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June 2, 2019

Dustin Fontenot and Dr. Mistry Discuss Testosterone Replacement Therapy

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 here with Donna Lee.

Donna Lee: 

Hello.

Dr. Mistry: 

Welcome back. We have joining us right now, Dustin Fontenot, who is one of the physician assistants in our practice and really one of the initial founders of Armor Men’s Health with us. Dustin, welcome.

Dustin Fontenot: 

Thank you.

Dr. Mistry: 

Why don’t you tell us a little bit about what brought you onto our practice and some of your background?

Dustin Fontenot: 

Absolutely. So, my background is in men’s health. I’ve been doing it now for almost seven years. I originally started as a, working in a low testosterone clinic, many that you hear on the radio. These are the clinics in which patients come in once a week and get an injection of testosterone.

Dr. Mistry: 

Now, this is a really popular way of getting testosterone, but I guess as somebody who’s working, I always found it kind of inconvenient to be forced to have to go somewhere for a weekly injection. Is that what you found when you were working there?

Dustin Fontenot: 

Yes, absolutely. And, it became very challenging for the patients in order to keep their compliancy up and the appropriate schedule of the medication. Due to these issues, I found that there was a lot of areas that were lacking in the men’s health realm and a lot of limitations that were placed on us. That’s when I joined with Dr. Mistry to begin Armor Men’s Health in which we were looking at more of the whole health of the man versus just his testosterone level.

Dr. Mistry: 

No, I couldn’t agree with you more. You know, early on when we started the practice, and now we have probably over 2,500 patients that we treat for low testosterone and very various different methods. I was really frustrated by the type of patient that would come to us with a lab in hand or a friend having been on testosterone and saying, you know, Dr. Mistry, get me on testosterone. I wanna feel like 1 million bucks like my friend. And then, if giving them testosterone didn’t help them feel better, they left. And I felt powerless. Did you get that sense too?

Dustin Fontenot: 

Absolutely. And a lot of men believe that the testosterone is sort of the silver bullet to fix all their ailments and they’re ignoring the other aspects in their health and wellness that they’re leaving out. So, addressing multiple aspects of the wellness and health side is paramount. And it’s the reason why a lot of men fail at the treatment is simply because they’re only addressing the testosterone aspect.

Dr. Mistry: 

When I talk about what we do with other doctors, especially other urologists, I kind of come up with that quintessential 44 year old man who is 270 pounds, 5′ 10″, snores like a diesel truck at night, sitting on the couch. And then he comes to us saying, well I think low testosterone is the reason that I’m sitting on the couch and overweight. And I immediately have to kind of shake my head because the testosterone is going to be one part of it. But what else do we address? And what do you find to be some of the big things that get that guy off the couch to lose weight and be healthy?

Dustin Fontenot: 

Right. So you mentioned the sleep. So the sleep is a huge component and, you know, obstructive sleep apnea is one of the most underdiagnosed and undertreated ailments out there. So, one of the things that we do is get these guys to complete a sleep study, whether it’d be in lab or a home sleep study. And, if they do have some degree of sleep apnea, we help them get that treated. We look at their nutrition, their diet, what they’re eating. We have our own in-house health coaching, that can help get these guys on track and get their diets back on track as well as getting them moving. So between addressing their hormone optimization, their nutrition, their sleep, and a lot of their mental wellbeing as well, that seems to be what can, get these guys back on track to gaining control of their health and wellness.

Dr. Mistry: 

You know, a lot of people do testosterone replacement therapy. You can get it at clinics that you do outpatient therapy. Most primary care doctors do testosterone replacement in some form or fashion. But I really feel that we take it to the next level. I think that we take the treatment of testosterone and associated of conditions with low testosterone really seriously. So let’s say somebody was interested, what are some of the, initial parts of the evaluation? What would you say are some of the special laboratory testing that we do and how do people get started?

Dustin Fontenot: 

So to get started, the initial part of the evaluation obviously, is to come in and have a visit and a consultation with us. And that visiting consultation would include a thorough conversation about your medical history, but more in depth than that and really about your lifestyle habits. So, what kind of diet you’re on or what kind of food you’re eating, how much you’re exercising, what your sleep habits are like, what your sexual habits are like. And really in detail about your overall lifestyle. At that point, we would get some laboratory testing. This can include just a basic hormone panel, or if it’s been a while since you’ve had a regular physical, we’ll check metabolic labs as well. This will include things like your cholesterol and your blood sugar, other hormone levels besides your sex hormones, including your thyroid hormones, vitamin D levels. So a whole host of other components that you may have some deficiencies in that need optimization as well.

