Vital Visions: The Vedala Brothers Podcast

4: Men's Health

August 10, 2023 Norman Regional Health System Season 1 Episode 4
Vital Visions: The Vedala Brothers Podcast
4: Men's Health
Show Notes Transcript

The Vedalas welcome Dr. Alex Jones to the podcast! Dr. Jones sits down with the doctors to talk about a few important pillars of men's health.  Dr. Jones, a Urologist with Norman Urology Associates, talks to the Vedalas about testosterone replacement therapy, kidney stones, signs to look for when examining for prostate cancer and more. Send this episode to all the men in your life for extremely helpful and good-to-know information from Dr. Jones.

Guest Bio:
Alexander Jones, MD is a board certified urologist originally from Edmond, Oklahoma. He attended Oklahoma State University where he graduated with a bachelor’s of science in physiology in 2010. Following his undergraduate years at OSU, he attended the University of Oklahoma College Of Medicine. Dr. Jones completed his general surgery internship and residency in urologic surgery at the University of Missouri - Columbia in 2019. While in training, he received extensive training using the da Vinci robot for procedures treating prostate cancer, kidney cancer, and pelvic reconstruction.

Urologist Dr. Alex Jones is passionate about utilizing the latest surgical technology to treat patients. He specializes in minimally invasive robotic surgery for pelvic floor dysfunction and kidney and prostate cancer. He also offers surgical treatment of benign prostatic hyperplasia (BPH), erectile dysfunction, and kidney stones.

Dr. Jones chose to work in the field of urology because of the great opportunity it provides to positively affect a patient’s quality of life. It also gives him the privilege of truly getting to know them over a long period of time. Dr. Jones is dedicated to providing patients with the most up-to-date, evidence based medical care to empower them to make the best treatment decisions.

Dr. Jones and his wife, Blair, have a daughter and two dogs. In his free time he enjoys spending time with family and friends, running, traveling and going to the lake.

Links:
Alexander Jones, MD
Norman Urology Associates
Blog - Norman Urology Associates Treats Any Type of Kidney Stone

This podcast is for educational purposes only. The information in this show is not to be used as medical advice. If you are needing medical care, please consult with your physician.

Norman Regional is hiring! See all our open opportunities here:
https://careers.normanregional.com/careers-home/

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Welcome, friends.

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This is Drs. Krishna and Veer Vedala.

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And we are the Vedala Bros.

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We are delighted to bring you our brand new podcast, Vital Visions.

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So in this podcast, we'll be discussing important medical topics

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that affect your community.

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We'll be looking into medical research Health and wellness tips

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and also available health

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care resources brought to you by the Norman Regional Health System.

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That's right.

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And in each episode, we'll also be joined by medical professionals,

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local community leaders and even some of our friendly neighbors

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as we talk through various issues that are affecting our community.

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So if you want to lead healthy lives or learn about the new healthy trends,

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we want this podcast to be your go to resource.

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Welcome back, folks.

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We are the Vedala Brothers.

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And we're back with another episode of Vital Visions,

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where we talk about all things vital, empowering our community.

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One health topic at a time.

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And today we're going to talk about men's health.

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And so the first thing is, is, well, what exactly is men's health?

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So with men's health, you know, your concerned about

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identifying, preventing and treating conditions

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that are most common or more specific to men,

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and this is encompassing

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all kinds of forms of health, not just, you know, about testosterone

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or cardiac, but also looking at mental health, well-being.

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Um, on average, you know, men tend to live approximately about 4 to 5 years

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less than females.

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And so why....and then the question is, why is that? And,

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you know, there's a lot of speculation about it, a lot of different reasons.

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Um, but really it comes down to behaviors and biology.

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For example, men tend to be more

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risk takers, you know, whether that is alcohol,

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cigarette smoking or also, you know, getting into fights or MBAs.

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Um, and then the other notion is that uh, has something to do with the hormones,

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and there's some studies that have shown that high

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levels of testosterone seem to actually reduce your immune system.

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And of course, uh, you know, whereas estrogen on the other hand,

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the more predominant hormone found in women seems to be the opposite.

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It seems to have increased immune immunity and immune protection.

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Um, you know, bottom line is there's many different factors.

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Uh, but one of the primary reasons behind this is this discrepancy could be that,

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um, men are assumed to be less forthcoming and also, um, uh,

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less and more and more hesitant in terms of seeking attention to their problems.

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Yeah, I agree.

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Krishna, I think it's, it's not a secret

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that men may not be as inclined to seek out health care,

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whether it be due to traditional norms of masculinity

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or because of masculinity or due to lack of access or resources

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that specifically target men and their needs.

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So it's our job as primary care physicians to keep

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those lines of communication open and provide support for our male patients.

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So the next time a patient comes in with chief complaint of,

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Yeah, my wife made me come in today, there are some important basic topics

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that I think all primary care providers should be aware of, such as testicular

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or prostate cancer, erectile dysfunction,

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screening for abdominal aortic aneurysm, like we've mentioned

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in one of our previous episodes,

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and even things like, you know, BPH benign prostatic hyperplasia.

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Yeah.

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And to discuss

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all of those topics with us today is our urologist extraordinaire, Dr.

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Alexander Jones.

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Dr. Jones, thank you so much for being here, sir.

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Yeah, thanks for having me. If you wouldn't mind introducing yourself.

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Yeah. I'm Alex Jones.

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I'm with Norman Urology Associates here in Norman.

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Grew up in Oklahoma.

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I went to Oklahoma State University for undergraduate and

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University of Oklahoma Health Science Center for Medical School,

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and then went up to, uh, mid-Missouri to University of Missouri and Columbia

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to do my urological surgery residency and then moved back to Oklahoma

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with my wife and be closer to family and,

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uh, have lived in Norman since 2019.

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It's amazing.

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We just found out that Dr. Jones and all of us went to same high school.

