Low T Kills: Increased Mortality in Patients with Low Testosterone
Donna Lee:
The Armor Men’s Health Hour is brought to you by Urology Specialists. For questions during the week, Call us at (512) 238-0762 or visit our website at armormenshealth.com. The Armor Men’s Health Hour is a show dedicated to providing information on a variety of medical topics, some of which may include sensitive subject material about penises. All cases discussed have been done with the permission of the people involved and their penises.
Speaker 2:
Welcome to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee.
Dr. Mistry:
Hello and welcome to Armor Men’s Health Hour. I’m Dr. Mistry, your host, here with my cohost, Donna Lee.
Donna Lee:
Hello everybody. Happy day.
Dr. Mistry:
Happy day. Donna Lee, as we continue this Corona quarantine, with limited office hours, limited patients in the office…
Donna Lee:
…and patients having patience.
Dr. Mistry:
…limited patients having patience. I am reminded of all the great things that I am blessed with in this world: a wonderful, thriving practice, wonderful people that work here, a loving family, and of course the ability to provide this show to a very appreciative audience.
Donna Lee:
I know everybody’s so nice and engaging. The questions we get are amazing. And I, this just gives me a glimpse of what you do every day. Cause I kind of didn’t really know. I just didn’t like you’re the doctor, you go in and out of rooms mysteriously, you make people happy and save their lives. But now when we get these questions I’m like, “Oh wow, these are really detailed and this is what Dr. Mistry answers all day long.”
Dr. Mistry:
Well, it’s been an absolute pleasure servicing the patients here in the Austin area since 2007. I am a board certified urologist. We started our practice initially called North Austin Urology if you’re a former patient, and then later transitioning to NAU Urology Specialists, a different name so that we could treat the South Austin/Dripping Springs market.
Donna Lee:
…and we’re gonna change it again, I think.
Dr. Mistry:
We might. If you’re a marketing person out there, you know how easy it is to change your brand. We bring you the Armor Men’s Health Hour as an opportunity to discuss men’s health issues in a really probing, insightful way. We love your questions, and we love for you to come visit us in the office as a patient. Donna Lee, why don’t you tell people about our practice?
Donna Lee:
That’s right. We want to see people again, we miss all the people and the faces, so. We’re still doing telemedicine, but we’d love to see you. Our number’s (512) 238-0762. Our website is armormenshealth.com, and easily enough you can send a question through that website or just go to armormenshealth@gmail.com. We’re in Round Rock, North Austin, South Austin, and super cute Dripping Springs.
Dr. Mistry:
Very nice. And if you do come to see us as a patient, if you’ve had a health condition that we think would be best suited by seeing us in person, we have limited numbers of patients that we have through our waiting room. We clean down the rooms between every patient. We use appropriate social distancing. And according to Texas medical board rules, we are both required to wear masks, although we had a patient today that was upset by the mask rule. He was very upset.
Dr. Mistry:
I can only tell you that it’s not up to us. This is the Texas medical board. Now, whether certain offices comply with that or not, that’s not our concern.
Donna Lee:
We choose to comply.
Dr. Mistry:
We want to stay you know, in the right mind with Texas medical board, even if some of their rules may not, you know, make complete sense to the patients.
Donna Lee:
Right. And the other patients I think are just, they feel comfortable when they see other people in masks. And we’re limiting people in the lobby. People are waiting in their cars or outside.
Dr. Mistry:
I’m not looking forward to when banks open their branch offices and we got to walk in with masks.
Donna Lee:
That’s so weird.
Dr. Mistry:
We’re going to get accosted.
Donna Lee:
I know. That’s so strange. I can’t imagine [inaudible]…
Dr. Mistry:
Well, we love your questions. Sometimes we get information from you guys, which you want us to comment on, like articles and things like that. I was just sent a wonderful article from a very good friend of ours…
Donna Lee:
Nice guy.
Dr. Mistry:
…a nice guy, and it was, it showed that there was an increased risk of dying from the Corona virus in men with low testosterone. And it was interesting is that I’m not going to make this a coronavirus talk, I’ll just talk about kind of the health effects and increased mortality for men with low testosterone in general. It has been proven that men with low testosterone have a higher incidence of prostate cancer, higher incidents of cognitive decline, a higher incidence of some forms of memory decline. Definitely an association with increased cardiovascular disease. Having a normal testosterone level certainly is something we think that men should strive to. In fact, if you have a testosterone level under the level of 150 in our clinic, regardless of whether you’re symptomatic or not, we will usually try to do something to get you above that value just for bone mineral density health. We try to ascribe to a low value of about 300. Of course doing it in a safe way that takes all your health considerations under wing. And then of course trying to find ways to for you to naturally boost your testosterone. So that was an interesting thing and we had a great question when it came to testosterone that I thought, you know, focused on a lot of these topics.
Donna Lee:
Right. Nice segue. Again, all your questions will remain anonymous and I’ll respond to the email to let you know to listen and we’ll send you the podcast link if you don’t tune in that day. Dr. Mystery: “Hey guys!” The subject is “Testosterone replacement and Leydig atrophy.” “Listening to your radio show and wanting to ask a question: I’ve been wary of using any kind of replacement therapy in the past due to cells that make testosterone not being used and atrophy, creating a scenario where either you have to be on supplemental testosterone for life or live with even lower testosterone if you stop the medication. Also curious about the effect on the sperm cells in men and the ability to produce kids if they take any external testosterone. Thank you.”