Dr. Mistry: 

And when we do labs we’re looking for testosterone, the total testosterone, which many people check. But we’re also looking at free testosterone or bioavailable testosterone, the actual amount that your body has available for you to use, which can be different for a variety of conditions. We’re going to check your estrogen level, we’re going to check your DHA levels, other types of smaller testosterone. And, you know, getting back to your initial evaluation, I think that we really focus on what symptoms are we really trying to fix, really not the number, we don’t focus on the number, but really what kind of symptoms. So what are some symptoms of low testosterone that patients come to see us for, some of which are typical, and some are somewhat atypical.

Dustin Fontenot: 

So that’s right. It’s not so much about the number. And a common question that we get is what’s an appropriate testosterone level for my age? And that question is really difficult to answer because there really is not an appropriate testosterone level for your age, but rather how you’re feeling and at what point you become symptomatic or start developing symptoms. So many men come in for symptoms of fatigue, low energy, poor sleep, low libido, poor erections, difficulty losing weight, difficulty maintaining muscle mass. So it can be a whole variety. And not everybody’s the same. Some, you know, some guys have plenty of sex drive and great erections, but they have no energy and they have very poor sleep and vice versa. So not everybody experiences the same low testosterone symptoms. And so, which is why we do more of an individual individualistic treatment plan.

Dr. Mistry: 

Well, one of the things I love about what we do is how many different ways we are able to replace testosterone. In addition to creams, we have sublingual pellets, we have creams that go in the nose, we have creams that go in the underarms. We have subcutaneous injections. We have intramuscular injections, we have pellets, we have injections and pills that don’t affect fertility. We have different types of treatments for patients really to individualize what their needs are. But I would say that the vast majority of our patients do a self directed injection therapy. Would you agree?

Dustin Fontenot: 

Yes.

Dr. Mistry: 

Why don’t you talk to us about kind of how we do it and how people pick the kind of therapy.

Dustin Fontenot: 

So the self administered injections are by far the most popular and that can be due to a variety of reasons. For one, it’s fairly short acting. These injections lasts in the body for about 7 to 10 days. So people that are a little unsure on their commitment level when they get started, it’s a great option. It’s also one of the most inexpensive ways of doing the testosterone replacement and it’s a method in which they can administer at home. So because of all those reasons, patients tend to initially start with the self administrated injections. We do a thorough job of instructing the patient on how to do the injections, make sure they feel completely comfortable doing it in our office before they start doing it at home.

Dr. Mistry: 

Yeah. A lot of our patients have their wives or one of their family members do the injections. Of course, if you want to come in and get us to inject weekly or biweekly, we’re more than happy to do that. But really for convenience sake, being able to do it at home. And I think that’s where we get a lot of patients that transfer their care from a clinic where they have to go weekly for their injections are just kind of fed up with having to go every week and we’re able to get them a pretty reasonably priced injection protocol. How much would you say the testosterone costs for about a three month supply?

Dustin Fontenot: 

It’s about $65.

Dr. Mistry: 

It’s pretty cheap. I mean, I think that a lot of patients would be surprised to learn, when their friends are going to $1,000-a-month clinics that really for very little money they can get appropriately monitored medical testosterone therapy. Most of the time it’s covered by insurance. But sometimes we get patients that aren’t covered by insurance. Why don’t you describe what our Armor Men’s Health testosterone program looks like and what it costs?

Dustin Fontenot: 

Absolutely. So our Armor Men’s Health program is really designed to help simplify things and to help streamline things. So what this program includes is all of your consultations with us at the office. And those can either be in person, by email, by phone, whatever you feel comfortable with. It’s really almost a concierge type practice. It also includes your medication and that can be whether you want to do injections, whether you want to do pellets, whether you want to do creams, and as well as all the associated lab work. So, it’s kind of an all-in, no hidden fees–we’re not gonna hit you up later on for something else. And the cost of that program is $150 per month.

Dr. Mistry: 

Well, I think that a lot of people would be surprised about how inexpensive it can be. And given that you’re getting treated in a urologist clinic, when you have associated urologic type issues, testicular pain, need for a vasectomy or any of the things that kinda come along with being a man, we’re able to kind of take care of that at the same time. So thanks a lot for talking about our low-T program, Dustin. And you can reach us at armormenshealth@gmail.com if you have questions, or visit our website at armourmenshealth.com. We’ll be right back.

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