ED and Low T: Don’t Just Treat the Symptoms!
Part One of my series with Johns Hopkins 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 recently interviewed urologist Kevin Billups, M.D., Director of the Brady’s Men’s Health and Vitality Program at Johns Hopkins Medical Institutions, who 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 his website: menshealth.jhu.edu or one of his videos addressing key issues related to men’s health. The website features 25 short videos of Billups talking 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?”
Update: Kevin Billups is now on the faculty at Meharry Medical College in Nashville, Tenn.
©Janet Farrar Worthington