Phone: 512-238-0762

Fax: 512-341-7370

March 28, 2020

Comprehensive Urology Care: Dr. Mistry and Donna Lee Answer Listener Questions on Epididymitis and Low Libido

Speaker 1: 

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

Dr. Mistry: 

Hello and welcome back to the Armor Men’s Health Hour. I’m Dr. Mistry, your quarantined host.

Donna Lee: 

A little brain fog there?

Dr. Mistry: 

That’s right. Welcome to all of our listeners. This is a show we’ve been putting on for almost a year now.

Donna Lee: 

Oh my gosh, it’s flown by!

Dr. Mistry: 

It’s been a wonderful experience. The feedback we’ve gotten from our patients, old and new, as well as listeners, has been exceptional. We love your questions. We love the opportunity to be able to share knowledge of men’s health issues and kind of our take on it with our listeners. Donna Lee, I think that what we do here is pretty unique.

Donna Lee: 

It is very unique, and it’s fully comprehensive. We’re not just seeing a bunch of kidney stones and UTIs over here.

Dr. Mistry: 

That’s really interesting. Yeah. And we try to be, we try to be very comprehensive and holistic in our approach. To give you an example, I would recently interviewed somebody who was interested in doing only male fertility and they trained at one of the most highly respected centers for men’s fertility in the country. When I told her how we treat a men’s fertility patient, she was speechless.

Donna Lee: 

She was blown away.

Dr. Mistry: 

This idea that when you come to us, because we know that high cholesterol and weight and abnormal sugar metabolism affect your sperm function, she was surprised to hear that those are things that we take a special interest in and taking care of, whether it be pharmaceutically or medically. If you have erectile dysfunction or sexual dysfunction, if you’re a woman, knowing that we have a sex therapist right in the office, it’s going to help coordinate with us because, you know, there are things that we can fix with medications and then there are things that we need to fix with a more multidisciplinary approach, and that’s really emblematic of how we treat all urologic conditions that we’re faced with, and I’m really proud of that.

Donna Lee: 

That’s right. And we have the registered dietician on site for those fertility patients as well. Well, all patients.

Dr. Mistry: 

That’s right. We draw your labs here in our office, most all of our services are covered by traditional insurance. But if you don’t have insurance, we have wonderful cash pay prices for so many of the different services that we provide. Don’t let finances be your barrier to getting great care. It’s often a lot more affordable than you think. And these are things that we strive to really help you achieve.

Donna Lee: 

You know, our men’s wellness division, Armor Men’s Health, which is what the show’s named after, the fee for people without insurance is only $150 a month, which is really, really low.

Dr. Mistry: 

Which I’ll tell you…and so if you are out there thinking that you’re going to have to pay thousands of dollars…

Donna Lee: 

…like other places…

Dr. Mistry: 

…to get testosterone therapy or really comprehensive hormonal therapy, that is not the case. For $150 a month, you can choose between in-office injections, between injections that you administer at home. You can do gels, you can do pellets, you can do any number of different types of therapies that are at your disposal. So there’s not a going to be a financial push from us to push you into one type of treatment or other. And if you want to jump between treatment options, that’s also an option for you. That will include your labs, all your visits, really everything involved with making sure that you’re comprehensively taken care of from a hormonal standpoint, for what I think is a very reasonable price.

Donna Lee: 

Right, I talked to a man recently on the phone. He paid $2,000 to join the hormone club that he’s in and then $1,800 a month. WHAT?!? So clearly, we’re not charging enough.

Dr. Mistry: 

Well then I’m the dumb one…Really since we started the practice, this idea of not being greedy as a physician who has knowledge has been something that’s guided us. And I think that there’s a lot of greed that comes through when people are being overcharged for treatments that don’t really require a lot of kind of basic medical knowledge. I mean, the people that run these clinics often aren’t even hormone specialists–they’re people who trained in something else. I’d love to hear a question from one of our listeners.

Donna Lee: 

We have a bunch. This one particularly says, “Dr. Mistry, can you effectively help cure chronic epididymitis, preferably without surgery as I travel for work? Thank you for the consideration.”

Dr. Mistry: 

