dr. Mistry: 

And, you know, we’re just committed to making anything you that we choose that’s going to work for you, we want to make sure that we maximize it. We’re not gonna do it in a kind of a half-witted way, because we want to make sure that we’ve given every treatment opportunity to work. And so then I’ll get to the next part of this, which is the libido or sex drive. So there’s really nothing inherently about the radical prostatectomy that would lead to a low libido, except for self esteem and confidence. So, you know, I use the analogy of me and golf. I’m terrible at golf.

Donna Lee: 

You must be because you talk about it a lot.

Dr. Mistry: 

And my desire to play golf is very low because I’m terrible at it.

Donna Lee: 

Oh, Barry’s is very high. But if all the sudden you were great at it…?

Dr. Mistry: 

My golf libido is very low. But if I was, if I was given a pill or some magical procedure in which I was, you know, I could play golf well…

Donna Lee: 

You’d probably do it.

Dr. Mistry: 

…then I might be more inclined to play golf. And so if you’re having severe erectile dysfunction, having low libido would be, in my opinion, very natural. Actually, those guys that have no erections and have a strong libido, those are some of my favorite patients because I’m like, “Well, hey, you’re already halfway there. You’re here and you’re and you want it and we have lots of treatments for you.” They’re disappointed that I don’t have a magic something, like a magic snap my fingers and get their erections back.

Donna Lee: 

Right.

Dr. Mistry: 

That’s not medically possible, and it’s not why I’m here.

Donna Lee: 

Right.

Dr. Mistry: 

I’m here to make sure that if you have a really significant underlying biologic issue that’s preventing you from getting an erection, then I provide you the tools to be able to fix that.

Donna Lee: 

And the options.

Dr. Mistry: 

That’s right. And if your libido is low and you’re getting a partial erection, then we check your testosterone, we check other hormone levels, we look at you biologically to see if there’s some, you know, some underlying thing. And maybe it is psychological. And then we have the sex therapist here to help with that, too.

Donna Lee: 

Mhmm, and I always say we take a look at, we look at a picture of your wife and we go, “Oh!”

Dr. Mistry: 

Oh, do not do that. You’re getting me in so much trouble.

Donna Lee: 

I’m kidding. The guys would get mad, they get mad at me and not you.

Dr. Mistry: 

Thank God. Well, another great show, Donna Lee. Thank you.

Donna Lee: 

That went by fast.

Dr. Mistry: 

It sure does, every time.

Donna Lee: 

KLBJ must love us. We get in and get out, and nobody gets hurt.

Dr. Mistry: 

That’s what she said!

Donna Lee: 

Speaking of…

Dr. Mistry: 

Why don’t you tell people how to get ahold of us?

Donna Lee: 

We also have ‘That’s What She Said” segments you can hear. Just Google our podcast and type in the words “That’s What She Said,” and you’ll hear our amazing female specialists who have been guests on our show and they’re giving out advice and letting you know what’s going on from the female issue for what the man should expect. But anyway, email us at armormenshealth@gmail.com. That’s armormenshealth@gmail.com. Listen to our podcasts. We’re in 4 locations in central Texas. We’re the 2nd largest urology group, Dr. Mistry. That means we try a little harder and we’re a little prettier on Friday nights. Our number again is (512) 238-0762. That’s (512) 238-0762. This show is brought to you by Urology Specialists. And our website again is armormenshealth.com. Thanks so much.

Speaker 2: 

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 Armour men’s health.com.

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