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May 30, 2020

Dr. Mistry Weighs in on High Blood Pressure and Testosterone Therapy

Speaker 1: 

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

Dr. Mistry: 

Hello and welcome back. I’m Dr. Mistry, your host, here with my cohost, Donna Lee.

Donna Lee: 

That’s right, with my hot, buttery-biscuit voice.

Dr. Mistry: 

It’s going to be hard to overcome that little comment.

Donna Lee: 

It really is. I’ve held on to it for days.

Dr. Mistry: 

For those of you that don’t listen to the show frequently, shame on you.

Donna Lee: 

Rude!

Dr. Mistry: 

Number 2 is I’m a board certified urologist. This is a men’s health show and we are brought to you by NAU Urology Specialist, the second largest urology group in town.

Donna Lee: 

But the prettiest, with the prettiest figures.

Dr. Mistry: 

That’s right. We have 4 urologists: myself, Dr. Sandeep Mistry, my real name.

Donna Lee: 

Your name is real.

Dr. Mistry: 

Dr. Stacy Ong…

Donna Lee: 

O.N.G.

Dr. Mistry: 

…also her real name. She was the former urologist at University Medical Center Breckenridge. And she was really the only one that handled all that trauma and all that very high level stuff.

Donna Lee: 

Can you imagine?

Dr. Mistry: 

She’s amazing. And then we have Dr. Christopher Yang…

Donna Lee: 

Y.A.N.G.

Dr. Mistry: 

…which I think Yang is a good name for a urologist.

Donna Lee: 

It sure its! You kind of get your yang fixed.

Dr. Mistry: 

Oh boy. Hopefully he’s not hearing it. Luckily he doesn’t…

Donna Lee: 

I don’t think he listens.

Dr. Mistry: 

…if he’s not on it, he doesn’t listen, I don’t think. Dr Yang is really not only an amazing urologist, but very well trained, specifically in the area of erectile dysfunction, advanced male prosthetics. If you’ve never heard of the inflatable penile prosthesis, you are missing out as someone who spent an entire year doing a fellowship just in the implantation of these prosthetics.

Donna Lee: 

I don’t think people know that you can do a whole fellowship on that, so I’m super impressed that we have him. That’s really amazing.

Dr. Mistry: 

No kidding. He’s one of very few, you know. And then we have Dr. Lucas Jacomides. He is a urologist that’s been in practice for probably 15, 17 years in Texas. He graduated from UT Southwestern, which is no Baylor…

Donna Lee: 

It’s not Baylor.

Dr. Mistry: 

…it’s no Baylor.

Donna Lee: 

But it’s something.

Dr. Mistry: 

Well, you know what they say, not everybody can get to Baylor. And that’s Baylor College of Medicine in Houston.

Donna Lee: 

I wish people could see your face when you say that.

Dr. Mistry: 

Yes, I do it for that. Interestingly, the alumni association hasn’t reached out to me for any reason.

Donna Lee: 

Still?

Dr. Mistry: 

Yeah.

Donna Lee: 

Maybe you need to send them a podcast link, or we’ll just do a loop of you saying Baylor College of Medicine over and over.

Dr. Mistry: 

That’s right. But Dr. Jacomides was really quite high up in the Baylor Scott and White echelon. You know, his desire to provide a more personalized level of care really encouraged him to go into more private practice arena. We are really fortunate and lucky to have him. He does all general urology exceptionally like cordial, has a great disposition and we’re really lucky to have this newest addition to our…

Donna Lee: 

Right, he’s got some great reviews. Before he joined us a few months ago, I was reading his reviews. I was like, “What a great guy.”

Dr. Mistry: 

You’re such a creep.

Donna Lee: 

No, I was totally. We have to Facebook stalk every new employee, you know that.

Dr. Mistry: 

Speaking of Facebook stalking, we also have some wonderful PA’s and nurse practitioners in our practice…

Donna Lee: 

Dustin.

Dr. Mistry: 

Dustin Fontenot is really somebody who has done probably more bio-Ts, which are testosterone implants than anyone in our practices. He’s exceptional, caring, thoughtful, compassionate.

Donna Lee: 

Is he? He can find anybody on Facebook, too.

Dr. Mistry: 

He’s very good at that. Then we have James Ramsdell.

Donna Lee: 

Jason.

Dr. Mistry: 

Oh, or Jake. He goes by many different first names.

Donna Lee: 

He does go by Jake. Jason Ramsdell.

Dr. Mistry: 

He is a physician assistant. He spent years in active duty in the Coast Guard. Just also an exceptional practitioner. He spent many years being a urology PA at Kaiser Permanente. I was going to say Kaiser [inaudible], but that’s not the right…

Donna Lee: 

Getting all the names messed up today.

Dr. Mistry: 

Leonora Brown.

Donna Lee: 

Near and dear to your heart.

Dr. Mistry: 

That’s correct.

Donna Lee: 

She’s been here 10 years.

Dr. Mistry: 

Shes been with us for more than a decade and an exceptional nurse practitioner and, or a clinical nurse specialist is actually what her official title is. She is probably the closest one to treat you exactly like I would treat you just because she’s been brainwashed for so long.

Donna Lee: 

I tell patients she’s like a female Dr. Mistry…

Dr. Mistry: 

Oh boy.

Donna Lee: 

…but nicer.

Dr. Mistry: 

She doesn’t like to do that one…

Donna Lee: 

But prettier and kinder.

Dr. Mistry: 

That’s right.

Donna Lee: 

No, you’re pretty and kind.

