Armor Men's Health Show

EP 681: Want to Feel Better, Look Better, and Sleep Better? Give T a Try Today!

Dr. Sandeep Mistry and Donna Lee

In this segment, Dr. Mistry and Donna Lee answer listener questions about the impact of testosterone supplements on prostate health. As Dr. Mistry explains, the off-label use of the lowest effective dose of testosterone will get you feeling better while minimizing any potential complications. Not only is the proper use of testosterone unlikely to cause any harm, but low levels of testosterone actually increase a man's risk of dying from prostate cancer. Fortunately, Dr. Mistry and his team at NAU Urology Specialists are experts in restoring sexual function. So if you or someone you love is interested in the benefits of hormone supplementation but wary of potential side effects, please give us a call or visit us online today!

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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Speaker 1:

<silence>

Speaker 2:

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

Speaker 3:

Hello and welcome to the Armor Men's Health Show. This is Dr. Mystery , your host, board certified urologist men's health specialist, joined by my wonderful co-host, Donna Lee. You

Speaker 4:

Forgot all around . Great guy <laugh>.

Speaker 3:

Maybe I don't feel it today. You

Speaker 4:

Don't feel it today, <laugh>. Well , it's true. Hi everybody, this is Don Lee. Oh, guess what? I have a monthly show at Cap City Comedy.

Speaker 3:

Wonderful. Tell us about it. So

Speaker 4:

If you're looking for something to do, check out cap city comedy.com . Visit the website and check out the calendar. My show is called Empty Gestures with Ruby Nicholas and Donna Lee. And she and I were both on the Nick at Night Show that I talked so freely about for 18 years.

Speaker 3:

<laugh> . Well, I'm so glad to hear that you're getting back into the standup comedy. I am , uh, as a , as a regular thing , uh, for our regular listeners, you may think that she's really the star of this show,

Speaker 4:

<laugh> and sometimes funny. Anyways, come see me.

Speaker 3:

So we are a men's health practice , uh, along with a , uh, incubator for , uh, future , uh, famous comedians. Woo . Uh , and we have a variety of topics that we do dealing with men's health issues. We have guests on our show. We love to answer your questions. Our practice is in central Texas. We have six urologists. We have six advanced practice providers, and we have a number of other type of providers that help to augment your care, including pelvic floor physical therapy, including nutrition, including sex therapy, including sleep medicine. And we have a health coach on board to help you with your diet and nutrition. Donna, how do people get ahold of us?

Speaker 4:

You can reach out to us right away at 5 1 2 2 3 8 0 7 6 2 or visit our website, armor men's health.com. If you're checking us out on YouTube through the Armor Men's Health Channel, we are so bougie that we record the show on an exam room table at the office. But I think people think sometimes we're in the studio, but we are sometimes in the studio. We're very flexible.

Speaker 3:

That's right. I mean, with modern technology, we can really do this anywhere. That's

Speaker 4:

Right. So if you visit our YouTube channel, sometimes you'll see us in a studio at KLBJ . Sometimes you'll see us on a card table or an exam room table. So

Speaker 3:

If you see us in a panel , this van in a , in a panel van <laugh>, then come save us.

Speaker 4:

If we're knocking, no. If we're rocking, don't come and knocking. I don't know . Anyway, we've got some really good questions. Let's do it. I have two questions from two different people, although maybe there's something floating out there for this discussion, but I thought you'd appreciate the question. I'm gonna tell you the two questions so you hear how similar they are . The first one, Dr . Mistry , do you have a podcast on testosterone replacement therapy and its effects on prostate cancer? And then we have this question. I'm a physician assistant. I have a patient with a history of prostate cancer. He's taking testosterone via injections. He is miserable off the testosterone. Is there ever a time you prescribed testosterone in a patient with prostate cancer?

Speaker 3:

These are all great questions. Uh , and I think that, you know, if I can just go back just a , a century ago to research that was done, that started this whole debate. Oh, that's right. So , uh, in the past when somebody had prostate cancer that had already metastasized to other parts of the body, we had very few treatment. Mm-Hmm . <affirmative> . But someone in our profession found that if you took the testicles off the patient Mm . And severely reduce the testosterone, that the cancer would slow down. Oh. And so it became a general belief Mm-Hmm. <affirmative> that testosterone feeds like food, prostate cancer. Hmm . And if you were to starve prostate cancer that it would die. Wow. Okay. But our feelings on this topic have evolved over time. So here's some , here's some truths. Truth bombs. If you have a really low testosterone, you have a higher chance of getting prostate cancer and the cancer's more aggressive. Okay. If you have cancer that it is responding to testosterone, it's a much better cancer than one that does not respond to testosterone. What does that mean? It's like being able to tame a dog with food once the dog doesn't eat your meat anymore. Now you gotta be really worried. Oh. Because it's gonna come after your neck. Oh. And so cancer aggressiveness in prostate is related to its sensitivity to testosterone. Okay. So I liken it to, if you're gonna think about the food analogy, more like a buffet. So just because you go to a buffet and there's all the food there, you don't eat everything. You eat till you're full and then you're done. And that's how cancer works. It likes testosterone. Mm-Hmm . Like it like sugar. But once , but once the level is over 50 and most test most the average testosterone is between three 50 and a thousand. Once the level's over 50, it doesn't care whether the level's 50 or 600. Oh. So if you're trying to really starve it, you gotta get below 50. Now, when you get the number below 50, now you're talking about bone mineral density loss, cardiovascular disease, fatigue, fatigue, loss of sex drive, all these things. And so we do testosterone treatment in my clinic, I, I prescribe testosterone to men with testosterone all the time. Mm-Hmm. <affirmative> because we want them to feel better. And in fact, there is data that suggests that even men with advanced prostate cancer might do better if you give them testosterone. Hmm . And the reason is these cells that live in the body, these cancer cells, they're not all the same. There are some that are stronger than others, and the strong ones will survive your radiation and your surgery and your chemo and your hormone therapy. And you're kind of cloning for them. You're, you're, you're selecting for the strongest mm-Hmm . <affirmative> to survive. But if you allow some of the weak ones to live, then they'll take up resources, not allow the bad ones to grow overgrow. And you kind of get a balance that's much more reliable. So it plays a role in several places in our clinic. So I have not seen an increased risk of te of prostate cancer in men with testosterone therapy. People ask that all the time. Mm-Hmm. <affirmative> certainly if they've been treated, I feel no qualms about giving them testosterone. And if they have a cancer that is clinically insignificant, meaning a very small amount of a non-dangerous cancer, I do not feel uncomfortable about putting them on testosterone because we're gonna be watching them closely. Hmm .