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Yeah, we grew up literally within a mile of each other.

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Yeah, exactly. Go BullDogs! Yeah, that's. Right.

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And I don't ever remember seeing you in high school or your neighborhood, so.

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You had Coach Walker too though? Yes, Coach Walker Well, we.

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yeah, yeah. That's right. That's right.

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I know, go bulldogs, go bulldogs.

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Um, so, Dr.

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Jones, what do

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you think are some important points when it comes to men's health? Yes.

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I think you'll hit on a lot of them.

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Um, I think men are more likely to kind of engage in risky behavior,

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also not seek out care for problems and tend to kind of

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sweep their problems underneath the rug.

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They're more likely to engage in smoking, excessive drinking

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and really just, you know, maybe not taking care of themselves as much as

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women are.

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And then men, you know, are are are prone

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to cardiovascular disease, stroke,

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depression,

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and may not seek out care for those issues.

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But a lot of those issues can be changed with lifestyle changes, whether that's

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engaging in regular exercise every week, both,

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you know, weight bearing exercise and aerobic exercise and also

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proper diet and, you know, moderate alcohol intake, if any.

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And then not smoking.

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I think those are really

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a lot of the big issues and those kind of really

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are the root causes of a lot of issues

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and then experiences they get older.

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Yeah, thank you, doctor and those are really great info and tidbits.

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Um, there's actually one topic in specific

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that Krishna and

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I wanted to discuss with you just because we see a lot more in our practice now.

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Um, and it goes with testosterone therapy, right?

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And so we were wondering if you could just give us a little insight into what

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the indications of being treated with testosterone are.

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Sure.

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So, um, so the American Urologic Association

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has guidelines for testosterone deficiency is what we call it.

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So that generally involves two lab values.

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So it's an early morning testosterone and they list a cut off of less than 300.

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That's debatable. But

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with the

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signs and symptoms

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of testosterone deficiency and there's a myriad of those symptoms,

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and that can be kind of divided into nonsexual and sexual side effects.

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So sexual side effects can be decreased libido, erectile dysfunction, men

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not responding to certain medications for erectile dysfunction,

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things like Viagra, cialis and then nonsexual,

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which can be weight gain, irritability, mood symptoms, depression,

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decreased muscle mass, decreased

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strength, decreased attention.

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But really, you know, low testosterone, those symptoms are very nonspecific.

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There's a lot of other medical issues, as you all are well aware of that

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can cause these

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that can causes these symptoms.

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But men who might be a good candidate

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for testosterone replacement therapy are those men that have a lab value

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that shows low testosterone plus the signs and symptoms.

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There's also other medical issues that

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people that have medical

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issues such as HIV, diabetes, chronic corticosteroid use,

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men that have had testicular cancer and receive radiation.

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Those men should be screened for low testosterone.

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That's a certain patient population that are at risk of low testosterone.

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Also, men that have unexplained anemia.

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Um, just because you kind of take advantage of a side

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effect of testosterone replacement therapy there.

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So but really, I really want to drive home

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that men that should be treated or that have a lab value that's low

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plus they're experiencing those signs and symptoms of testosterone

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without both of those

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treatment may not be appropriate. Yeah.

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So you kind of touched on this maybe in your previous your previous answer,

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but what are some side effects of inappropriate testosterone use?

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Yeah.

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So we see quite a bit of that in the urology clinic.

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So I've seen men come in that or were unaware

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that testosterone can shut down a man's sperm production.

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Generally that's reversible if you stop it.

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Sometimes, though,

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if they've been on it for several years, it's not reversible.

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I've also seen men you can get testicular atrophy or, you know,

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decreased sizes of testicles with chronic use.

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Also, when you're replacing testosterone, it can increase

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the number of red blood cells circulating.

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So something called polycythemia.

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So that's something that we kind of monitor

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when somebody is being, uh, on or placed on testosterone replacement therapy.

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There's a lot of other there's some controversy

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regarding side effects of testosterone replacement therapy.

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And we really don't have trials to tell us

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if, if this is you know, which way testosterone replacement therapy goes.

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But one thing a lot of people heard about is, is the cardiovascular risk.

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Yeah, I think there's a trial just finishing this year or just finished

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called the Traverse Trial that was powered to look at that

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and address that question of testosterone replacement therapy,

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um, raises the risk of a major cardiac event

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or decreases it or if it's neutral.

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In the past, studies are pretty mixed and, um,

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so that's really

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something we can't answer right now.

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In regards to prostate cancer, it's pretty, pretty well known

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that testosterone replacement therapy will not cause prostate cancer.

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Now, certainly you don't want to give a man with active

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or or prostate cancer that's spread outside the prostate, testosterone.

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But just giving a man testosterone

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will not cause him to or increases the risk of getting

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prostate cancer.

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Yeah. Is there a risk of.

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Worsening like BPH symptoms?

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Yeah.

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There's been several analyses.

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I've looked at that.

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I think initially there may be a little bit increase

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in size of the prostate, but overall,

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generally, men

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may not experience a significant worsening.

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Now if they are coming in

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and they have are having a lot of issues urinating or having a lot of lower

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urinary tract symptoms, there may not be a person

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you want to start on therapy without addressing those urinary issues.

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Does testosterone use Um, raise

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risk of any particular cancer like testicular cancer? No, um,

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I can think of one subset maybe of a testicular cancer,

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something called a leydig cell tumor, which is certain cell

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type in the testicle, but in general it's not going to be

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associated with increased risk of testicular cancer.

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And that's testicular cancer in general is mainly a young man's disease.

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And and those men generally won't be receiving testosterone

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replacement therapy. Right, Right. Um.

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And just a just to start to pick your brain so much.

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Yeah, yeah, yeah.

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These are like really good

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info for our primary care providers and our residents and students.

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Sure. Listening.

