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August 8, 2020

Pumping Out Testosterone: The Many Options for “Supercharging” Your Testosterone Production

Speaker 1: 

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

Dr. Mistry: 

Hello and welcome to the Armor Men’s Health Hour. I’m Dr. Mistry, your host, here as always with my wonderful and bubbly and spectacular cohost and office manager, Donna Lee.

Donna Lee: 

That’s me! Hello everybody. Happy day.

Dr. Mistry: 

Happy day, everyone. This is a men’s health show. I am a board certified urologist and Dr. Mistry is my real name, not just some gimmicky thing that we put together.

Donna Lee: 

M-I-S-T-R-Y when you go to Google.

Dr. Mistry: 

When you go to our newer website, you’re going to see us talk about the “Mistry difference,” and what that means is how our approach to urology might be different than you’ve experienced. We have a more holistic approach. We have nutritionists. We have pelvic floor physical therapy and biomechanics. We really take your health seriously when it comes to urologic health. We are open for business,

Donna Lee: 

Partly due to the amazing response on the radio, we’re adding more providers.

Dr. Mistry: 

That’s right. That’s right. We’re getting busier. We’re getting more people. We love second opinions. So although we’re going to talk about a number of things on this show today, if you have other urologic concerns, please send us your inquiries. Donna Lee, why don’t you tell people about our practice and how to get ahold of us?

Donna Lee: 

You can call us during the week at (512) 238-0762. You can ask for me if you’d like. Our locations are Round Rock, North Austin, South Austin, and Dripping Springs, soon to expand probably from that as well in the future, maybe. Also you can go to our website, armormenshealth.com, and see our smiling faces. You can send an inquiry through there, the questions that we love to receive. Or you can email us directly at armormenshealth@gmail.com. And we have very important shout outs.

Dr. Mistry: 

Okay, let let’s come on. Let’s get the shout-outs, especially the one shout-out where somebody was overheard at a restaurant talking about our show.

Donna Lee: 

That’s right. I thought that was spectacular, but his, appropriately, his name is Dickey. So we want to give Dickey a big shout out because he listens every week and he apparently is a fan. So hello, Dickey!

Dr. Mistry: 

Hello, Dickey.

Donna Lee: 

And then the other one is our youngest listener. She’s nine years old. Her name is Raquel and she’s listening right now. Raquel is the daughter of our employee Jasmeen and her dad of course, is Andy and their dad lives with them. And he listens all the time. So everybody keep listening except for Raquel.

Dr. Mistry: 

That’s right. Raquel. Sometimes, you know, some of our targets were a little juicy for children’s ears, but we really appreciate all the listenership out there, both on the radio when you’re in your car and those people that are downloading the podcast. We have almost 2000 downloads a week. It’s something that is such a wonderful…

Donna Lee: 

We’re still shaking our heads.

Dr. Mistry: 

That’s right. We love it. We love it so much. One of Donna Lee’s favorite things to do is to look and see where in the world people are downloading us.

Donna Lee: 

That’s right. After the United States, it’s Ireland and Germany.

Dr. Mistry: 

And then we had 10 coming from Australia.

Donna Lee: 

And we have Japan and Africa.

Dr. Mistry: 

Very good.

Donna Lee: 

So thank you all. We should learn a language.

Dr. Mistry: 

It’s an incredible ego boost. The questions that you send us are really what drive this show, and we really appreciate those of you that take the time to engage with us by asking your questions. If it’s something to us that we think is a medical urgency than we may not address it on the show immediately. We may call you first and have you come in so that those people that have severe testicular pain and you email us, we want to see you right away. And so it would be better if you have an urgent medical issue just to call us to make that appointment. But if we do catch it via email, we’ll definitely try to address it. Donna Lee, any questions this week?

Donna Lee: 

We do have a question: “Dr. Mistry, I was on testosterone treatment some years ago and got dizzy spells and other side effects like emotional issues. It was a topical treatment. What are other options that have less side effects and will not put me at risk for not producing any testosterone?”

Dr. Mistry: 