Speaker 4:

Okay.

Speaker 3:

Is it possible that some patients may respond in a way that we don't want? Certainly, but to banish all patients to a life of no sex drive, no energy, poor muscle mass. Mm-Hmm. <affirmative> for the one or two that we could have caught anyway, because we're watching them closely, I think is a shame. Hmm . And so that really just reflects our approach to medicine in general. So , uh, when it , if you look on the testosterone label, it's gonna say that patients with prostate cancer are contraindicated, but we do this in an off-label way and a well monitored way. Right. To make sure that your risk is not like high.

Speaker 4:

How often do the patients return for follow-ups and more testing if they have prostate cancer in their on TRT?

Speaker 3:

Generally we'll get a PSA every three months. Okay . And we really emphasize this concept in medicine called lowest effective dose, which means that we don't snow you with testosterone. We wanna understand what are you looking for? Is it better energy? Is it better sex drive? Is it better muscle mass? Mm-Hmm. <affirmative> . And then we make sure that the dose we're giving you is the effective dose to give you what you want. Mm-Hmm. <affirmative> and injections and pellets work really well in this, in this group, but we also use a variety of other ways that people get testosterone. We have pills, we have sublingual , uh, trophies, we have creams. Mm-Hmm . <affirmative> . We have autoinjectors. We have all sorts of different ways that can help kind of match your needs with your particular situation. But I think it's very reasonable. And I, I like to see men concerned that their doctor might be doing something that's harming them. I, I think that's important. Mm-Hmm. <affirmative> . But I wouldn't just assume that your two minute Google search is the end all and be all of what is a complicated research driven discussion on whether or not testosterone is something that is going to work for you symptomatically if you have a diagnosis of prostate cancer. Right. Because not all prostate cancers the same. Not all testosterone replacement programs are the same. But if you go to a doctor and we have some in our practice that are just adamantly against it. Adamantly against it, okay . And if your urologist is adamantly against it, then look for a second opinion. It's such an important part of what we believe here. This physician assistant is telling us his or her patient is miserable off testosterone, replace , it's their choice. If I tell you, sir, you have prostate cancer, my belief as a physician and my research into this topic, and my colleagues that research this aggressively believe that this therapy is unlikely to lead to any harm for you. Even though in the general press and media and conventional wisdom, there's some concern. If you are willing to take and understand that there's some uncertainty perhaps in this topic and want to feel better, then let's go for it. And that's what medicine and , and what we call shared decision making is all about. If you just put everybody in the same box and algorithm, then you're, you're not gonna get the same output every time because the , what you're putting into the, into the machine is different. People are different. People's needs are different. People's desires are different. Mm-Hmm. <affirmative> , if I treated every 72-year-old man in this practice the same, it would be a shame because some don't want to have sex and don't care about their physical fitness and have too many illnesses already. And others come in here that could bench press me. Mm-Hmm . And they could, and , and they , and they have sex every day and they're married to 42-year-old women and they're looking for getting, squeezing out the maximum in life. Mm-Hmm. <affirmative> . And that's really what it's about. You know, making sure that you find a practitioner and a practice that gives you what you want. And when it comes to testosterone and prostate cancer, there are some protocols that even give high doses of testosterone to advanced prostate cancer patients with success. That's called a Johns Hopkins , uh, high dose intermittent testosterone program. If you have a low testosterone, you're at risk for, for prostate cancer. If you are symptomatic from low testosterone and have cancer, then you need to find a doctor that is open-minded enough to properly titrate you. And I would say do that in the hands of a urologist. Right . That , that's the one advice that I would give this listener because

Speaker 4:

You sort of went to school for a few years.

Speaker 3:

Well , that's okay. <laugh> and primary care doctors are very smart and bright. Right . But I think that their comfort level with doing it in a prostate cancer patient may be lower. Sure. So, Donna, how do people get that second opinion and become our patient of ours?

Speaker 4:

You can reach out to Doctors Sunny second Opinion Mystery at 5 1 2 2 3 8 0 7 6 2 and visit our website, armor men's health.com and listen to our podcast. Wherever you pod

Speaker 2:

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.

Speaker 3:

This is Dr . Mystery host of the Armor Men's Health Show, joined by Donna. Hey Donna. Hey.

Speaker 4:

Oh, hi. You know

Speaker 3:

What? I love

Speaker 4:

Doing the show with me

Speaker 3:

Making people pee better.

Speaker 4:

Oh , there's that too.

Speaker 3:

We love to make America pee again. And you know that a lot of men out there can't pee. Right.

Speaker 4:

What

Speaker 3:

I know. And we like to help them pee better. Mm .

Speaker 4:

Mapa

Speaker 3:

How are people gonna get to us if they want to pee better ?

Speaker 4:

They call us at (512) 238-0762 or visit our website, armor Mens Health .