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What exactly when you said you need to have a confirmed lab value, can you, um.

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You know, enunciate had a little bit on that

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like when to get it and how many times we need to repeat it and what not.

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Sure, yeah. Yeah.

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So um, according to our guidelines, the American Urologic Association

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guidelines, that's a total testosterone less than 300 measuring in the early morning

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because that's going to be when it's highest testosterone.

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It's kind of a,

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um, a diurnal, um, lab value,

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meaning that the morning it's highest and it drops in the afternoon.

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So we want to measure it generally before 9 a.m., roughly give or take.

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And there's some people are also check a free testosterone

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not to get too much into the weeds on it.

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Um, which may correspond more with

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low testosterone symptoms

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than the total testosterone,

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but really a total testosterone in the early morning.

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And I would get two lab values to confirm

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less than 300 is kind of our cutoff.

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Um, and that's, that's,

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you know, looking at the guidelines, that's what our guidelines will tell you.

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Yeah.

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So in situations where that first initial testosterone let's say is like like 180,

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but then that second one you get just a little bit earlier is like 350 or 400.

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You can pretty much confirm and say or would you do it a third time then.

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Yeah, I.

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Think there you know, that's kind of where there's some nuance and you kind of have

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to look at the overall picture, you know, what else is going on with the patient?

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Are they, you know, metabolically ill or the insulin resistant or are they,

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you know, overweight or how is their sleeping?

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Yeah, You know, there's a lot of other things

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that can go in to these things that may be driving testosterone down.

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Or, you know, another thing that, you know, I'm sure you all have seen

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chronic narcotic use. Yeah. Yeah.

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I mean, that's I see I've I've seen not infrequently

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younger, younger people coming in with low testosterone

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or they've been treated for low testosterone because of a history of

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maybe opioid abuse.

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Um, but

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yeah,

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that's kind of what we're

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I think

00:13:54:22 - 00:13:57:23
you got to really look at the the overall picture. Yes.

00:13:58:03 - 00:14:01:22
Um, for the patient and maybe use a little bit of clinical judgment

00:14:01:22 - 00:14:05:27
and maybe it's, it's, it's something where you, you recommend, you know,

00:14:05:28 - 00:14:09:00
kind of more conservative things and then just monitor it.

00:14:09:00 - 00:14:09:26
Yeah.

00:14:09:26 - 00:14:13:25
So this is something that I've seen not a whole lot,

00:14:13:25 - 00:14:16:26
but I've seen it in some of my patients that have come to me,

00:14:17:09 - 00:14:21:19
um, women that tend to be on testosterone supplementation.

00:14:21:19 - 00:14:26:00
And of course you know, some of them do have side effects of, of virilization,

00:14:26:00 - 00:14:29:23
specifically male male pattern like facial hair and chest hair.

00:14:30:07 - 00:14:34:05
Um, but is there really any, is there really any medical indication

00:14:34:05 - 00:14:37:00
for for women to be on testosterone?

00:14:37:00 - 00:14:37:26
That's a great question.

00:14:37:26 - 00:14:41:15
I, I have no experience with that, to be honest with you.

00:14:41:15 - 00:14:43:06
I've never prescribed it.

00:14:43:06 - 00:14:45:26
Um, we don't have guidelines for it.

00:14:45:26 - 00:14:47:03
I that's kind of

00:14:49:09 - 00:14:52:10
the Wild West a bit.

00:14:53:01 - 00:14:56:22
I yeah, I don't have any experience with that.

00:14:56:22 - 00:14:59:28
And then I would have to, I would have to dig into the literature.

00:14:59:28 - 00:15:02:28
I'm not sure there's much literature on it either. Uh, yeah.

00:15:02:28 - 00:15:05:11
Something for us to continue to look into. Yeah, yeah.

00:15:05:11 - 00:15:07:11
Learn about together.

00:15:07:11 - 00:15:08:13
Right.

00:15:08:13 - 00:15:12:03
Um, and, uh, speaking of, you know, stepping away

00:15:12:03 - 00:15:15:27
a little bit and testosterone topic, but like, is there any instead of, like

00:15:16:10 - 00:15:19:21
actually getting injections or doing other formulations

00:15:19:21 - 00:15:23:13
such as topical and whatnot, is there any other like have you

00:15:24:20 - 00:15:28:02
seen or heard of any in the literature natural substances

00:15:28:02 - 00:15:31:03
or supplements patients can take to boost their natural testosterone?

00:15:32:03 - 00:15:33:16
Yeah, yeah, yeah.

00:15:33:16 - 00:15:36:18
There's, um, there's some over, the well,

00:15:37:07 - 00:15:40:08
there's a, I think it's a herb from Africa

00:15:40:10 - 00:15:43:09
or wheat from Africa ashwagandha.

00:15:43:09 - 00:15:43:19
Yeah.

00:15:43:19 - 00:15:48:04
I've heard about, I've seen patients on and I've listened to other other podcasts

00:15:48:04 - 00:15:51:05
that talk about some of these supplements.

00:15:51:09 - 00:15:53:06
That's what I've seen. But again,

00:15:54:21 - 00:15:57:22
once you start getting into those supplements,

00:15:57:22 - 00:16:00:23
I, you know, what I tell my patients is

00:16:01:01 - 00:16:03:19
I'm not sure what's in it. Yep.

00:16:03:19 - 00:16:06:20
You probably don't know what's in it either.

00:16:06:27 - 00:16:08:07
And we don't know dosages.

00:16:08:07 - 00:16:11:28
We don't know, you know, purity, all these things, they're not regulated.

00:16:11:28 - 00:16:15:00
Right, Right. And does it work? Maybe.

00:16:15:00 - 00:16:18:07
But also placebo is a very real thing. Yep.

00:16:18:20 - 00:16:20:07
So, yeah.

00:16:20:07 - 00:16:22:07
Yeah, that's great.

