Phone: 512-238-0762

Fax: 512-341-7370

August 29, 2020

BioTE Pellets and Natesto Nasal Gel: Dr. Mistry and Donna Lee On Little Known Testosterone Replacement Options

Speaker 1: 

Welcome 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 as always with my cohost, the underappreciated, but wonderful Donna Lee.

Donna Lee: 

Finally learned your lesson. You made me cry again and now I’m appreciated. Hello everybody. It is me. It is I, appreciated.

Dr. Mistry: 

Luckily, the office, the job of office manager for our practices still filled, so we’re not looking for a candidate at this time. I’m a board certified urologist, and this is a men’s health show. This show is brought to you by our urology practice, NAU Urology Specialists. We’ve been in practice since 2007. We’re worldwide.

Donna Lee: 

We’re worldwide, Mr. Worldwide. And we have an anniversary coming up.

Dr. Mistry: 

We sure do. We have really enjoyed trying to expand the scope and nature of urologic practice. Really cutting edge stuff that we provide everything from robotic surgery to minimally invasive BPH or enlarged prostate procedures. We have, I would have to say one of the most comprehensive male fertility programs in the country. We have board certified, excuse me, fellowship trained erectile dysfunction experts. And…

Donna Lee: 

Why dont’ you tell people what that means? The lay people who don’t know what “fellowship trained” means.

Dr. Mistry: 

It means that after your four years of college, and after your four years of medical school, and after your five years of residency…

Donna Lee: 

There’s more?

Dr. Mistry: 

…Dr. Chris Yang spent an entire extra year…

Donna Lee: 

…learning about penises?

Dr. Mistry: 

…learning, nothing about how to men, how to help men get erections.

Donna Lee: 

Wow!

Dr. Mistry: 

That’s pretty good.

Donna Lee: 

How many years is that? 13 years? 28 years of training, and then he became a doctor.

Dr. Mistry: 

And then, and then he became a doctor. It’s an incredible care that you’re going to get in our practice. And we are open for business. We are seeing patients via telemedicine in the clinic, taking all those added precautions to keep you safe and to keep us safe. Donna Lee, why don’t you tell people about our practice and where our offices are?

Donna Lee: 

That’s right. You can call us during the week at (512) 238-0762. We’re located in Central Texas. If you’re listening from out of state, this means nothing, nothing to you, but we’re at Round Rock, North Austin, South Austin and Dripping Springs, Texas. If you are though out of state and want one of these amazing second opinion, prostate cancer discussions with Dr. Mistry, you can reach out to us. You can email us at armormenshealth@gmail.com. That’s armormenshealth@gmail.com. You can see our fabulous website by going to armormenshealth.com. Dr. Mistry is his real name. M-I-S-T-R-Y. It is not a fake name.

Dr. Mistry: 

It is not. It is gimmicky perhaps, but not fake.

Donna Lee: 

Maybe. Donna is a fake name. My real name is Falula.

Dr. Mistry: 

Oh, so Donna Lee, I thought what we’d talk about today is the types of treatment options that people have if they’re interested in getting testosterone.

Donna Lee: 

I bet every man listening right now on KLBJ is very excited. Because there’s like a hundred different ways to do it.

Dr. Mistry: 

So what I’m not going to talk about is injections, topical gels–because those are two things that a lot of men know about.

Donna Lee: 

Right? That’s pretty common.

Dr. Mistry: 

So I thought I’d talk about two different ways that testosterone is delivered that not a lot of people know about, but is amazingly effective and useful in certain scenarios.

Donna Lee: 

And easy.

Dr. Mistry: 

That’s right. The first one is called Natesto and it is a testosterone you put in your nose.

Donna Lee: 

That is fascinating. Is it like a spray?

Dr. Mistry: 

It is like, it’s like a little gel you put in your nose. And I’ll tell you when I first heard about it, I was like, “This is not going to work. You know, there is no way this is going to work. Nobody’s going to put this in their nose.”

Donna Lee: 

Is it thick? I mean, what does that, how is it?

Dr. Mistry: 

It doesn’t run out. It’s thick enough to stay on the inner mucosal membrane of the nose. It has to be applied twice a day. So for all those reasons, I was like, ‘These poor guys, they bought a patent of something that’s never gonna work.” And then a couple of interesting things happened. The first one is that the nose became a very discreet and effective way to be able to absorb testosterone in the body without having any transference to a partner, which has been the biggest downside of creams. You don’t want to put it on your chest and then, you know, not be able to rub up with somebody with your chest….unless she, you know, she got a little too much testosterone. Although we do give testosterone to women for a variety of reasons. Then Natesto also ends up having another benefit, which is incredible, which is that on this show, we always talk about how taking testosterone may drop your own body’s production of testosterone and can help contribute to making you infertile. But the studies are showing that Natesto, this nasal based testosterone, doesn’t do that. And it’s because there’s something about how it’s absorbed through the nose and the dosing on a twice a day basis allows for non-interruption of something called the HPT axis, the hypothalamus/pituitary testis axis. And so this is really groundbreaking, interesting stuff, because we have a number of patients that come to us with low testosterone who are interested in maintaining their fertility, and we’ve given them medicines like Clomiphene, Anastrazole, HCG in the past, but some of them, maybe 30% of them, don’t respond like they would to testosterone and we’re kind of limited. But now we have this added bullet for our armamentarium, which is the Natesto.