Well, that’s a great question, Donna Lee. Really, when we’re talking about chronic epididymitis, it really dovetails into the broader discussion of chronic testicular pain or ball pain as we put it. Interestingly enough, if you talk to most urologists, the idea of taking care of people’s chronic testicular pain is something that they consider really a burden because it’s hard, it requires lots of understanding, but it’s something that we definitely specialize in here in our practice. Being able to incorporate pelvic floor physical therapy, nerve blocks, all sorts of kind of less-invasive technologies to help with chronic testicular pain has really expanded our ability to take care of it. But let’s just talk about the chronic epididymis–the classic patient. So that’s going to be a patient that has recurrent episodes of testicular pain, maybe associated with swelling, maybe associated with infection, in which the back of the testicle usually hurts, become swollen, and is very tender to touch. When it happens, where you get that every so often, meaning like every 4 or 5 months, this chronic epididymitis recurs, usually the epididymis needs to be removed. I mean, that is a surgical procedure. It’s not a big deal. It takes me an hour to do in the operating room. Your recovery is really less than a week, and you’ll have recovery and improvement for your life. So if that’s what you’re having, recurrent infections of the epididymis–so chronic epididymitis I usually define as more than 3 in 1 year, or really more than 3 in less than 18 months. If you’ve had a vasectomy and you’ve had epididymitis like this, then really the epididymectomy is going to be your best course of action. That is different from someone who kind of complains of similar pain that happens all the time and never gets better. So, those patients will come to me and tell me they have 6 months or more of kind of a nagging or lower degree of discomfort in their epididymis or in their testicle. Those patients often will respond well to pelvic floor physical therapy, because there can be a muscular component of it. They can respond to a nerve block, which we do here in the office, that can give relief and not be very invasive. A lot of times those patients do not do better with an epididymectomy where we remove that organ where sperm is stored right behind the testicle, and they do better with what’s called a spermatic cord denervation. And so that’s something that we’ve specialized in. We have a lot of experience with, if you have chronic testicular pain, definitely, you should put us on your list of places to get a second opinion. The…

Donna Lee: 

Why would you go with six months of ball pain?

Dr. Mistry: 

Well, you know…

Donna Lee: 

Is it the pride in you guys?

Dr. Mistry: 

You know, if it’s severe, you don’t wait.

Donna Lee: 

Right.

Dr. Mistry: 

It’s when it’s low grade…

Donna Lee: 

…just annoying.

Dr. Mistry: 

…and it’s only when you’re wearing certain kinds of pants…

Donna Lee: 

Well that’s fair.

Dr. Mistry: 

…or only when you’re standing. I mean, and you know, guys, they’re scared of the doctor.

Donna Lee: 

They’re scared of the ones with the big hands.

Dr. Mistry: 

That’s right. And the moment you tell them that there may be some kind of knife-to-skin involved in fixing that pain, they are even more apt to say, “Well, maybe I’ll just live with it.” And so, uh, but we do have nonsurgical treatments for chronic testicular pain. Oftentimes, we are employing the use of medications like Cymbalta or Gabapentin for chronic nerve pain. And I would strongly encourage you to come in and if that’s what’s happening for you, especially if you’re worried that surgery is going to take you out of the game for too long.

Donna Lee: 

You want another question?

Dr. Mistry: 

Yeah, let’s do it.

Donna Lee: 

We have a good, um, well this might be pretty detailed, but, “Is there something Dr. Mistry I can do to have more frequent sex? My libido has diminished as years progressed. Six years ago was the surgery.” But he doesn’t list what the surgery was.

Dr. Mistry: 

OK. Well, let’s just say that what we’re talking about is, what determines sexual frequency in a man? And there are, in my opinion, several components. So, number 1 is the availability of a willing partner. Number 2 is going to be your sex drive or what we call libido. What’s your desire for sex? And then number 3 is how well can you perform. My joke was always that, you know, I’m not a very good golfer so I don’t play golf very much. So if you’re not getting a rigid, hard, straight erection, then you may be less willing to initiate, you know, sex with your partner.

Donna Lee: 

Sorry, I just had a visual of you not playing golf very well.

Dr. Mistry: 

That’s right. And so, the willing partner, we can help you if your partner has a low libido due to hormone deficiency, whether there’s something psychological that needs to be addressed, or whether they don’t want to have sex because of pain, which is very common–called dyspareunia. If you have a partner that has vaginal pain, whether they’re young, old, post-menopausal, premenopausal, prior surgery, prior…you know, we have so many treatments for them, we would encourage you to enlist our help in trying to make sex a more pleasurable experience for both of you. If your libido is low, that can be due to psychological issues, that can be due to hormonal issues that you would know like low testosterone, but also hormonal issues that you may not know like impaired thyroid function or high prolactin levels. And so part of our evaluation of the libido in men is going to be, that an evaluation of those hormones and then correcting them. There are also medicines that we can use in an off label way to enhance libido. We actually have those libido enhancers for both men and women. So for both men and women with low libido, we have certain treatments.

Donna Lee: 

That’s right. We’re a men’s wellness show but we do treat women.

Dr. Mistry: 

That’s right. You can refer to any one of our shows on erectile dysfunction and orgasmic function to get an idea of what we might do for those.

Donna Lee: 

That’s right. You can find our podcasts wherever you listen to podcasts [inaudible] Armor Men’s Health and erection.

Dr. Mistry: 

There you go. You wanna know how to get a hold of us?

Donna Lee: 

Call us during the week at (512) 238-0762. Email us your questions at armormenshealth@gmail.com. And we will be right back.

: 

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

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