Dr. Mistry:
It’s a great question. You know the breadth of the question suggests that this is a younger man…
Donna Lee:
Oh 39.
Dr. Mistry:
…and what they’re really kind of curious about, and I’ll just start with first, that term, “Leydig cell atrophy.” Leydig cells are the particular cells in your testicles that are responsible for making testosterone. Sometimes, naturally, they can either be few in number like atrophy or they can be too many in number called hypertrophy, and you can actually get something called Leydig cell hyperplasia or even Leydig cell masses in which you hyper produce testosterone–it’s probably my problem. No, it’s not.
Donna Lee:
We’ve seen you on a sail boat.
Dr. Mistry:
Oh boy. If you’ve ever been diagnosed with a testosterone level that was super high, a Leydig cell hyperplasia condition could exist. What this particular questioner is asking me is specifically about what is the longterm impact that testosterone replacement can have on your body’s ability to naturally produce testosterone? And I would say this: that if you are taking testosterone, external testosterone through injection or cream or through pellets, and you’re taking them for a very long time, by very long time, I would generally say 7 years or longer, it could impair your ability or your body’s ability to begin naturally producing testosterone. But these things change depending on how old you are. The older you are and start testosterone, the less likely your body’s able to regenerate its own production value on its own. The younger you are, the more robust your body is at at rebounding. But it really belies the underlying question: Why are you taking testosterone in the first place? If you don’t feel great, if you’re not making enough, then, and if it makes you feel better, then you need to, you know, you would need to come up with a sound medical reason to stop it in the first place. If your energy is better, libido’s better, erections are better, muscle mass is better, you know, better cognitive function…I mean, this is why you’re taking it. So if your body’s not making enough, if your, you know, engine doesn’t have enough horsepower, then you know, then then adding a supercharger is something that’s worthwhile.
Donna Lee:
What a good analogy.
Dr. Mistry:
So if you’re trying just to figure out if testosterone is the problem, then we generally put men through a 12 week course of testosterone replacement. So that’s 12 weeks on a stable level that we think is sufficient to get an idea of whether this is helping you and you can easily overcome a 12 week treatment course. So don’t think to yourself that, man, if I go into that program and I try testosterone for a few weeks, that somehow is going to ruin you forever. That is not the case, you know, by any means for the vast, vast, vast majority of men, if they don’t have an atypical response to the medicines. I don’t think that trying to see if testosterone, if you were diagnosed with a low level or you have symptoms that are very, very consistent with low testosterone levels, that you should be concerned about longterm side effects, if you just go through a short course, something between 12 and 20 weeks. And I say 12 weeks because about half the patients that we see are complaining of erectile dysfunction. And the studies generally show it takes about 12 weeks to see if it makes an impact on erections. And who knows, maybe your wife won’t even let you touch her for once every 12 weeks.
Donna Lee:
Oh, that hits close to home.
Dr. Mistry:
So it probably helps to have a longer timeline to see if it impacts you.
Dr. Mistry:
And then the second part of the question had to do with sperm production. And that too, it is the case that when you take testosterone externally, the signals to produce sperm are reduced from your brain, and then ultimately sperm production is cut off or severely in most men who are on testosterone. So if you’re trying to retain your fertility but increase your testosterone, we find ways that use medications–prescription medicines–to naturally boost your body’s production of testosterone. And we use this technique frequently in men who come to us for infertility. We have a very robust infertility practice. If you are, you know, thinking about having a child and you want to get your fertility checked, it’s something that we do all the time, day in, day out. I think we do probably more advanced fertility procedures than virtually any other practice in town. And so this is, this is what we do. And so, but it will impact your sperm production. So if you’re on testosterone out there, you’re taking injections or creams and you think and somebody didn’t tell you that that will impact your sperm production and that matters to you, please come in so we can assess you and get you reversed and get you on the right track. Because it is a very disappointing thing for a man and his partner to learn that something that they’ve been using that they thought was helping them from a health standpoint was hurting some other aspect about that that was going to be important, like their fertility.
Donna Lee:
Right. How defeating and upsetting.
Dr. Mistry:
It is. And we deal with it every day here. People that got on some kind of treatment program, and you know, to no fault of the physician taking care of them…maybe you didn’t want to have kids at that time, maybe something changed in your, in your lifestyle plan.
Donna Lee:
You met a hotter girl?
Dr. Mistry:
Maybe you’re, maybe you’re 45, maybe you’re 45 years old and somebody decided that you probably weren’t trying to have more children. And so any number of reasons can result in patients being in that situation or predicament. And we’d love to get you out of it. If you’re interested in making an appointment or reaching out to us for a question, Donna Lee, why don’t you tell people how to get ahold of us?
Donna Lee:
I know the answer to that question. You can call us at (512) 238-0762 our email address is armormenshealth@gmail.com or you can go to the website armormenshealth.com. We will be right back after these messages.
:
The Armor Men’s Health Hour will be right back. If you have questions for Dr. Mistry, email him at armormenshealth@gmail.com.