EP 666: Surgery Showdown: Dr. Mistry Weighs In on the iTind vs. TURP Debate for the Treatment for Enlarged Prostate

In this segment, Dr. Mistry and Donna Lee answer a patient who wonders which is best for the treatment of his enlarged prostate: the TURP or the iTind procedure. The iTind is a revolutionary new non-permanent implant that gently reshapes the prostate to help relieve urinary symptoms without the dreaded side effects of prostate surgeries. The implant is placed without anesthesia and removed after several days. The TURP procedure, or the TransUrethral Resection of the Prostate, is another option for treating urinary symptoms. Tune in to learn which procedure may be right for you! To learn more, call to schedule your consultation or visit us online!

Voted top Men's Health Podcast, Sex Therapy Podcast, and Prostate Cancer Podcast by FeedSpot

Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.

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Phone: (512) 238-0762

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Transcript

Speaker 1: 0:00

<silence>

Speaker 2: 0:07

Welcome to the Armor Men's Health Show with Dr. Mystery and Donna Lee.

Speaker 3: 0:15

Hello and welcome to the Armor Men's Health Show. I'm Dr. Mystery , your host joined as always, with my wonderful co-host, Donnel Lee . Hello,

Speaker 4: 0:23

Everybody. Welcome to the show. Ooh , I sound good. I sound sexy today.

Speaker 3: 0:26

You do sound good. <laugh> a little cold, huh? <laugh> <laugh> . This is a men's health show. Uh, we talk about everything from the nipples to the knees. I'm a board certified urologist. We talk about a lot of urologic issues like how people pee and erectile dysfunction, and a number of different topics that you would consider your urologic. But , uh, our practice is really focused on making you better. So we often give you advice on topics that you may not think are urologic in nature. You know, back pain that's not due to stones or giving you recommendations for great gastroenterologists or, or great orthopedic surgeons. We handle sleep medicine here. Hormones are a big part of what a urologist does, and hormonal health is very important in making you feel your best. Uh, and we do a lot of hormones both for men and for women. Uh, we love your questions, and it's so important to us that , uh, you take advantage of everything that we have to offer here. Mm-Hmm . <affirmative> , even though it may be just broader than what you would think from a urologist.

Speaker 4: 1:21

That's right. We do have some questions about , um, how we can become their PCPs <laugh> , but I was

Speaker 3: 1:27

Like, Hmm . Right. Maybe not. The interesting thing is, is that , uh, as a urologist , um, we are surgeons, and so we spend all of our time in training just trying to get in the operating room. Right. It's like when you're 16, just trying to get in somebody's pants and then when you, when

Speaker 4: 1:40

Is that the analogy you're gonna use

Speaker 3: 1:41

Today? Yeah . And then when you're married, <laugh> , you spend so little time in the operating room, if you know what I mean. Oh,

Speaker 4: 1:46

Okay. <laugh> . Oh boy.

Speaker 3: 1:48

I should have learned how to clean dishes and do laundry, because those are skills that really come more in handy now that I'm a practicing urologist. That's right. Uh, Donna, if people wanna become our patient, how do they do that? And , uh, how do they get ahold of us and how do they ask us questions and how do they become part of our family?

Speaker 4: 2:02

First of all, if you find us on YouTube someday , you'll know that we are a janky setup over here. So there's that. Oh , you can reach out to us at (512) 238-0762. That's our phone number, Monday through Friday. And you can visit our website, armor men's health.com, visit , listen to our podcast wherever you check out free podcasts, and send your questions to armor men's health.com. There's a little button at the top right, Dr . Mystery , that says, submit your question here and we'll answer them anonymously. I have a question or two. Let's do it. All right . This gentleman is a young 80 years old, and he sent this in the other day, and I love him so much. He said, TUIP versus I tend , I think your audience would be interested. My urologist recommends TUIP. What does that stand for?

Speaker 3: 2:45

Transurethral incision of the prostate. What's

Speaker 4: 2:48

The difference with the terp then ? TURP .

