Phone: 512-238-0762

Fax: 512-341-7370

June 20, 2020

It’s Complicated: Dr. Mistry and Donna Lee Answer a Patient’s Question about the Effects of Testosterone Therapy

Speaker 1: 

Welcome back to theArmour 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 host, men’s health expert extraordinaire, here with my office manager partner, in crime, and right hand, Donna Lee.

Donna Lee: 

Mhmm. You got so excited that you forgot the words there about how talented you are.

Dr. Mistry: 

That’s right.

Donna Lee: 

All your titles.

Dr. Mistry: 

That’s right. That’s right. I’ll tell you that. I didn’t think that being on the radio would go to my head. I do like it when people tell me how good I sound.

Donna Lee: 

But it has. You do sound good, but it definitely has a major ego even bigger, which I didn’t think could happen.

Dr. Mistry: 

That’s right. And when it comes to things around here, we love bigger.

Donna Lee: 

You know, I love that you can say you’re a surgeon, but I think you get a kick out of the radio that you’re a radio cohost or host.

Dr. Mistry: 

That’s right. That’s right. That’s right. My wife also knows that when she needs to get a couple little credits into the bucket for herself, she’ll also tell me, “Oh, I heard you on the radio. You sounded really good.”

Donna Lee: 

You know what else your wife said, that we need more Donna Lee. Thanks, Krista!

Dr. Mistry: 

The listeners though, the listeners know it’s a lie. There’s never a time when my wife is trying to make me feel better about myself. Well, I am a urologist, a board certified urologist. A urologist is a surgeon. That’s how we train. We train in a number of urologic conditions. This week alone, we’re going to be taking care of bladder cancer, kidney cancer, prostate cancer, testis cancer, even penile and urethral cancer. This last week, even during this Corona epidemic, pandemic, quarantine, I diagnosed a basal cell carcinoma of the scrotum. So cancer makes up a big part of what we do. And then we deal with a lot of lifestyle issues. We deal with things like Peyronie’s disease and BPH. We deal with irritative urinary complaints. We have a wonderful treatments that we try to initiate that have multiple different facets. They include nutrition, biomechanics, supplements, really changing your lifestyle.

Donna Lee: 

That’s right.

Dr. Mistry: 

And then, and then we deal with hormonal things. So we deal with testosterone, men’s fertility people. It’s hard for me to believe there’s even anything left in medicine to deal with after urology has done with you.

Donna Lee: 

Not that we’re bragging or anything.

Dr. Mistry: 

And then somebody will tell me they have a runny nose and I go, “I have no idea. I have no idea what to do about that.” “Can you look in my ear doctor?”

Donna Lee: 

If your ear is your penis!

Dr. Mistry: 

I’m like, “Uh, I could. I don’t know what I’m looking at, but I can look in your ear.” And we love your questions. It’s what drives this show. We get a lot of questions that seem pretty standard fare. A lot of those questions could be answered by any one of the talks that we give on the radio or on the podcast. And you can look it up, and erectile dysfunction, BPH. But what we love a little bit of the off the wall question, because you know, this is going to be questions that you would not make a doctor’s appointment and go get an answer for. And you’re going to get a nice, you know, five or seven minute answer. So, Donna Lee, why don’t you give us this next question?

Donna Lee: 

You’re going to enjoy this one listener sent in a couple of days ago. “I would like a second opinion,” which we brag a lot about. We like that second opinion.

Dr. Mistry: 

That’s right. We do love second opinions.

Donna Lee: 

He goes on about his insurance plan. I would like to announce that we do accept about 97% of the insurance plans out there, probably is covered by insurance.

Dr. Mistry: 

We are also making up that percentage. We take everything that we can.

Donna Lee: 

And hope for the best that’s right. This patient kind of goes into a little bit of detail. “I started on testosterone therapy in November and it doesn’t work for me. And I want to get off of it. Something is causing my high blood pressure to rise. I believe it might be from…” and he lists a bunch of things like hematocrit levels, talks about his testosterone is 753, but it was 187 in January, PSA is 0.4. His weight is 345–he’s a big guy, right? Height 6’1″. Type two diabetic, sleep apnea, high blood pressure, currently seeing a person at the largest urology clinic in Austin. So I’m leaving that name out.

Dr. Mistry: 

We are the second largest…

Donna Lee: 

…which means…

Dr. Mistry: 

…we try harder…

Donna Lee: 

…and we’re cuter on Saturday nights.

Dr. Mistry: 

Okay. So this listener has some, has a great question. And I’m going to break it down again, like I like to break down these questions.

Donna Lee: 

Break it down! I’ve never seen anybody that wants to get off testosterone. Like he’s not happy with it. He thinks it’s causing high blood pressure.

Dr. Mistry: 

It happens all the time, people want to get off testosterone. It’s actually one of the reasons that we really started becoming a more comprehensive men’s health clinic here, is because so many guys, they would come in and say, “I have a testosterone of 180,” like this guy. And then you put him on testosterone and he doesn’t feel any better. And he’s like, “Well, you know, screw you guys I’m outta here.” And so, you know, it was so one dimensional to look at these men and say, “Well, you know, they came in with a numeric value on some laboratory panel. We gave them a treatment that fixes that laboratory value. Shouldn’t they feel better?” But men aren’t unidimensional.

