Episode #3
Urology with Dr. Amy Pearlman
In this episode:

Guest star Dr. Amy Pearlman, a reconstructive urologist and men’s health specialist in Iowa City, Iowa. She specializes in treating quality of life concerns affecting everyday men, including restoration of sexual health, urinary control, and treatment of male hormonal deficiencies. Send us questions to be featured in future videos by emailing hosts@menexplainedpodcast.com.

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Show Highlights
  • Urologist
  • Sexual Health
  • Restoration of Men's Health
Resources & People Mentioned in Podcast


Aaron Tharp  0:00
The information provided in this episode is provided for informational purposes only, and is not intended to replace professional medical advice. If you have questions regarding your health, please contact your medical provider.

Welcome back to Episode Three here at Men Explained.

Josh and I have a very special guest today.

We have

Amy Perlman, who is the director of men’s health program and a clinical assistant professor of Urology at the University of Iowa, Iowa City. She has a Bachelor’s in neuroscience from the University of Miami,

her MD from the Baylor College of Medicine, and did residency in urology at the hospital of University of Pennsylvania. So we’re super excited to talk to her. Today we’re going to dive into some TRT testosterone replacement therapy, we’re gonna dive into some fertility, talk about some of the things that she sees and get a little bit more about her background. So Amy, welcome to the show.

Dr. Amy Pearlman  1:07
Happy to be here live from Iowa City.

Aaron Tharp  1:10
Oh, yeah, I was waiting for the Go Hawks. Right from the top.

Josh Simms  1:13
I didn’t know you were a fellow neuroscientists. That’s awesome. I have a BS in neuroscience too. So

Aaron Tharp  1:18
So yeah, keep me honest. Was that? Did I have all that? Right? I kind of fumbled through it. But that’s your

Dr. Amy Pearlman  1:23
Yeah you made me sound really boring.

Aaron Tharp  1:25
Oh, I love the honesty.

Dr. Amy Pearlman  1:30
Yeah, I did a lot of training. You know, I did, um, maybe 15 years of training. 10 of that was, you know, within the medical field. I wish I did an additional year specialty training after my urology residency. And yeah, the body is a complicated thing. Most of what I do today, I actually didn’t learn in training I’ve learned from people like you patients in my office. That’s where I’ve really gotten the valuable information.

Josh Simms  1:56
What was your fellowship in?

Dr. Amy Pearlman  1:59
In men’s health and prosthetic urology and fertility reconstruction.

Aaron Tharp  2:04
So from in a very general sense, I have a burning question that I have to ask, but we have to just

Dr. Amy Pearlman  2:10
You should see a urologist.

Aaron Tharp  2:13
Wow, that’s something good to see. Okay. So just in medical terms for the listeners, what what is Urology and what do you specialize in? Exactly?

Dr. Amy Pearlman  2:25
You’re right urology is the study of the genital system and the urinary system in all genders. We think about urology perhaps as being only for men. But everyone has or for the most part has kidneys and bladders, and ureters and genitalia. And actually, a lot of the work that I do within urology is caring for our transgender patient population. So really, anyone along that gender spectrum, we think about the urinary system as being from or the genital urinary system as being anything from the adrenal gland to outside of the penis, you know, but, but really, it starts even higher than that, from from the brain to the tip of the, you know, your rethrow per se, because a lot of the signaling, well, that comes from the brain even higher than the adrenal glands.

Aaron Tharp  3:16
Yeah, so and we’re gonna get into that, because there’s, that’s obviously a big component. And I think it gets it gets widely overlooked, right? That the fact that there’s a lot more going on North. So we’re gonna get into that. My burning question is, what what attracted you to this specific branch of medicine? What is your What is your why in pursuing this, this branch of genitourinary health? I had this practice that, but tell us tell us about what led you here.

