What do you tell male patients about men’s health clinics?

July 25, 2019

"Men’s centers here are offering testosterone treatments without doing much testing beforehand. They also give little or no warning about potential comorbidities of testosterone," says one urologist.

Urology Times reached out to three urologists (selected randomly) and asked them each the following question: What do you tell male patients about men’s health clinics?

"Men primarily ask me about treatments those centers offer for ED or low testosterone. Patients ask, ‘Are they offering something other than what you guys do, and who’s doing it?’

I tell patients, ‘Look on the website; see who is running those clinics.’ If they don’t have a doctor listed, I wouldn’t bother going. If doctors are afraid to put their name behind the clinic, it’s probably some place patients should avoid.

Some clinics offer shock wave therapy for ED; some offer platelet-rich plasma; some, bioidentical hormone substitution. Patients ask whether they should consider those therapies. Typically, I counsel them to avoid therapies which haven’t been proven successful through randomized clinical trials.

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Some men go, then come back and say it didn’t do anything. Others go and we never see them again. It really depends. Most times, we offer patients enough alternatives that they really don’t need to go there.

The usual feedback from men who have gone is that the places were a little sketchy. They weren’t sure if the people running them were doctors or nurses or what. They didn’t get good explanations about exactly what they were doing. A lot of these places prey on men who are looking for alternative treatments they think the medical establishment doesn’t consider.

They make promises they can’t keep, like ‘we guarantee you’ll be able to get an erection,’ but when it’s not the appropriate treatment, patients end up with a priapism and have to come to us. When they find their way here, we treat them with proven treatments.”

Jason Kovac, MD / Greenwood, IN

Next: “We have one of those cash-grab clinics on every corner."

“We have one of those cash-grab clinics on every corner. They promote injection therapy, supplying patients intracorporeal injections with prefilled syringes for many months so they lose their potency. Their latest gimmick is low-intensity shock wave treatment, using shock wave therapy to treat Peyronie’s disease and ED. The AUA and Sexual Medicine Society of North America came out with similar statements that shock wave is investigational and men who are interested should sign up for a study evaluating it.

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Questions come up every day from my patients. If they’re interested, I tell them to find a clinical trial because we don’t know whether it’s truly efficacious. We don’t know what intensity should be administered or how often.

Clinics are charging $500 per treatment, usually giving patients six or seven treatments for cash. Shock wave therapy was approved by the FDA for tissue regeneration, but not for tissue regeneration in the penis.

Most of the time, after I talk to men, they don’t try it. Some men already tried it and it didn’t work. They’re upset they spent a lot of cash, that wasn’t covered by insurance, and didn’t get any benefit.

None of these centers are being run by urologists. My patients who have gone haven’t even seen a physician. They have physician assistants or nurse practitioners, but none of them have seen a urologist.

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If they come to me before doing the treatment, I explain our position. If they come afterwards and it didn’t work, I try to help them.”

Sheldon Freedman, MD / Las Vegas

Next: “We definitely see more patients coming to us for second opinions after they’ve been to one of those clinics."

“We definitely see more patients coming to us for second opinions after they’ve been to one of those clinics. We don’t see many going the other direction. They come once they realize something’s not quite right or if they have questions that aren’t being answered.

They usually realize they’re lacking lab reports or that no one checked their hematocrit levels, their blood count, estrogen levels, or their PSA; or they weren’t satisfied with the medication. Some places use nonstandard sources for their medication.

Sometimes it’s the cost. Patients expect them to be less expensive, but actually they usually cost more than health systems.

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I avoid talking negatively about other practitioners, but I will tell patients that we have a multidisciplinary approach, coordinating with cardiologists, with endocrinologists about bone density, and other practitioners with skills in different areas that can benefit patients more than just looking at an isolated area such as testosterone.

I think the standardized protocol is the key benefit missing on their side. We track patients’ labs, follow men for all aspects of health-whether it be mental health, bone density. Many health systems do, but that’s usually lacking in pop-up clinics that really just focus on one thing.

Men’s centers here are offering testosterone treatments without doing much testing beforehand. They also give little or no warning about potential comorbidities of testosterone.

Patients generally like that we follow stricter guidelines.”

Matthew Wosnitzer, MD / New Haven, CT