00:16:22:07 - 00:16:25:15
So taking a step back, I think we kind of, um, should have asked

00:16:25:15 - 00:16:29:16
this question earlier, but what, what made you want to go into urology?

00:16:30:04 - 00:16:30:13
Yeah.

00:16:30:13 - 00:16:33:11
So, um, I went into medical school, 

00:16:33:11 - 00:16:35:15
I didn't even know what urology was.

00:16:35:15 - 00:16:39:13
It's a fairly obscure field that, uh, there's

00:16:39:13 - 00:16:40:24
not many people that I grew up going.

00:16:40:24 - 00:16:42:24
I want to be a urologist.

00:16:42:24 - 00:16:44:16
Um, that's pretty rare.

00:16:44:16 - 00:16:47:17
Uh, so I like surgery.

00:16:47:17 - 00:16:49:00
I kind of knew.

00:16:49:00 - 00:16:52:21
I kind of wanted to do maybe something surgical going through medical school,

00:16:53:19 - 00:16:57:10
looked at all the surgical specialties, and then I started rotating on urology,

00:16:57:10 - 00:17:01:12
and then I kind of, you know, like, hanging out with that group

00:17:01:12 - 00:17:04:22
and sort of looking all the surgeries and getting some more experience

00:17:04:22 - 00:17:06:02
with some of the surgeries they did.

00:17:06:02 - 00:17:08:26
And it's a fairly broad, broad field.

00:17:08:26 - 00:17:14:18
And, you know, we treat cancer and kidney stones, We do robotic surgery.

00:17:14:18 - 00:17:16:16
We use lasers to break up kidney sounds.

00:17:16:16 - 00:17:19:10
We do endoscopic surgery. So. SCOPES.

00:17:19:10 - 00:17:22:04
Mm hmm. Yeah. A lot of technology. Yeah.

00:17:23:24 - 00:17:26:16
And you treat men and women, young and old

00:17:26:16 - 00:17:30:11
and and there's you know, you follow a lot of people for a long period of time.

00:17:30:11 - 00:17:33:20
It's not like you operate on somebody and then cut them loose ,you form

00:17:33:20 - 00:17:37:12
a relationship with somebody over a long time.

00:17:37:12 - 00:17:39:00
Really get to know them and their family.

00:17:39:00 - 00:17:42:02
And I think that's a that's a pretty rewarding thing,

00:17:42:02 - 00:17:45:22
as you all know, as I mean, family medicine docs, um,

00:17:46:05 - 00:17:51:07
that that a physician patient relationship can be a pretty rewarding relationship.

00:17:51:07 - 00:17:54:15
And it's one of the main things I think, why we go into medicine.

00:17:55:05 - 00:17:58:09
But urology has a really just neat

00:17:58:09 - 00:18:01:10
aspect to medicine and surgery.

00:18:01:23 - 00:18:04:24
There's a lot of medicine that you

00:18:05:05 - 00:18:08:11
get to use, medical knowledge to use and urology

00:18:08:13 - 00:18:12:17
and treating kidney stones and evaluating why someone is getting a kidney

00:18:12:17 - 00:18:16:10
stone and medications you can try to use to prevent kidney stones.

00:18:18:03 - 00:18:19:04
So I really

00:18:19:04 - 00:18:22:13
liked that interaction between medicine and surgery.

00:18:22:13 - 00:18:25:11
And and it worked out.

00:18:25:11 - 00:18:28:18
And I would encourage anybody looking at a medicine, look at Urology.

00:18:29:01 - 00:18:29:21
Yeah.

00:18:29:21 - 00:18:32:22
It's not all operating on penises.

00:18:33:12 - 00:18:34:25
Yeah,

00:18:34:25 - 00:18:35:22
that's a  great story.

00:18:35:22 - 00:18:39:23
I think a little, good tidbit tell our students listening.

00:18:39:25 - 00:18:40:15
That's right.

00:18:40:15 - 00:18:44:10
Um, I it's one thing that, um, you know,

00:18:44:26 - 00:18:48:25
that it's always a bit of a mystery based on guidelines

00:18:48:25 - 00:18:52:01
and things is we've got clear cut guidelines for breast

00:18:52:01 - 00:18:55:09
cancer screening and and cervical cancer screening.

00:18:55:09 - 00:18:58:03
And, you know, we're taught that, hey, this at this age,

00:18:58:03 - 00:18:59:08
this is how often you get it.

00:18:59:08 - 00:19:02:14
But then we're always taught about the little obscurity of prostate cancer.

00:19:02:14 - 00:19:03:05
Right? Right.

00:19:03:05 - 00:19:07:00
And it's like, oh, it's a you know, you you talk to the patient

00:19:07:00 - 00:19:10:01
and you make a decision if you want to do a PSA or not or

00:19:10:08 - 00:19:12:20
or this is the age you should start and stuff.

00:19:12:20 - 00:19:16:27
In your experience as a specialist, when do you start having that conversation

00:19:16:27 - 00:19:19:23
about prostate cancer indications and how do you approach that topic?

00:19:19:23 - 00:19:23:01
Yeah, so kind of first off, I just kind of take a little,

00:19:23:09 - 00:19:24:14
you know, history from the patient.

00:19:24:14 - 00:19:26:10
What is their risk for prostate cancer?

00:19:26:10 - 00:19:28:10
Are they an average risk person?

00:19:28:10 - 00:19:31:07
Right. Or are they a higher risk person?

00:19:31:07 - 00:19:35:22
And certain things we look at when we put people into those two camps,

00:19:35:22 - 00:19:39:14
higher risk, it's going to be somebody with an African ancestry,

00:19:40:23 - 00:19:44:07
somebody with multiple family members, first degree relatives

00:19:44:07 - 00:19:48:16
or with prostate cancer, especially metastatic prostate cancer.