Speaker 3: 2:50

We'll talk about it. Okay. Finish your question,

Speaker 4: 2:51

Lady. I'm sorry. He hadn't heard of itin , his urologist. I'm 80 years old, sexually active. Hey , in good health, been taking Finasteride Tamsulosin for decades. No side effects, aside from retrograde, which we know all about, which doesn't bother me. Recently went to a urologist for urgency. He said, based on PVR, around 200 ccs. I need a procedure. Recently switched to a fussin and my symptoms improved and libido increased. He put in parentheses, dear Lord, he's an active 80-year-old. I love it. After T-R-T-R-U-S cystoscopy and discussion, he said, one, my prostate is , uh, like the little tilde sign, 25, CC two, no median lobe. And three, I'm okay for now, if and when I do need a procedure, what are the advantages of I 10 versus TUIP?

Speaker 3: 3:39

So there's so much packed into this question. Uh , first of all, let's talk about an 80-year-old sexually active man. Yes, sir. And , uh, good job. For those of you that are regular listeners to the show, there is no patient that I love more than the 80-year-old who's surprised that he, his erections aren't as strong and is trying to get his groove back. Right. So there is no age limit in our clinic about when you're allowed to be sexually active. Now, what is different about what we do is our goals of treatment and our goals of evaluation are different when you're much younger. So if you come in and you are 35 years old and have erectile dysfunction, I really, really, really wanna find out why. Yeah. When you're 80, I'm more concerned about making sure that you're functioning well, because age related issues and vascular neurologic issues are just so like prominent , uh, and prevalent in this, in this age group. Mm-Hmm. <affirmative> that really just finding the right solution for you that doesn't cause side effects is probably a bigger goal of mine. But that notwithstanding, he, so he was on several medicines, tamsulosin, Finasteride, and then lf Osis and Tamsulosin and Alosi are similar medicines. Okay. The fussin we give to men who are trying not to have retrograde, which is when you orgasm not as much fluid comes out. Love it. Now, what's different about not a lot of fluid coming out, and this is important for the, this terp , this TUIP itin discussion, that that's why I'm going through it. There's a difference between not having a good orgasm Mm-Hmm. <affirmative> , which is called hypo orgasm, and not having fluid come out of you. And a lot of men, they feel like when the fluid comes out, that's what makes them feel good.

Speaker 4: 5:08

Is it psychological?

Speaker 3: 5:10

And it's not. It , it is part of it's psychological in my experience, and of course not all men are the same. There are drugs that we can give you. One of them is called CID doin , which is similar to fussin , which is similar to tamsulosin. Mm-Hmm. <affirmative> , those three alpha blockers. Okay . The CID doin actually cause you to have hypo orgasm, which means it's not, it doesn't feel as good to orgasm. Forget about the fluid coming out. It doesn't feel as

Speaker 4: 5:32

Good. Oh, you said hypo not hyper

Speaker 3: 5:33

Hypo. Hypo hypo. We have drugs for hyper orgasm, but those, you know, are different. <laugh> , uh, and <laugh> , those

Speaker 4: 5:40

Are the

Speaker 3: 5:41

Opposite. That's the opposite. And so , um, the drugs that he's on, if he switched a drug and it made his libido better, it's only because now he could see the show. Oh,

Speaker 4: 5:50

That's right.

Speaker 3: 5:51

Okay. Because it really shouldn't affect your libido. Now, the drug that will affect your libido is finasteride . And if you're a patient of mine, you'll know that I almost rarely have ever never used Finasteride, because I don't like the potential effects. And if you're out there and you're 35 years old and you're suffering hair loss, and you went on to a website and some doctor online prescribed you finasteride, that's coming in the mail, don't take it. Don't, don't be surprised. I mean, you should know the number of men that are surprised that they're hypo orgasmic or, you know, have no libido is very

Speaker 4: 6:19

High. You know why? 'cause that's bad for marketing. That's

Speaker 3: 6:21

Right. <laugh> . That would be , that's right. You want hair, but you don't wanna have sex. You're gonna have great hair. Why have hair in the first place? Except for attacked women. Right .

Speaker 4: 6:28

The Oh , attack women.

Speaker 3: 6:30

Attract women. Oh,

Speaker 4: 6:31

Attack . I thought you said attack . No, I was like, wow. E <laugh> .

