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July 25, 2020

Low Libido Post-Prostatectomy: Can Testosterone Boost Sex Drive & Function After Prostate Removal?

Speaker 1: 

Welcome to the Armour men’s health hour with dr. Mystery and Donna Lee.

Speaker 2: 

Hello, and welcome back to the armaments health hour. I’m dr. Mystery, your host here with my cohost, Donna Lee. Hi, welcome back everybody. You know, somewhere along the way in an actual release of our show, there’s like a whole paragraph on you. Alright. That’s right. It has like, she was voted like this and this, that, and I’m wondering if you wrote it,

Speaker 3: 

Maybe do you have access to our account to upload that information? Well, I love welcome to the Donnelley welcome liver buddy,

Speaker 2: 

Because she’s going to be the most regular fixture of this show. Thank God for your humorous disposition, your dirty, dirty jokes, this place going

Speaker 3: 

Well. We have to be a little dirty and urology. That’s right. You know why I became a urologist because of the joke, because of the joke. I had a tee shirt on yesterday that had a penis on it and I had to go somewhere after work and kind of forgot. Cause it’s just second nature for us. And the looks I got, Oh boy. Oh boy. I forgot. And then our other t-shirts says we’re nuts for urology at urology specialists.

Speaker 2: 

My funniest shirt that we ever had here was when you didn’t know urology very well. And you put the term year and you’re you’re you’re, you’re in good hands instead of U R I N E Y O U apostrophe RA. And I was like, I think, I don’t think she gets the joke. I think she misspelled the T shirt.

Speaker 3: 

I remember that I still have that tee shirt

Speaker 2: 

And, and, and then we blame the tee shirt guy and then he had to make them again. But that was pretty good. Good job, Donna. Thanks for being a great office manager around here. That’s right. Welcome to the RN men’s health hour. I’m dr. Mystery, your host and I am a board certified urologist. Our urology practice is called NAU urology practice, a urology specialists, sorry, NAU urology specialists. And I’m dr. Mystery. That is my real name. M I S T R Y. That’s right. And we have dr. Yang as part of our practice. Dr. Jacqueline meetings don’t even try it.

Speaker 3: 

JCO M I D S and then doctor on O and G that’s. Right. That’s easy. Her name’s easy. Cause it’s like O and G

Speaker 2: 

No, that’s right. Oh, there you go. Everybody’s extremely well trained here. Very much focused on making your life better and try and do so in a safe and effective manner. I think that we really pride ourselves in trying to take a new and unique view to your men’s health issues. Uh, much, much to our chagrin of our, of our staff here. You know, there was no such thing as a simple problem or a simple question, you know, I like to make maybe things a little overly complicated because I want people to know that they’re their own individual problems are something that we take with an individual approach, not a cookie cutter approach. If you have an enlarged prostate, not just one treatment is going to work for everybody. If you have prostate cancer and not just one, treatment’s going to work for you. That’s so old school thinking it is if you have overactive bladder, any number of conditions, even kidney stones, you know, we want to make sure, you know, what’s the buffet or plethora of options that are available for you. And then how are we going to take care of you after the initial problem? How do we take care of you for not getting more stones or having more urinary complaints or having a worsening cancer, even after we do the initial treatment, that’s why so many of our patients become really a part of our family. We’re so appreciative for all of their support for our practice, the show. And of course, all of you that participate by sending us the questions, right?

Speaker 3: 

I have a question right along those lines. This patient sent in the subject is testosterone after press prostate removal. Dr. Mystery, I had robotic prostatectomy one year ago. My libido is poor. Would it be a danger to get testosterone? Now I’m 62 had a fairly aggressive cancer located in the anterior section of my prostate, the original biopsy. He said missed it. First PSA after surgery was zero.

Speaker 2: 

This is a, um, like if you’ve listened to the show before, I’ll try to break this down into several different components. So what is the likelihood that you’re going to miss up cancer? When you do a prostate biopsy? Now, most of the time you’re doing a prostate biopsy. If you had an elevated PSA level, that’s a blood test looking for your stratify years for prostate cancer. And if the tumor is located kind of far away from the rectum, because that’s how we access the prostate is trans rectally. Then it is possible to miss an anterior or a central tumor. And so that’s why in our clinic, we almost always will obtain an MRI, even if you’ve had a biopsy. Uh, we get an MRI about six months after your biopsy, just to make sure we didn’t miss a tumor that may have been somewhat inaccessible from the, our traditional template.

Speaker 2: 

A lot of insurances won’t pay for the MRI before the biopsy, which we prefer, because if you can get an MRI beforehand, we can do something called an MRI, guided biopsy, much higher degree of accuracy, and we’re not going to miss something big. That’s, that’s usually not in the right place. That’s, uh, something that we make kind of commonplace in our practice. The second question is what do we do about men with either low testosterone or low libido after the radical prostatectomy? And this is where we get a little bit in a nomenclature. A lot of times men confuse the term libido with erectile function, just like I have very low golf libido because my golf function is poor. You understand? Like I don’t want to play golf because I’m terrible at golf. So if you’re not getting an erection, then your desire for having sex is low.