00:19:48:16 - 00:19:51:17
So prostate cancer spread to other parts of the body.

00:19:52:02 - 00:19:54:15
But then also we gotta think about breast cancer because there is

00:19:54:15 - 00:19:57:18
a there is a strong link between breast cancer and prostate cancer.

00:19:57:18 - 00:19:59:10
Right. It's good to know. I don't know.

00:19:59:10 - 00:20:03:13
A lot of guys don't or guys don't think about that.

00:20:03:13 - 00:20:05:00
Yeah. Relationship.

00:20:05:00 - 00:20:08:05
Other cancers, pancreatic cancer, melanoma,

00:20:08:21 - 00:20:11:22
colon cancer, ovarian cancer.

00:20:12:28 - 00:20:16:20
You pick up somebody with that strong family history, you know, ears

00:20:16:20 - 00:20:21:07
kind of perk up and might think they might be able to at higher risk. Um,

00:20:22:18 - 00:20:25:09
of prostate cancer

00:20:25:09 - 00:20:28:18
generally for me you know at an average risk and going by

00:20:30:01 - 00:20:33:02
or AUA guidelines

00:20:33:05 - 00:20:36:06
generally we'll start start screening at around age 55.

00:20:36:15 - 00:20:39:06
So guys age 55 to 69

00:20:39:06 - 00:20:42:16
and I'll tell you, they have a conversation with the patient,

00:20:42:20 - 00:20:46:12
I tell them what are the risks, What are the benefits of screening?

00:20:46:24 - 00:20:51:00
You know, prostate cancer oftentimes is a slow growing, um, cancer.

00:20:51:00 - 00:20:54:15
And it takes a long time for men to see that benefit of screening.

00:20:54:18 - 00:20:59:02
So you want to also make sure that person will benefit from screening.

00:20:59:02 - 00:21:02:27
And that's somebody that has at least a ten or 15 year life expectancy

00:21:03:26 - 00:21:06:08
just because of the long horizon.

00:21:06:08 - 00:21:10:17
And with prostate cancer now somebody who might be at a higher risk

00:21:10:17 - 00:21:15:00
camp, you might start earlier, right around age 45 or so.

00:21:15:19 - 00:21:18:04
And there's there's several I mean, there's

00:21:18:04 - 00:21:20:18
I don't know how many sets of guidelines out there.

00:21:20:18 - 00:21:22:14
I prostate cancer screening, which makes it.

00:21:22:14 - 00:21:23:20
Difficult.

00:21:23:20 - 00:21:28:10
But less than 40 not recommended to screen

00:21:29:22 - 00:21:33:07
but those guys at higher risk around age 45.

00:21:33:15 - 00:21:37:04
And then once somebody gets over the age of 70

00:21:37:16 - 00:21:41:08
generally we're not screening an average risk person at that point

00:21:42:00 - 00:21:47:04
unless they need if have that conversation with them, they prefer to be screened.

00:21:47:04 - 00:21:51:11
After discussing the risks of overtreatment, overdiagnosis,

00:21:52:14 - 00:21:55:17
or they might in their, you know, higher risk person potentially.

00:21:55:19 - 00:21:56:14
Yeah.

00:21:56:14 - 00:21:58:13
In your screening usually with the PSA.

00:21:58:13 - 00:21:58:22
Yeah.

00:21:58:22 - 00:22:02:08
So generally we're doing a PSA and that's every 1 to 2 years

00:22:03:19 - 00:22:05:24
it's a strategy

00:22:05:24 - 00:22:09:11
that we're doing and we're also doing doing a prostate exam

00:22:09:14 - 00:22:14:27
at least in my clinic, I am just because it's extremely rare, but

00:22:15:22 - 00:22:20:00
you can pick up prostate cancers that may not be screened in a PSA

00:22:20:19 - 00:22:23:13
just to make sure you're not feeling any abnormalities on the prostate.

00:22:23:13 - 00:22:25:05
Yeah, let's be clear to our listeners.

00:22:25:05 - 00:22:27:28
The PSA is prostate specific antigen. Yes. Which is a blood test.

00:22:27:28 - 00:22:29:01
Yes, it's a blood test.

00:22:29:01 - 00:22:35:04
The PSA is a protein that's secreted by the prostate gland into the bloodstream.

00:22:35:04 - 00:22:39:08
And so we measure it and we have certain cutoffs for ages and races.

00:22:39:08 - 00:22:42:21
And then to kind of tell us if there's an abnormality.

00:22:43:04 - 00:22:47:21
Now, an elevated PSA doesn't necessarily indicate malignancy all the time, correct?

00:22:47:21 - 00:22:50:08
Yeah. Yeah. PSA is not perfect by any means. I

00:22:51:22 - 00:22:52:23
you know, infection

00:22:52:23 - 00:22:56:27
inflammation, even, you know, I tell my guys sexual activity

00:22:56:27 - 00:23:00:28
within a few days of getting your blood drawn can falsely elevate that PSA.

00:23:01:05 - 00:23:03:11
Okay my general I tell my guys

00:23:03:11 - 00:23:07:04
you know abstain for two or three days before your blood drawn

00:23:07:19 - 00:23:11:06
just so we're not having any confounders and there and really

00:23:11:06 - 00:23:13:03
we're not going off of one data point. Right.

00:23:13:03 - 00:23:16:04
Just just like in a lot of things in medicine,

00:23:16:26 - 00:23:19:07
you kind of want to see a trend

00:23:19:07 - 00:23:20:02
on a PSA.

00:23:20:02 - 00:23:23:08
They used to teach us in medical school that a rectal exam prior to the PSA

00:23:23:08 - 00:23:25:08
could also elevate it. Have you heard that?

00:23:25:08 - 00:23:28:05
I guess if you're very enthusiastic.

00:23:28:05 - 00:23:31:14
Gotcha, that explains that.