Donna Lee: 

You’re full of big words today.

Dr. Mistry: 

I’m working on them. My wife’s doing the word day thing. And so she’ll use that word like 14 times per day.

Donna Lee: 

That’s cute.

Dr. Mistry: 

Just like Michael saying, “Porte cochere.”

Donna Lee: 

“Porte cochere. Park the car in the porte cochere.”

Dr. Mistry: 

The other type of therapy that we have been doing in our office for many years is the use of the BioTE subcutaneous testosterone pellet. Interestingly, I thought that most all urologists were BioTE kind of providers. But as I look around and you speak to the company, that’s not the case. Many urologists and many pellet providers are putting in kind of off-brand or compounded pellets that are not as widely produced as something like what we use BioTE also in the past, they were similar to Sottopelle, that’s what they call it.

Donna Lee: 

Sottopelle.

Dr. Mistry: 

And what’s beneficial about the BioTE pellet is that it’s inserted subcutaneously.

Donna Lee: 

In the butt?

Dr. Mistry: 

It takes about…it’s in the buttocks. It takes about 15 minutes. It’s done with a local anesthetic. And it is a set it and forget it kind of testosterone.

Donna Lee: 

Wow.

Dr. Mistry: 

As soon as we dial in your dose, you’re going to get these BioTE pellets put in. After that your levels are going to shoot up to what we consider a good normal level for you, and they’re going to stay there for six months.

Donna Lee: 

You don’t have to keep coming in.

Dr. Mistry: 

You don’t have to keep coming in. You don’t have to keep applying anything, even if it’s to your nose and you like it. It’s not going to involve injections. It’s not going to involve repeat office visits to the office because really we only see you once…

Donna Lee: 

Every six months.

Dr. Mistry: 

…the very first time you get it done and we see you at a month to make sure that your body’s responding to it appropriately, or if you need a booster, and then every six months, if you’re feeling good, we’ll kind of, you know, reiterate that dosing. I think that most of our patients, we have a greater than 90% re-pelleting rate, meaning that patients that get it are really happy with it. The cost to our patients, which we can also do for women–so women on testosterone and estrogen replacement after menopause, they’re also candidates. With women, the pellets only lasts three months, so they have to come in a little more often and it’s about $300 every three months. And with men, it’s about $600 every three months.

Donna Lee: 

Six months.

Dr. Mistry: 

I’m sorry, every six months.

Donna Lee: 

So about a hundred dollars a month is pretty affordable.

Dr. Mistry: 

Which I think is very reasonable. And there are a number of low T clinics and hormone clinics that charge up to $2,000 a year for their services that you can get for $1,200 a year. So if you’re paying a lot for your testosterone or you think that there, you’d be interested in exploring a better way to do your testosterone…Now, why would you do the pellets? Not just because of the lack of having to manipulate it or to give yourself the dosing regularly, but by giving yourself, by having a steady dose, you avoid the peaks and troughs that an injection regimen can include. A lot of men will feel really good at the beginning of their injection and not so good at the end of their injection. We also see a lower incidence of a side called polycythaemia, which is where your red blood cell count increases. So a number of our patients who developed polycythaemia or high red blood cell counts on injectable testosterone did not do so, do not do so on the pellets. We also see in some patients less of a change in mood. So some people report some emotional changes when they’re on testosterone, although rarely. But I think that’s a lot to do with the fact that some days you’re doing good and some days you’re not doing so good. And so having the pellets in your system really works well..

Donna Lee: 

It’s a tiny little slit.

Dr. Mistry: 

Tiny little, tiny, little.

Donna Lee: 

Teeny tiny, and they do something first. So they numb it a little?

Dr. Mistry: 

They do, they numb it up really well.

Donna Lee: 

Okay. And then after that, it’s 15 minutes, the procedure’s over, you’re walking out the door?

Dr. Mistry: 

You’re walking out the door.

Donna Lee: 

A little tiny stitch?

Dr. Mistry: 

Little tiny–no stitch, we don’t stitch it. It just stays that small. And you’re limited a little bit from strenuous squatting type activity for a couple of days, just so they don’t get pushed out of you. But by far and away, it is the most popular method that we prescribed testosterone in the office. We have six BioTE providers all throughout the city, so if you’re interested in examining that we would highly encourage you to come and call us and Donna Lee, how are people going to do that?

Donna Lee: 

You can call us for your pellets right away at (512) 238-0762–actually, during the week. You can send your questions to armormenshealth@gmail.com, and I will respond to them and get you an answer. I’ll even send you a link to the podcast if you send a question, but missed the answer. Again, that’s armormenshealth@gmail.com. Thanks Dr. Mistry.

Dr. Mistry: 

Thank you.

: 

Dr. Mistry wants to hear from you. Email questions to armormenshealth@gmail.com. We’ll be right back with the Armor Men’s Health Hour.

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