Dr. Mistry: 

And smaller fingers. You know, half the time the patients are like, “Would it be okay if Leonora did my annual exam?”

Donna Lee: 

Oh, you guys have so much to think about.

Dr. Mistry: 

I know, I try to be gentle, but…We have within our practice Angela Treadway who is a pelvic floor physical therapists. We think that the mind, body biomechanical connection can really affect a number of different conditions from pelvic pain to testicular pain to sexual pain to erectile dysfunction to premature ejaculation, on and on and on. So…

Donna Lee: 

She’s pretty woke.

Dr. Mistry: 

And she’s a wonderful, very important member of our team. As a matter of fact, one of the longest relationships that we’ve had within our team as well.

Donna Lee: 

13 years.

Dr. Mistry: 

That’s right. And then we have an in house sex therapist, we have in house nutrition with Robert Mendiola. And then because there’s such a big overlap between a number of urologic conditions and obstructive sleep apnea, and the fact that our patients would never go get tested when we sent them, we had to bring that in house.

Donna Lee: 

That’s true. So Austin sleep solutions.

Dr. Mistry: 

That’s right. And so our testing efficacy on, or just the efficiency in how patients were making it from our referral to actually getting tested went up from 4% to over 60%, and it really has improved the health and wellbeing of our patients, especially so many of our testosterone patients. And I think that, you know, patients that are interested in testosterone therapy, it happens to be one of the most commonly inquired about things that we get as questions. You as listeners and your questions are really big drivers of the story here or else it’d just be the same four topics over and over again, and so we really appreciate all the questions. And a lot of those questions come about with, really pertain to side effects of testosterone therapy that people are worried about.

Donna Lee: 

That’s right. We have one of our regular listeners would like to give a shout out to, John. I can say his name because it is a common first name. Right. But he’s our new friend. He’s specifically wanting to know about high blood pressure and testosterone therapy. His primary care physician basically told him, “Don’t ever ever take testosterone because I’m worried about your blood pressure.” So what are your thoughts with that?

Dr. Mistry: 

That’s a great question. So specifically when it comes to hypertension or high blood pressure and testosterone therapy, first just remember the way we treat testosterone today is very different than how even I learned when I graduated from Baylor College of Medicine in 2001. So 20 years of kind of research and education at new medications and new approaches has really changed both how important we think of testosterone as a part of your overall health program and how we go about treating it. And then in the primary care residency, testosterone is in many ways seen more of a kind of a burden. You know, the patients coming saying they feel tired, fatigued…

Donna Lee: 

They don’t like it. They don’t want to treat it.

Dr. Mistry: 

And I think it’s because men oftentimes try to put many of their symptoms, which are weight related and exercise related, solely on testosterone. But what they’ll learn from us is that it’s a chicken and egg phenomenon. If your testosterone is low, you’re not going to feel motivated to workout, you’re not going to be motivated to feel healthy. By giving testosterone appropriately, we can manage. Another thing to remember is that not all side effects are going to happen to all men. In fact, if you look at the data, the data shows that if you have a low testosterone level that your blood pressure is easier to control with the normal testosterone, not harder. It also shows that if you have prediabetes or diabetes, your sugars are easier to control when your testosterone’s normal. If you have low testosterone, your chance of having a heart attack is greater and it’s better if you normalize your testosterone. So having normal hormone levels and that, if I just said that statement, having normal hormone levels makes you healthier, I think that you would accept that. But then the moment you kind of substitute the word hormone for testosterone, people get all these kind of, you know, emotional baggage associated with it. And so, it is the case that if you are an uncontrolled hypertensive, so if you have uncontrolled high blood pressure, that testosterone, at least initially, in the first six weeks of treatment, can increase your testosterone. But if you are a controlled high blood pressure patient, meaning you’re already on meds, then there should be no increase in your blood pressure. The exception is if you develop a condition called Polycythaemia, which is excess red blood cells from the testosterone therapy, which in our practice only occurs 4% of the time because of our aggressive management of other medical conditions. And so because of that, if you develop thick blood or very high blood count, then you can develop high blood pressure complications from that. But that doesn’t happen for many, many weeks after initiation of therapy, and is something that we monitor and can take care of in certain ways. For this particular patient, I think we started them on a gel just to kind of kind of ease them into it. But I think that as a general rule, hypertension is not going to be a routine complication of testosterone therapy. Now there are going to be individuals that may be particularly susceptible. There may be something with the injection or the material that the testosterone or the vehicle, the testosterone is dissolved in, and that’s why it’s nice to go to a place that has a hundred different options, not just one. So we have many different options of replacing your testosterone or normalizing your, your hormone levels. And I think that taking that kind of approach, not just kind of summarily saying, “Well this whole field of medicine is not available to you because of a fear of hypertension,” I think that that is something that, you know, going to a specialist like we are and especially a medicine that we provide will help overcome some of those concerns.

Donna Lee: 

Right. And we’ve visited a lot of PCPs that are like, “I just don’t want to treat the testosterone. I have so much going on that I’ll just hand you the urologist testosterone patients,” because they have everything else they need to know about, so.

Dr. Mistry: 

And we’re happy to take care of it.

Donna Lee: 

That’s right, we’ll take it.

Dr. Mistry: 

Why don’t you tell people how to get ahold of us if they want us to take care of it?

Donna Lee: 

You can call us at (512) 238-0762. I forgot our number for a second. Our website is armormenshealth.com and you can send your questions to armormenshealth@gmail.com and we will answer them. They will always be anonymous except for that one because he’s our new, he’s our fan. He’s our friend. So anyway, we’ll 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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