Speaker 3: 6:34

They're not gonna get in my van if I don't have hair <laugh> . So then we talk about prostate procedure . So this particular patient has a small prostate, which is under 30 grams. Mm-Hmm. <affirmative> . And that's why he's being offered one of these two solutions. I tend , or TIP mm-Hmm. <affirmative> . There are so few doctors doing, I tend that I might be, I I was the first in Austin in central Texas, and I still may be the only in Austin, central Texas. That's right . And it's because it's not covered by insurance. And

Speaker 4: 7:02

Surgical facilities

Speaker 3: 7:03

Don't have it. That's , and , and , and , and , and the , and the hospitals don't wanna buy it. Yeah. So it's , it's not easy to do. But the difference between an I tin and A-T-U-I-P is in the end, what's happening to the prostate is essentially the same. Okay. There are three grooves getting cut into the prostate at 12 o'clock, at five o'clock and seven o'clock. Literal

Speaker 4: 7:22

Grooves,

Speaker 3: 7:23

Grooves, grooves. Okay. And these grooves allow the urine to flow out better. It's like, you know, cutting part of a cave open Okay. In three different positions. Okay. In the, I tend , it's a metal, like a stent, right. Which pushes into the prostate and causes these grooves. And then the stent is removed after

Speaker 4: 7:42

A few days . A week later.

Speaker 3: 7:43

Yeah . Oh , okay . A week later. So there's no foreign body in you. The most important benefit of the eye tend is it rarely causes, if ever retrograde. So especially in this particular individual who's very concerned, which I think that just seeing the show is making him have a better libido, the eye tend is better. It , this particular listener, his urologist, despite retaining 200 milliliters of urine in his bladder, said, don't do anything right now, which is not the advice that I would give you. Oh . When you're 80 and you're retaining that kind of fluid, you're at a much higher chance of getting a urinary tract infection. And I don't care how sexually active you are, when you're 80, 85 years old, you get a bad urinary tract infection, you're gonna crump and you're gonna be in the hospital. Oh . So my job is to keep you outta the hospital. That's what I , that's what I really wanna do. I see. So I would be more urgently trying to encourage you to have some type of procedure. Okay. The I tend doesn't last as long as another procedure, but maybe at 80 you don't care. But a sexually active 80, he's probably gonna be around for 20 years. So I'm assuming a lot about this particular individual because he's trying to have sex right now . Maybe he's not, maybe he's just trying to make himself sound good on the radio.

Speaker 4: 8:45

Maybe he's just showing

Speaker 3: 8:46

Off. Yeah. Maybe just showing off <laugh> . But then, but then, but then there's the TUIP and I do a lot of tu UIPs. It is, it is my preferred procedure for small prostates. Okay. It takes me 15 minutes in the operating room. I make those grooves just like you would in my practice, in my hands. You keep a catheter for three days, but you go home that day. Okay. Most urologists are more aggressive. You go home that day and you keep a catheter for one night or zero days. Mm . That may sound like, I'm mean, but I have very few complications. I have, you know, like I , I feel like my very overly conservative approach of keeping the Catherine longer keeps people outta the emergency room, which is my goal. And

Speaker 4: 9:22

You like to keep your patients around hot nurses.

Speaker 3: 9:24

I do like , anyway, the home health nurses that we send , uh, you know, to take that catheter out, no complaints yet. <laugh> . So , um, but that, that's how I'm different than others. Uh , but if you're offered A-T-U-I-P, you're gonna get essentially the same defect as a , as an IT tend in the prostate. Mm-Hmm . <affirmative> , it's gonna help you pee better. I think it probably works a little bit better than the, it tend , I think the, IT tend is a little bit more of a gimmick right now, uhoh , which proves

Speaker 4: 9:48

Won't tell the IT tend rep that well,

Speaker 3: 9:49

Until they come back <laugh> , they need to sponsor a show maybe. Um , and , and we have had them on the show, and I have done about five of them. Yeah. Again, the highest number of its in central Texas. Right. Um, but the , the process is not as smooth , uh, as people would like it to think. And there are many other similar products coming on the market in the next two or three years. Okay . So I think, I think this is gonna get better, but everyone is trying to do the least possible to the prostate when we've had the perfect solution around for the 50 years. The TUIP has been around so long. Mm-Hmm . <affirmative> , it works so well. It takes so little time and it's so effective. Right. And about 85% of men still have an antegrade Mm-Hmm . <affirmative> after the TUIP fewer in my hands because I make a little bit bigger of a defect. But , um, but if you're, if you're really concerned about your integrated , I, I can do that surgery and modify it in a way to keep your, an your , your , you know, so that you still have your show. Uh , Donna, how do people get ahold of us?