Speaker 2: 

That’s understandable if your libido is low and that you’re just your sex drive is low and you think it might be due to testosterone, it could be improved testosterone, but if you have severe erectile dysfunction after a radical prostatectomy, after they remove the prostate gland, that may not be something that’s going to get fixed with testosterone. Usually in a case like that, the nerves that helps transmit the signal to your penis to get erect, they’ve been damaged. They may have been irreversibly damaged and other things may be necessary. And that’s a different topic, different show. And absolutely we’ve talked about it many times. And if you have severe ed or stress urinary incontinence, after your prostate has been removed, it’s something that we consider ourselves to have a special expertise in here, special fellowship training, and would love to see you about it. But if your libido is low or you’re symptomatic from low testosterone in other ways like low muscle mass, poor cognition, and you’re worried about taking testosterone after prostate cancer, I can tell you that the data does not support that there’s any risk to you, the data supportive, in fact, that normalizing your testosterone and taking testosterone replacement, may in fact, decrease your chance of getting a later recurrent disease.

Speaker 2: 

That’s research that’s been published just in the last year, but this has also kind of proven or been very consistent with data that we, we as urologists have known for a long time, which is that low testosterone levels are often associated with more aggressive cancers. And so if you have low testosterone, you actually have a higher chance of getting cancer and taking testosterone should not pose any additional risk to you, uh, after you’ve been treated. And certainly if you’ve been surgically cured, uh, as, as this, uh, listener, uh, has, um, has suggested taking testosterone, we consider safe. We have hundreds of patients that are on testosterone after prostate cancer treatment. We even have hundreds of patients on active surveillance for prostate cancer that are getting testosterone. And that data also shows that it is safe to be able to prescribe that we don’t hyper dose you, we get you to a normal level, get you to feeling good.

Speaker 2: 

And that’s kind of what the goal of any doctor that’s taking care of you should do is to get you to normal levels in a safe, in a safe way. So you don’t want levels at like a thousand, 2000. Maybe you don’t want to, you know, we don’t need bodybuilder kind of, kind of, uh, that’s fine. That’s what you’re doing after you’re doing, but, um, in terms of kind of what we’re going to be able to do and kind of a safe manner, that’s kind of what we’re going for. And when it comes to, uh, issues, um, like the safe administration of testosterone or regaining functioning after prostate cancer, this really gets to that heart of that point, which is that, you know, just being diagnosed with cancers tough enough, right? But not getting guidance on how to adjust your diet, your lifestyle, how to maximize your function, having the right physical therapist, having the right sexual, uh, advice, uh, you know, warning you about how you’re a jacket volume and an orgasm might change after such a surgery coming to grips and helping you overcome that, that that’s what we do, right. That’s, that’s the thing special that we do, I think, uh, and, uh, absolutely something that we’ll spend just as much time on, right. Then just trying to convince you to do a radical prostatectomy or any kind of procedure for your prostate. And so, uh, I think that’s, um, something that if you haven’t gotten enough of, uh, and you’ve been suffering from any of these medical conditions, uh, it is absolutely an appropriate reason to seek a second opinion,

Speaker 3: 

Second opinion, doctor, second opinion over here,

Speaker 2: 

We’ve been together so long and finishing my sandwiches.

Speaker 3: 

I will finish your sandwich. I’m hungry. Oh my goodness. So you said rectum earlier. And I just had to throw out there every time. My husband has some joke that he knows. And every time somebody says rector, which is unfortunately a lot around our house with three teenage boys, somebody will say wrecked him. And he says, rectum damn near killed him. I don’t know what the joke is, but that’s the punchline. And that’s all I hear at home. We’ll have to we’ll find the joke

Speaker 2: 

Comedian is that she doesn’t know that. Well, good job. Common joke.

Speaker 3: 

You don’t know I’m going to find the joke and we’ll have it for you next week.

Speaker 2: 

They didn’t teach that in our urology residency.

Speaker 3: 

Oh, well, I can’t steal other people’s jokes, but I can certainly repeat that joke when I find it. I’m telling Carlos [inaudible] good story. I met him and we had a long talk about people stealing jokes.

Speaker 2: 

That’s right. He was unhappy with you. Well, Donna Waters taught people how to reach out to us for questions. And for that second opinion or for appointments with us or anything else,

Speaker 3: 

Or for the rectum joke, you can call us at five one two two three eight zero seven 62. Our website is Armour men’s health.com. You can send questions to that website. There’s a little spot there to send your questions. Um, or you can email us at Armour men’s health@gmail.com. We’re located in round rock, North Austin, South Austin in dripping Springs. And we so very much appreciate your questions because that’s what keeps us going. Right? Dr. Mystery,

Speaker 2: 

The armor men’s health power. We’ll be right back. If you have questions for dr. Mystery, email him at Armour men’s health, ed gmail.com.

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