Donna Lee: 

Right. You’re not?

Dr. Mistry: 

We’re multidimensional, incredibly complex, thoughtful feeling people…

Donna Lee: 

You’re not Flat Stanley?

Dr. Mistry: 

…you know? And so, and so, you know, what it came down to, and this listener is the quintessential person that we want to take care of. First of all, having sleep apnea puts you at risk for hypertension if it’s not properly treated. And the number of people that have sleep apnea that don’t use their C-PAP or don’t use proper treatment is a ton. That’s why we offer oral dental appliance therapy as an alternative. 345 pounds, 6’1″, BMI looks like it’s over 42, puts you in the morbidly obese category–losing weight is going to be a primary determinant of your testosterone, as well as…

Donna Lee: 

And your blood pressure.

Dr. Mistry: 

…and your diabetes and your sleep apnea. So an aggressive program. And if you’ve heard of the show, if you’re at that level and somebody has not talked to you about weight loss surgery, then at least you should have heard the, you should have heard the conversation. To think that, and I don’t know, but I’m guessing you’re probably on five, six, seven, eight medications, to go down none or one or two is something that you should really consider as part of the program and your testosterone level will go up. The fact that testosterone may have led to an increase of your blood pressure is not necessarily surprising. It can do that in a certain subset of patients, but the type of patient who we’re most worried about is the guy in whom testosterone has raised your hemoglobin level or hematocrit–that means the red blood cells in your blood or the red blood cell count in your blood has raised, it’s now made your blood thicker, harder for your blood to pump through your body. It can cause hypertension. Another thing that happens specifically, Oh, not specifically, but more commonly in men who are obese is an increase in estrogen levels. And so that testosterone that you’re injecting or putting on by cream can be getting converted into estrogen.

Donna Lee: 

Oh, that’s right.

Dr. Mistry: 

A lot of people out there don’t even check the estrogen. If you’re free going to a urologist, it’s pretty clear that you probably are, but a lot of people out there are being treated for testosterone, they never even check an estrogen level. And at that level is high can lead to a whole host of issues biologically that needed to be addressed. So, for sure, as painful and obvious as it may sound, the weight loss is going to be a major component of fixing what’s going on in terms of your whole body. When it…does kind of, apply to getting off testosterone, you know, there’s other reasons to take testosterone, except for libido, erections, energy, muscle mass. We also have, sometimes we have problems with bone growth or osteoporosis or osteopenia that can affect some men. And that’d be, that would be a reason. And, but that’s really the only reason that I kind of for sure put people on testosterone is if they have poor bone mineral density. If you want to get off the testosterone and want to find ways to increase it more naturally, then we have a wonderful program that’s really geared towards making sure you’re on the right nutritional program. It’s largely a Keto-based program that tries to eliminate the inflammatory effects that some carbohydrates can have in your system. And that’s kind of the approach that we take. Exercise with even a moderate walking that can be measured is something also that will promote a higher need for testosterone production. If you don’t like taking testosterone like through injection or through creams, we have ways that are less likely to lead to increases in blood pressure through some types of pills that we offer. And another great thing to do sometimes, which really helps, amazingly, is just to give you a medicine that will stop the conversion of testosterone to estrogen. It’ll increase your natural testosterone, drop your estrogen, it won’t affect your blood pressure adversely, it’s super cheap, super easy, make you feel better. And so there’s definitely different approaches that people can take to low testosterone. But, you know, continuing to go to someone who’s looking at you in that unidimensional way, I think is going to continue to give you an outcome that you’re not happy with.

Donna Lee: 

Oh, that was a good answer. That makes me think of the primary care doctor that we went to see once for lunch. And she said, “I don’t want to deal with testosterone and hormones. I’m going to send them to you because it’s not my jam. I just don’t like it.” But I did have a patient who came in and he was 40 pounds overweight and he wanted to testosterone, and that’s all he wanted. And I got a little upset and she said, “I challenge you to lose 20 pounds. If you lose 20 pounds, I’ll put you on testosterone.” So he went out and he lost 20 pounds and he came back and had his labs re-done.

Dr. Mistry: 

Didn’t need testosterone!

Donna Lee: 

Testosterone level was perfect. And she’s like…

Dr. Mistry: 

Breathing better. Well, no kidding. Guess what?

Donna Lee: 

Exactly. She was like “Sucker!”

Dr. Mistry: 

That’s right. Tell people how to get ahold of us.

Donna Lee: 

You can call us during the week at (512) 238-0762.

Dr. Mistry: 

Our email address is armormenshealth@gmail.com. We’re located all over the place. We’re at Round Rock and North Austin and South Dustin and Dripping Springs. You can email your questions to armormenshealth@gmail.com. I know I can’t repeat that enough because I read these questions are amazing and we’re giving out all this amazing advice. And I don’t think we’re everybody’s favorite in town, Dr. Mistry. I think they’re like, “Why do you keep giving out free advice?” So anyway, you can see our lovely faces on armormenshealth.com. That’s our website. Listen to our podcasts. They’re free. They’re amazing. And we’ll be right back.

: 

Dr. Mistry wants to hear from you. Email questions to armormenshealth@gmail.com. We’ll be right back with the armor men’s health power.

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