Speaker 4: 10:43

Um , you can visit our website, armor men's health.com.

Speaker 3: 10:45

Hello and welcome back to the Arm Men's Health Show. I'm Dr. Mystery , your host, board certified urologist men's health expert. Uh, joined by my co-host Donnelly. Hello.

Speaker 4: 10:54

Add producer to my title, please. There . Look at all these buttons.

Speaker 3: 10:57

We are so fortunate , uh, to be able to give you this show , uh, thanks to our friends on the radio. Mm-Hmm . <affirmative> , uh, as well as to our efforts , uh, to make the podcast. We love being able to present this show to the listeners of Central Texas who listen to us on Saturdays in their car while they're driving their kids from place to place. Or the farmers out there that always come in and tell us that they're , they hear us on the, you know, in their trucks as they're driving on the farm. So, right. So we talk about the same thing over and over again, because you never know when somebody's gonna be like, you know, in their car. That's true. Um , and then ,

Speaker 4: 11:27

And then my , my sister-in-Law, who is , uh, a Democrat, she listens to KLBJ for some reason, <laugh> , and I know that's more of a conservative radio station, but she heard us the other day on the radio on a Sunday .

Speaker 3: 11:36

Liberals, like nothing more than just to get enraged , uh,

Speaker 4: 11:39

At the prostate problem. <laugh> .

Speaker 3: 11:43

So I get it. It's good. Um, so our , uh, our practice is in central Texas. Uh, we have patients that come to us from all over the country for a number of different procedures that we are unique to offer. One of the things that we offer is high intensity focused ultrasound , uh, or high food treatment for prostate cancer. This is a relatively minimally invasive way of treating prostate cancer for those with low grade disease that are trying to avoid surgery or radiation. We do a number of things for , uh, sperm extraction and fertility that can sometimes be a little more unique , uh, in our practice, including electro, which we offer to men who are unable to orgasm. Uh , sounds like

Speaker 4: 12:17

A sex toy gone wrong. It ,

Speaker 3: 12:19

It , it's a tremendous toy. Hmm . Uh, and especially , uh, used in spinal cord injury patients. Uh, we have a particular interest in patients with neurologic diseases like multiple sclerosis and Parkinson's when it comes to atypical urinary issues. Really try to, you know, personalize the treatments that we have for your underlying medical problems. Which sounds like everybody should do that.

Speaker 4: 12:39

You would think

Speaker 3: 12:40

So. You would think so. Yeah. But truth is, is that so much of medicine is treated as cookie cutter. And as we move more and more to towards physicians not providing the primary care Mm-Hmm. <affirmative> , you're gonna find more what we call algorithmic care. Mm-Hmm. <affirmative> , you have a cough, you need a chest x-ray, you should be put on nebulizers, yada, yada, yada. As opposed to you have a cough, maybe it's allergies from the cat, find out. Or maybe it's from your lisinopril. Maybe it's this, maybe it's that. So, you know, that's the difference. But because of the shortage of physicians Mm-Hmm. <affirmative> because of an aging population, we need, you know, help from mid-level providers. We have a ton of mid-level providers. They're amazing. And , and how we, and how we use them is very effectively to initiate plans that the physicians have come up with. Mm-Hmm. <affirmative> . And we spend a lot of time training them. Were you up to three hours a week? I spend with my, you know, PAs and my nurse practitioners, and in many places they never even see the doctor. Right. And so, you know, I treat them more like residents or students. And I constantly, constantly kind of look at their cases, make sure they're doing the right thing, answer their questions, and that's what makes them excellent. Excellent. Leonor Brown, one of our , uh, nurse practitioners is, is probably functioning, you know, at or better than most practicing urologists, you know, well ,

Speaker 4: 13:52

Patients would rather see her sometimes than here . She's effective

Speaker 3: 13:54

<laugh> and they wanna see her because her fingers are smaller. I think that's right . So I can't get a finger shrinking surgery. That's true. Uh , Donna, how do people become our patient ? Well,