That’s a great question. It really is more than one question put together. And it’s a topic that we handle very well in our practice. The first part of the question is what are some side effects that you can expect with testosterone therapy and is this particular caller’s or listener’s side effects likely related? And I will say that dizziness is not something that I see very often with testosterone therapy. Dizziness can be from blood pressure issues, blood sugar issues, any number of things that we would at least try to evaluate. If that particular listener was also seeing a urologist, they may have been put on a medicine called tamsulosin, or there’s other medicines that we give patients for enlarged prostate, and some of those can cause dizziness. But the topical testosterone therapy is not something that I usually see with dizziness. Now, the emotional issues that we see. You can either have emotional issues because getting back to a normal testosterone level makes you feel something like a little on edge or something of that nature. But if you’re getting more weepy and emotional that way, then it could be because of an estrogen increase. And estrogen increases very commonly with testosterone therapy, especially if you’re a little bigger, if you have fat around your midsection, that those types of patients often convert testosterone to estrogen at a higher rate. And we can actually give other medicines to combat that. So if that’s the big issue, it may be testosterone is the best option for you. The second part of the question is what are options for testosterone therapy other than topical? We have injections, we have pellets, we have sublingual testosterone, we have subcutaneous testosterone, we have long acting injections, and now we even have oral testosterone. So we have tons and tons of just straight up testosterone. We even have nasal that’s right, Natesto. And then there are ways that we can maximize the topicals. We prefer injections and pellets in our office because I get a more steady dosing and it’s easier to change. Pellets are by far and away the best option for testosterone because you avoid the peaks and troughs of injections or even topical treatments. And if you’re interested in changing over to pellet therapy, it’s something that we’d be happy to help you with. The final part of the question though, almost puts every other part of the question on its head, and that was how you treat testosterone if you don’t want to stop your own natural production? And that’s a very insightful question. For those listeners that don’t know if you take external testosterone, what will happen is your own body’s production of it will reduce. Your body will think that it’s getting enough. It shuts off the little checkpoints in your hormone system and your own testosterone production from your testicles will drop. If you’re not making enough, usually we don’t worry about it. If you don’t have enough horsepower, you get a supercharger, and you’re, it’s not…

Donna Lee: 

It’s always about a car, isn’t it?

Dr. Mistry: 

I don’t know. I’m terrible at analogies.

Donna Lee: 

You are terrible. Especially those car analogies.

Dr. Mistry: 

Do cars have superchargers? The point is that if you’re not making enough, the fact that it may shut down your own body’s production may not or should not necessarily bother you. But if you don’t want to alter your body’s physiology that way, there are ways that we can naturally, when I say naturally, I mean, use your own body’s machinery to make more testosterone. We use medications like clomiphene we use medications like arimidex, medications named HCG or human chorionic gonadotropin–these are medicines that will just use your body’s chemistry and send more signals to your testicles to increase your levels. Now, the downside is if your testicles can’t produce more, these medicines aren’t going to work. The use of these medicines really is predicated on you having that extra capacity to make more testosterone naturally. We use these types of techniques very frequently in younger men who are trying to get pregnant, because not only will testosterone externally taken reduce your own body’s testosterone production, but it will also reduce your sperm production. It’s a daily occurrence where I meet a man who I’m seeing for infertility that’s taking testosterone and not making any sperm.

Donna Lee: 

That sounds so counterproductive to me. Like you assume men who have high testosterone are just pumping out tons of sperm.

Dr. Mistry: 

Well, naturally maybe pumping out…

Donna Lee: 

Whatever.

Dr. Mistry: 

That’s quite a visual there, lady. It is, we often will equate virility with this idea of machismo. But if you’re taking a lot of testosterone, you’re probably not going to be making any sperm, and it takes…

Donna Lee: 

You’re not pumping it out.

Dr. Mistry: 

You’re not pumping it out. And it can take 3, 6, 9 up to 12 months in about a good, a good half of our patients if they’ve been on testosterone long term to get production of sperm back. So if you’re taking testosterone and you think you’re going to want to have a baby one day, you better come in, so we can find an alternative way of handling this issue for you because, your wife’s going to be very upset with you when she learns that you’re the cause of their, your infertility as a couple because of testosterone use.

Donna Lee: 

You always blame it on the woman though. It’s always the woman who, “Oh, it’s your fault. You can’t get pregnant.”

Dr. Mistry: 

Well, I think it’s society, you know, I think our approach to male fertility not only includes the use of medication, but also a very deep dive into nutrition, lifestyle, making sure that we’re handling your other medical concerns like diabetes or high blood pressure or high cholesterol, because all of those things affect it. We use the analogy here that your fertility or your sperm count is like a litmus test for your overall health. So if you’re not healthy, if you’re sick, if you have lots of medical conditions, don’t be surprised if your sperm count’s low. Because in a way your body, your body doesn’t know that you’re trying to reproduce if you’re not handling your own business when it comes to your health. And so we want to help you get pregnant in the most natural way possible. And often that includes deep dives into your nutrition.

Donna Lee: 

Deep dives into little sperms.

Dr. Mistry: 

You can just think about them swimming all the time.

Donna Lee: 

Right? You know, with every year anniversary at our company, you get a little sperm pin that you get to wear on your shirt. It’s very cute. It’s a little offensive out in public, but it’s cute in our office.

Dr. Mistry: 

Why don’t you tell people how to get ahold of us?

Donna Lee: 

During the week at (512) 238-0762. And of course, keep sending these amazing questions to armormenshealth@gmail.com or go to our website and you can leave an inquiry there, armormenshealth.com. And that was a really good question. Thank you so much for the detailed answer, Dr. Mistry.

Dr. Mistry: 

Well thank you.

: 

Dr. Mystery wants to hear from you email questions to armormenshealth@gmail.com. We’ll be right back with the Armor Men’s Health Hour.

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