ED and Low T:  Dont Just Treat the Symptoms!

Part Two of my series with Urologist Kevin Billups, M.D.

Elephant Tea PartyLow testosterone is a worrisome thing for many men.  It doesn’t help that many have seen advertisements for testosterone-boosting supplements promising to cure all — except what’s really causing the problem, notes Kevin Billups, M.D., formerly Director of the Brady’s Men’s Health and Vitality Program at Johns Hopkins Medical Institutions and now Medical Director of the Billups Center in Murfreesboro, Tenn.. “Men think it’s just a sex drive thing, but a lot of what we see is related to other common chronic conditions.  Treating that one symptom without finding out the whole story would not be a good idea.”

Diabetes or even pre-diabetes can lower testosterone.  So can a big gut, Billups adds.  “Having a waist circumference greater than 40 inches lowers testosterone.  Matter of fact, that’s the biggest culprit.”

Having a waist circumference greater than 40 inches lowers testosterone.  Matter of fact, that’s the biggest culprit.

Fat, especially belly fat, makes the enzyme aromatase, which converts testosterone to estrogen.  “A lot of guys measure their waist where the pants go, but that doesn’t count because you miss the belly.  You have to measure a little above the belly button.  That brings the sad reality home.”

The diagnosis of low testosterone is the symptoms plus the blood test, Billups says.  “The most common symptoms are ED, fatigue, feeling sluggish, loss of strength or endurance, daytime sleepiness, even cognition issues.  We can document with the blood test that your testosterone is low, but what’s going on with your cardiovascular status, your thyroid?  Is there any depression going on?  If a man has obstructive sleep apnea and low testosterone, he really needs to get the apnea addressed first, because that can make the testosterone worse.”

When I interviewed Billups, I asked if he has ever seen men turn their low testosterone around, and not need medication any more.  His response was encouraging:  He has seen it many times.  “Some men come in, they’re overweight, and they’ll say, ‘I know I need to do something, I’ve been putting it off.’  But this sexual health crisis, a diagnosis of low testosterone or problems with ED, happens, and it breaks the ice.  They’ll exercise and lose weight.  Or, if we pick up sleep problems, when they correct those, their testosterone comes back up.  Or, if the pills (for ED) weren’t working and I had to put them on the next step,” a different treatment, such as penile injection to help with erection, they get themselves tuned up, lose weight, get their sleep habits under control, exercise, and they’ll find out that they can get much better erections.  They might be back to using the pills once in a while, and their energy level improves.  There are many lifestyle changes that can help.”

 

©Janet Farrar Worthington

railroad manED and Low T:  Dont Just Treat the Symptoms!

Part One of my series with Urologist Kevin Billups, M.D.

 If you have erectile dysfunction (ED) or low testosterone, and you go see a doctor about it, that’s good:  Because in both cases, there’s probably something else going on.

I interviewed urologist Kevin Billups, M.D., formerly Director of the Brady’s Men’s Health and Vitality Program at Johns Hopkins Medical Institutions and now Medical Director of the Billups Center in Murfreesboro, Tenn.  Billups has treated thousands of men with these problems.  “These are symptoms that will get a man interested in seeking help,” he says.  But they’re generally not the only things he ends up treating. “The first thing I do is point out that these problems don’t occur in a vacuum. There are reasons why you have this.”

The first thing I do is point out that these problems don’t occur in a vacuum. There are reasons why you have this.

If you are a man between the ages of 40 and 50 and you have ED, growing evidence suggests that you could have nearly a 50-fold increased risk of developing heart disease over the next 10 years, Billups says.  “It’s a group we’re really looking at.”  He believes many of these men need a more aggressive workup, “not just with the standard stress test,” which he sees as more of a fitness test, but with a coronary CT scan to look for coronary plaque.  “You can get a coronary cat scan now for $75.  I’ll be very honest when I talk to these guys.  I’ll say, ‘Your insurance may not cover this.  But if you turn out to have plaque in any of these arteries, I will manage you differently.”

Let’s just take a moment here to note that if you have ED and you just take a drug like Viagra or Cialis, you probably aren’t doing yourself a favor.  “Treating that one symptom without finding the underlying cause would not be a good idea,” says Billups.  “Here’s my biggest concern:  When a guy has ED, that may be a symptom that will actually get him to come to a doctor,” and that’s an opportunity to improve his overall health.  “If you just get medicine, that will mask the real problem in a number of men.  Then you’re just pushing everything back.  So this 40-year-old guy who’s having problems, maybe the medicine will fix what he cares about,” and the man has a heart attack several years later that might have been preventable.

What else could be going on?  “We do a very thorough evaluation to find out,” looking for, in addition to cardiovascular risk factors, diabetes or pre-diabetes, chronic sleep problems, urinary problems, and prostate problems.  Billups refers many of his patients to general urologists, primary care physicians, sleep specialists, or preventive cardiologists for further testing or more aggressive treatment when needed.  “We’re offering very integrated, multidisciplinary care.”

Billups, who sees patients from all over the country, estimates that more than half of his patients are self-referred; many have seen one of his videos addressing key issues related to men’s health.  He has made more than 25 short videos about specific symptoms — any one of which might get a man through the door of the doctor’s office, where Billups then goes on to treat the whole patient. “Yeah, I’ll treat your ED, but what else do you have going on?”

 

©Janet Farrar Worthington