Speaker 4: 14:01

You call us at (512) 238-0762. And you can visit our website, armor mens health.com , where you can submit your questions. We have questions exactly on this exact topic. I'm so excited. Let's do it. So we have two back to backs . So I'm gonna read 'em really quick, but they're both kind of similar. This one came in a couple of weeks ago. I haven't heard, I've heard your radio show. And I'm checking to see if you're available as my primary care physician. In addition to being my urologist, I'm currently on medication to manage blood pressure, cholesterol, and heart health. I'm also seeking a new PCP, which is why he sent that. So that particular question goes along with this next question we got just a few days ago. Dr . Mystery , I love the show. I have , um, a ton of concerns and questions to ask. I have low energy. I get very emotional when listening to customers about their problems. Like my eyes get watery, almost crying. I'm 45 years old, I should lose, he said. And I'm trying about 30, 35 pounds over the next four to six months. Currently . Currently I'm around 260 pounds. I always say six foot, but my wife says I'm five 11 <laugh>. With that small information about myself, my main concern is my. I can't send it <laugh> , you wait for this next one. I can't , I didn't see that twist coming. I can't send it flying over my, he my wife's head to the wall anymore. The semen only gets in my hand. No pressure. And I am turned on and very happy with my wife. Should I visit a doctor with a bunch of question marks? I'm currently living in Louisiana, is that too far to become a patient of your practice? And he said, thanks for your time and the service with the podcast. Well, that's

Speaker 3: 15:24

Wonderful. So love you. So first of all, this primary care medicine. Yeah . So we do in our practice a lot more primary care medicine than I think a lot of urologists agreed . So, you know, we definitely put people on cholesterol medicines. If you come in with high blood pressure and you're 45 and you're trying to have a baby, you know, those are gonna be the main patients that I'm gonna take over their primary care. They're not gonna go see one. I need to make them healthy so they can have a baby. But if you're gonna have long-term care needs, then the primary care doctor, they keep better track of the things you need, you know? Right . And they , and

Speaker 4: 15:54

Your insurance might dictate you have to see a primary

Speaker 3: 15:56

Care , maybe, maybe especially if you have an HMO . Yep . Now, what you can have with us is referrals and recommendations. So we know which primary care doctors out there, especially in central Texas, are the best. Right. And we can get you in because we'll call them and say, Hey, get this person in <laugh>. So, you know, you know, and , and that's true of orthopedic surgeons. You know, people come to us all the time and they're like, well, I'm gonna get my knee done and I'm gonna go to this doctor. I'm like, no, no, no. We're gonna send you somewhere else. Yeah. And that may sound presumptuous, but I mean, you're a patient of mine, like, I'm gonna take care of you. Right . I'm gonna make sure that you have the right doctor. When it comes to ENTs, when it comes to cardiac people, like we're gonna send you to people that we think are, are exceptionally good, thoughtful, caring, personalized doctors. Mm-Hmm. <affirmative> when it comes to this other patient, you know, why is he orgasming outside of his wife? First of all,

Speaker 4: 16:43

Over her head.

Speaker 3: 16:44

Over her

Speaker 4: 16:44

Head. That's back in the day. My goodness. Now he just kind of in his hand. Mm-Hmm .

Speaker 3: 16:48

<affirmative> . Uh , so anyway, as you get older, there's both decreased volume. Mm-Hmm. <affirmative> that's created by the prostate and the coordination of the muscles that give you that, you know , is

Speaker 4: 16:57

That how you have sex? I saw you moving . Like you're

Speaker 3: 16:59

On a bike . Yeah . You're moving . No, I I I was, I was mimicking the bubble chanos muscle, which squeezes right at the base of the penis that Okay . And gets that out of you. Mm . So if you have poor pelvic floor contractions Mm-Hmm. <affirmative> , you are not gonna get it out. It's just gonna ze out.

Speaker 4: 17:14

Oh. Into his hand. Well, that's what he meant. Yeah .

Speaker 3: 17:16

So, so if that's happening, then , uh, treatment with a pelvic floor physical therapist can certainly help. Okay. If it's your volume, and we can test that with a semen analysis. If we , you're not just making, if you're not making enough, then we have a number of things that can help. So , uh, anecdotally I'll tell you that , uh, a medicine called HCG, which is one of the ways that we increase testosterone in our clinic, we've seen that disproportionately improve volume. So, you know, that helps people orgasm, I think better and have more , uh, clomophine testosterone replacement. These are the kinds of things that we can do hormonally Mm-Hmm . <affirmative> to help make more. Mm . If this 45-year-old is on Tamsulosin or any alpha blocker prostate medicine, then that will also kind of reduce the volume. And that could be a potential , um, a competing issue. That's

Speaker 4: 18:02

What I slip in my husband's coffee. He doesn't need the medication. I just <laugh> .