00:23:31:20 - 00:23:32:09
Yeah. Yeah.

00:23:32:09 - 00:23:32:28
Most time.

00:23:32:28 - 00:23:35:22
Uh, yeah. You're not a it's not aggressive.

00:23:35:22 - 00:23:36:25
It's not aggressive. Okay.

00:23:36:25 - 00:23:40:21
But are there anything that that men need to look out for in terms of symptoms

00:23:40:21 - 00:23:42:02
when it comes to. Sure.

00:23:43:02 - 00:23:43:25
Prostate cancer.

00:23:43:25 - 00:23:46:18
Yeah. I mean the vast majority time, it's asymptomatic, right?

00:23:46:18 - 00:23:49:05
It's picked up with a screening test.

00:23:49:05 - 00:23:55:02
Um, with that blood test, some guys may come in noticing blood in the urine,

00:23:55:02 - 00:23:59:13
or you might pick it up on a on a urine test on a routine office visit.

00:23:59:23 - 00:24:03:11
Some men may describe you have a hard time urinating

00:24:04:16 - 00:24:05:25
a weak stream.

00:24:05:25 - 00:24:09:27
Um, pelvic pain, maybe bone pain, maybe for advanced

00:24:11:12 - 00:24:13:21
disease.

00:24:13:21 - 00:24:15:02
Though there are other causes.

00:24:15:02 - 00:24:17:15
May be

00:24:17:15 - 00:24:21:05
your kidneys not draining very well, of course, which may cause some back pain.

00:24:21:08 - 00:24:24:07
Mm hmm. So, yeah.

00:24:24:07 - 00:24:26:19
Wow, that was really great info and learning a lot of.

00:24:26:19 - 00:24:30:24
Yeah, that's a this is a this has been a really informative session.

00:24:30:24 - 00:24:32:16
Yeah. So, yeah.

00:24:32:16 - 00:24:36:19
And in terms of like, I guess educating our male patients,

00:24:36:27 - 00:24:38:20
what are some things that you,

00:24:38:20 - 00:24:41:23
you would recommend for all regardless of their age, you know

00:24:41:23 - 00:24:45:11
really for men to take care of their or get a grasp of their own health

00:24:45:11 - 00:24:48:18
or some things that you would recommend that they do or watch out for.

00:24:48:18 - 00:24:49:18
Yeah, I.

00:24:49:18 - 00:24:54:01
Think I mean, again, kind of going back to when we were first talking about,

00:24:54:01 - 00:24:58:12
I think, um, really taking your health seriously early on

00:24:58:14 - 00:25:02:18
will do you, will pay major dividends, um,

00:25:03:09 - 00:25:06:28
you know, 20, 30 years the road because a lot of times we want to,

00:25:07:02 - 00:25:09:10
you know, how do you know

00:25:09:10 - 00:25:12:01
what do you want your life to be like when you're 80 years old?

00:25:12:01 - 00:25:14:05
Yeah, right. Um.

00:25:14:05 - 00:25:17:19
You know, and to get there and to be functional

00:25:17:19 - 00:25:21:20
and to have a high quality of life, you have to start early.

00:25:21:20 - 00:25:22:00
Yeah.

00:25:23:00 - 00:25:25:07
Um, and that goes back to,

00:25:25:07 - 00:25:30:08
you know, the not easy, but routine things of exercise.

00:25:31:01 - 00:25:32:27
You know walking, you don't smoke.

00:25:32:27 - 00:25:36:13
Um, you know, moderate if any alcohol intake

00:25:37:15 - 00:25:39:20
and also, you know, mental health, right.

00:25:39:20 - 00:25:41:26
Um, you know, taking that seriously and making

00:25:41:26 - 00:25:45:17
sure you're surrounding yourself with, like a good social circle

00:25:45:17 - 00:25:49:10
that will take care of you and has the same values because

00:25:49:17 - 00:25:52:18
it's going to be easier to do it if you're surrounded by a good group.

00:25:53:04 - 00:25:54:12
Um, of people.

00:25:54:12 - 00:25:58:18
But it's those things that, you know, are harped on all the time.

00:25:58:18 - 00:26:01:19
But it's, it's, uh, it's definitely true.

00:26:01:27 - 00:26:06:18
Um, but those things will help prevent cardiovascular disease,

00:26:06:28 - 00:26:11:12
diabetes, um, you know, nerve degenerative disorders,

00:26:11:20 - 00:26:15:07
Alzheimer's, depression and then also cancer.

00:26:15:13 - 00:26:16:19
Yeah, right. Of course.

00:26:18:10 - 00:26:19:12
Yeah.

00:26:19:12 - 00:26:23:16
Well, is there anything in, like, new and up and coming advanced technology

00:26:23:16 - 00:26:26:17
or such treatments in the urology world that you can think of.

00:26:26:22 - 00:26:28:19
In the urology. World?

00:26:28:19 - 00:26:31:12
Oh. Well, I mean

00:26:31:12 - 00:26:33:14
for all, for, um,

00:26:33:14 - 00:26:36:27
I mean kidney stones, you know, I kind of briefly touched on that.

00:26:37:09 - 00:26:40:24
You know, we're, we use a lot of laser technology

00:26:40:24 - 00:26:43:25
to bring kidney stones up.

00:26:44:01 - 00:26:46:09
In the old days, people used to get big incisions

00:26:46:09 - 00:26:47:19
to get their kidney stones taken out.

00:26:47:19 - 00:26:51:28
Now we use tiny little cameras to go inside the body through the bladder,

00:26:52:00 - 00:26:55:01
you know, without making any incisions and use, you know, these

00:26:55:04 - 00:26:59:07
extremely small laser fibers to break up the kidney stone, take them out.

00:26:59:07 - 00:27:02:26
And so there's a new laser technology

00:27:03:08 - 00:27:06:21
that can really chew through large amounts of stone.

00:27:06:21 - 00:27:07:21
And in Oklahoma,

00:27:08:22 - 00:27:11:24
it's a it's a good place to be a urologist.

00:27:11:24 - 00:27:14:25
There is plenty of kidney stones around.

00:27:15:17 - 00:27:19:04
We all like we all like barbecue with lots of salts.

00:27:19:04 - 00:27:21:17
Yeah, lots of a lot of animal protein.

00:27:21:17 - 00:27:23:11
And so that's those are all things that,

00:27:23:11 - 00:27:25:23
you know, may predispose you in kidney stones.

00:27:25:23 - 00:27:30:11
So we, um, you know, Norman has recently gotten, um,

00:27:31:13 - 00:27:34:18
new technology to treat kidney stones,

00:27:35:23 - 00:27:38:22
and so it's always available there for us to use to,

00:27:38:22 - 00:27:42:14
to treat patients who are coming in with acute stone episode or,

00:27:42:24 - 00:27:46:15
or large kidney stones that need to be dealt with.

00:27:46:15 - 00:27:51:04
And so that technology is always on the on the up and coming.

00:27:51:04 - 00:27:53:27
And there's new innovations to

00:27:53:27 - 00:27:58:01
work through smaller scopes and smaller channels to treat those kidney.

00:27:58:01 - 00:28:00:04
Stones, less invasive. Less invasive.

00:28:00:04 - 00:28:03:05
And so all that stuff is in your office or is it?

00:28:03:19 - 00:28:05:21
No. Yeah. So it's all in the operating room.

00:28:05:21 - 00:28:06:20
So we all

00:28:06:20 - 00:28:10:14
these are procedures have to be done under a general in the operating room.

00:28:10:14 - 00:28:15:11
And so it's either out at the hospital or an outpatient surgery center

00:28:16:28 - 00:28:18:22
to treat these kidney stones.

00:28:18:22 - 00:28:22:10
Um, but it's, it's pretty incredible technology.

00:28:22:10 - 00:28:24:16
So that's fascinating.

00:28:24:16 - 00:28:25:14
So since we're on the topic,

00:28:25:14 - 00:28:29:15
kidney stones, um, I just wanted to just see if you could correct me.

00:28:29:15 - 00:28:33:16
Is it true that taking in, uh, supplementary calcium

00:28:33:16 - 00:28:36:17
actually increases your risk of kidney stones.

00:28:36:25 - 00:28:40:28
So it can, but also cutting out calcium totally can increase

00:28:40:28 - 00:28:41:24
kidney stones as well.

00:28:41:24 - 00:28:45:00
So our recommendations are you need to have a moderate amount

00:28:45:04 - 00:28:46:07
of calcium in your diet.

00:28:46:07 - 00:28:47:16
So I see, you know,

00:28:47:16 - 00:28:51:15
some people come in, you know, they they're lactose intolerant, right?

00:28:51:15 - 00:28:55:05
They they don't Yeah, they cut out all the all the dairy.

00:28:55:05 - 00:28:56:21
Right. They don't have any calcium. Right.

00:28:56:21 - 00:28:59:14
They don't take a supplement or anything or getting it from something else.

00:28:59:14 - 00:29:01:23
And so in they're having kidney stones.

00:29:01:23 - 00:29:06:28
Well, you do a, um, a lab test on them, and lo and behold, um,

00:29:07:06 - 00:29:10:18
you know, some of their parameters are off and you need to supplement some calcium.

00:29:10:22 - 00:29:14:02
Now, you can also see where somebody is just,

00:29:14:20 - 00:29:19:24
you know, really enjoys calcium or some calcium containing food. Uh.

00:29:20:27 - 00:29:21:13
Yeah, Yeah.

00:29:21:13 - 00:29:22:15
A Tums, right? Either.

00:29:22:15 - 00:29:25:06
Yeah, I've taken tons of Tums, things like that.

00:29:25:06 - 00:29:29:01
I also, you see, you know, patients will take vitamin C a lot.

00:29:29:01 - 00:29:29:19
Yeah.

00:29:29:19 - 00:29:34:10
And vitamin C, your body will break that down into a chemical called oxalate.

00:29:34:26 - 00:29:37:27
And the most common type of kidney stone is a calcium oxalate.

00:29:38:09 - 00:29:41:21
And so, uh, yeah, the, the vitamin C supplementation.

00:29:42:15 - 00:29:45:16
If you're if you're on that bandwagon, yeah.

00:29:45:24 - 00:29:48:23
They may make you meet me at some point.

00:29:48:23 - 00:29:50:00
Yeah.

00:29:50:00 - 00:29:53:07
We’ll do it, too much of a too much orange juice, huh?

00:29:53:10 - 00:29:54:03
Yeah, yeah, yeah.

00:29:54:03 - 00:29:57:00
So you're calcium and

00:29:57:00 - 00:29:57:28
vitamin D fortified?

00:29:57:28 - 00:30:01:00
Yeah, yeah, yeah, that's right.

00:30:01:05 - 00:30:02:17
That's right.

00:30:02:17 - 00:30:04:12
Oh, this is a great time. Yeah.

00:30:04:12 - 00:30:05:23
Thank you so much.

00:30:05:23 - 00:30:06:20
I really appreciate it.

00:30:06:20 - 00:30:07:17
I appreciate.

00:30:07:17 - 00:30:10:24
It. We, uh, we usually do a segment at the end of our podcast

00:30:10:24 - 00:30:14:01
called The Question of the Day, and it's a question

00:30:14:01 - 00:30:18:19
that's brought about by our know peers listeners, I guess not yours.

00:30:19:25 - 00:30:21:13
And because they want to ask this.

00:30:21:13 - 00:30:25:07
Yeah, So this was a very interesting question that we got, which was

00:30:25:22 - 00:30:28:21
how can I discuss my sexual health with the provider

00:30:28:21 - 00:30:31:22
in a very non-judgmental and comfortable nature?