Speaker 3: 18:07

I just don't wanna mess. That's right. No more wet spot. I'm tired of cleaning. I'm tired of cleaning up <laugh> . So , um, then comes the other issue about this, the person, which is that he's really heavy. Mm-Hmm. <affirmative> . So at two 60, it's gonna cause pelvic floor issues, it's gonna cause prostate issues. It's gonna increase your risk of cancer. And of course , uh, potentially make it so that he's not either feeling the orgasm as , um, uh, as well Mm-Hmm. <affirmative> and will be contributing to his , uh, overall libido and his volume. Gotcha. So that's another thing. And, and mainly for patients that are in Texas or in central Texas , uh, we do lots of weight loss , uh, in our practice. We have a health coach named Holly Spear . She's gonna work on your diet. Mm-Hmm. <affirmative> , we do medications, whether they be , um, you know, Topamax or

Speaker 4: 18:50

Semaglutide.

Speaker 3: 18:50

Well, phentermine are gonna be how we started. Mm-Hmm. <affirmative> . And then , uh, glide and o other other medications, you may feel like they're too expensive, but we can find ways to help you get, you know, similar the same medications at a cheaper rate. Okay . And , and we don't charge a lot. We don't, you know, you just kind of, you know, your insurance and you just kind of pay a little cash price. And I think there are many men out there that would be willing to spend, you know, 500 to $700 a month. But there's certainly even a lot more men that would be willing to spend two or $300 a month. And that's about what it's gonna cost. Mm-Hmm. <affirmative> to get on these medicines and, and lose weight, you would like to do it in a safe, monitored way. Right . A lot of these companies are gonna start offering like online people again, that, you know, and , and that's fine. The internet is a wonderful place to, you know, order pies and get your stuff from your Amazon you shopping. But I'm not , I'm not so certain that the internet is the perfect place to get your medical care <laugh>. And so <laugh> , you know, because it , that's more about convenience, right . And honestly, going to the doctor should be a little inconvenient. Mm-Hmm . <affirmative> .

Speaker 4: 19:49

Good

Speaker 3: 19:49

Point. If you want excellent service, if you want somebody who studied for , I don't know, 25 years Mm-Hmm . <affirmative> to be able to take care of your dingleberry. Mm-Hmm . <affirmative>

Speaker 4: 19:59

<laugh> .

Speaker 3: 20:01

Maybe it's okay to wait in the waiting room for a little bit and maybe it's okay to wait for, you know what I'm saying? I mean, this is, this is not, I mean, I didn't just read it off a cereal box.

Speaker 4: 20:09

I'm gonna play this clip over and over on the on hold message <laugh>

Speaker 3: 20:12

For patients . <laugh> . Yeah, that's right. Love it. It's worth it to see a good doctor, you know, and it will change your life and keep you living longer. Mm-Hmm. <affirmative> . And so we would encourage you to make sure that you find your doctor and for this patient in Louisiana, I'm afraid I'm gonna have to see you in Texas. My license is not extended Louisiana <laugh> . But , but you know, finding a great doctor that takes care of these individual issues , uh, and even bringing up the topics that I brought up with you , uh, on the radio here as an answer. Uh, you know, things that you can take to a urologist and many of them will listen to it. Uh, and of course I'd be happy to talk to anybody on the phone. Mm-Hmm. <affirmative> Donna, how to be become patients of

Speaker 4: 20:46

Ours. You call us right away at (512) 238-0762 Monday through Friday. You can even ask for me, our website is armor mens health.com where you can submit your questions just like this one. We'll answer it anonymously on this show. And if you reach out to me by email, again, I can send you the link and listen to our podcast wherever you listen to your podcast. And , uh, we're award-winning. Dr. Thank you so much.

Speaker 2: 21:10

The Armor Men's Health Show is brought to you by NAU Urology Specialist. For questions or to schedule an appointment, please call 5 1 2 2 3 8 0 7 6 2 or online at armor men's health.com.