00:30:32:00 - 00:30:32:08
Yeah.

00:30:32:08 - 00:30:34:27
So I think if you're coming to see your urologist,

00:30:34:27 - 00:30:36:27
these are conversations we're having, of course.

00:30:36:27 - 00:30:39:07
Yes. All the time. 20 times a day. Yeah.

00:30:39:07 - 00:30:43:13
You know, and so we're very it's it's it's routine for us.

00:30:43:13 - 00:30:46:25
You know, I think if, you know, somebody is just, you know, upfront

00:30:46:25 - 00:30:50:03
and honest and, you know about what their goals are for their care,

00:30:51:04 - 00:30:54:05
it's going to be, uh, it's going to be a lot easier.

00:30:54:19 - 00:30:58:05
But there's probably nothing you're going to tell a urologist

00:30:58:05 - 00:30:59:07
that's going to shock us.

00:31:01:06 - 00:31:02:00
And so we're

00:31:02:00 - 00:31:06:00
very used to having these these sensitive conversations with patients,

00:31:07:09 - 00:31:09:27
you know, obviously in a very private manner.

00:31:09:27 - 00:31:11:10
Yeah.

00:31:11:10 - 00:31:13:17
Um, to address any,

00:31:13:17 - 00:31:16:17
uh, you know, concerns that they might have. Mm.

00:31:16:17 - 00:31:20:08
So obviously these are conversations that people are typically having,

00:31:20:22 - 00:31:23:21
you know, amongst their friends and family.

00:31:23:21 - 00:31:24:00
Yeah.

00:31:24:00 - 00:31:27:16
And I think that goes back to our focus on this podcast, bridging that gap.

00:31:27:22 - 00:31:28:01
Yeah.

00:31:28:01 - 00:31:30:28
You know, the question is, do your doctors.

00:31:30:28 - 00:31:31:26
And that's the same thing

00:31:31:26 - 00:31:35:17
and I mean it just runs for you and me and all primary care providers too.

00:31:35:17 - 00:31:36:13
And we want our patients

00:31:36:13 - 00:31:40:11
to feel comfortable talking about, you know, all their issues, including,

00:31:40:21 - 00:31:43:22
you know, their lack of or sexual health in general.

00:31:43:24 - 00:31:48:25
And so, yeah, it's just I don't think we ever want any of our patients to feel

00:31:49:21 - 00:31:53:20
that they're being judged or that they're being, you know, mis-viewed

00:31:53:23 - 00:31:56:24
based on any sexual health issues that they're having.

00:31:56:24 - 00:31:59:04
So. Absolutely. Absolutely.

00:31:59:04 - 00:32:00:07
Yeah.

00:32:00:07 - 00:32:02:22
And and, you know, I think a lot of people don't

00:32:02:22 - 00:32:06:00
realize is that, you know, a lot of people have the same questions.

00:32:06:07 - 00:32:06:15
Right.

00:32:06:15 - 00:32:10:15
And they may think they're the only person that has that question or is wondering

00:32:10:15 - 00:32:14:23
if, you know some about some question they might have.

00:32:14:23 - 00:32:17:26
But I think there's a lot of commonality of what we're seeing.

00:32:18:02 - 00:32:20:10
And at least in the urology clinic.

00:32:20:10 - 00:32:21:08
Mm hmm. So

00:32:22:07 - 00:32:23:14
likely if they have that question,

00:32:23:14 - 00:32:26:15
they're not the only person that's ever asked the question for.

00:32:26:16 - 00:32:27:20
Yeah, you're not.

00:32:27:20 - 00:32:29:13
You're not alone. Yeah. Yeah, exactly. Yeah.

00:32:29:13 - 00:32:31:21
Not the first one won't be the last. That's right. That's right.

00:32:31:21 - 00:32:32:10
You know.

00:32:32:10 - 00:32:35:26
Yeah, well, Dr, Jones is there anything else you'd like to say?

00:32:35:28 - 00:32:37:12
I dont think so, you know, that was great.

00:32:37:12 - 00:32:40:19
And kind of, um, covered a lot of important men's health topics.

00:32:41:06 - 00:32:43:23
Um, appreciate you all having me in today.

00:32:43:23 - 00:32:45:10
And, uh, so thank you, guys.

00:32:45:10 - 00:32:47:11
Thank you. It's an honor to have you here today.

00:32:47:11 - 00:32:48:12
We learned a lot, too.

00:32:48:12 - 00:32:52:03
And so and that's, uh, and that's, that's also part of the focus of this podcast.

00:32:52:03 - 00:32:53:17
It to continue learning.

00:32:53:17 - 00:32:56:14
So medicine's an ever growing field and we're never going to know everything.

00:32:56:14 - 00:33:00:14
And yes, it's important for us to sit and discuss with experts

00:33:00:14 - 00:33:02:04
like you and expand our own knowledge.

00:33:02:04 - 00:33:04:23
And so we really appreciate you coming on by.

00:33:04:23 - 00:33:07:24
Um, so thank you. Hey thank you all.

00:33:08:02 - 00:33:11:03
this has been another episode of Vital

00:33:11:03 - 00:33:14:18
Vision's case where we talked about an important topic of men's health.

00:33:15:04 - 00:33:19:04
Um, and remember that there's no question that is, uh,

00:33:20:06 - 00:33:22:12
that's going to make anything awkward, That's

00:33:22:12 - 00:33:26:09
inappropriate to ask your your physicians primary care urologist otherwise.

00:33:26:14 - 00:33:29:20
Um, and in honor of our urologist extraordinaire, Dr.

00:33:29:20 - 00:33:33:01
Jones here, I want to continue my format of Be water Water, my friends

00:33:33:08 - 00:33:35:13
from Bruce Lee. And stay out of trouble.