Dr. Amy Pearlman  3:51
I like talking about sex and sensitive subjects. And people think that the stuff that I deal with on a daily basis are Oh, my God, why would you want to talk about it, and you see genitals and penises and vaginas all the time, who would ever choose that job? The reality is when you think about all the different topics that are taboo and sensitive, well, let’s name some of those weight, whether someone is overweight, normal weight, underweight, death, and dying, cancer, all of you know all of those topics are sensitive drug abuse, domestic violence. And so when I think about the stuff that I get to talk about on a daily basis, most of what I do makes people feel better, both about themselves and about their relationships. I have a lot of tools in my toolbox. That’s why I feel really lucky to because for a lot of what I do, there are very few people that I can’t help. But that’s based on the 1000s hundreds of 1000s of people who have put in the research, development time and resources to create those tools. And I have those tools at my disposal. So I feel like I can help them A lot of my patients, but when I talk to trainees and they’re trying to figure out, you know what sub specialty within urology they want to do or even medical students are trying to figure out what they want to specialize in. I tell them, what do you like to talk about? What do you want to talk about 30 to 50 times a day, several days a week, and that should be the field that you go into. Because even though there are other types of surgeries that I like to do, that’s where the majority of my time is spent. The majority of my time is spent sitting down with patients, talking about those meaningful concerns that affect their quality of life, and educated community members.

Aaron Tharp  5:38
Very cool. Very cool. So you talked a lot about the patients that you see and being able to help them. And obviously, it’s something that you’re really passionate about, I wondered if you could kind of talk about the patients that you see, you know, what is their age range? What are the symptoms that they’re experiencing? Like, how do they arrive? How do they arrive in your office?

Dr. Amy Pearlman  6:04
Yeah, I would say it takes a lot of courage for a lot of the guys to end up in my office. And, you know, part of my goals are doing, you know, podcasts like this are to say, Hey, man, you’re not alone, you have the same concerns of everyone walking around as undergrad campus. You know, I see the pictures of health in my office, I see athletes and former athletes and engineers and, and farmers and, you know, I really see the whole gamut from late adolescence up until men in their 90s. And the questions are all the same, which I think is is kind of surprising. They’re worded a little bit differently. People use different terms and their phrase a little bit differently, but they’re all based on the same questions, which are, I’ve noticed something different. Am I normal? Is this just due to age? And is there anything you can do to help me? But you know, I have 70 year olds that are asking the same questions as my 20 year olds having to do with their genitourinary system. My hope is that they don’t wait until they’re 70 before they get those answers, you know, just because we have all those different tools that we can use to help them. So the common things that I see in my office, and I like to turn them the five S’s of men’s health, sex streams, steroids, sperm, sleep, you could even extend that to say size, and sex reassignment surgery to name a few others. But really having anything to do with how the penis works, orgasm, ejaculation, urinary system, and the penis in general.

Aaron Tharp  7:39
Yeah, the five or the seven, almost eight S’s that pretty well covers it, I think, be honest. Okay, so now that the big Cornerstone here, the big thing is, how do you get them to really open up? Right? That’s a wide age range. And you said you don’t want them to wait till they’re 70. This is a pride thing. This is something that you’re obviously very versed in, apart from knowing that you have really good tools, resources and coping strategies for to get around this stuff. How do you get them to really just open up and be vulnerable and honest about it?

Dr. Amy Pearlman  8:20
I verbalize those scary terms before I make the man do it. And I’ll give you an example. I can tell for the most part why someone is coming in to see me it’ll say in their chart, erectile dysfunction, premature ejaculation. Sometimes it may say something else, and they’re coming in to talk about a different concern. And so what I’ll do is, you know, walk into the room, I used to do a nice handshake. But now well, you know, maybe do a nama say, you know, sit down, um, and I introduce myself and I say, Hey, I’m Amy Perlman. I’m a men’s health specialist. I understand you’re coming in today to talk about sexual health concerns. Before we get into the reason for today’s visit, why don’t we just get some basic information out of the way? So what medical problems? Do you have any issues with diabetes, high blood pressure, what prior surgeries have you had? So I tried I don’t do this all the time. But I try to talk about those topics that are not as sensitive. So let’s just get the basic information out. Let’s start to develop that rapport. And then we’ll get into the reason for the visit. But But when I go back to that reason for the visit, I’m the one saying I hear you know, I understand you’re coming in to talk about sexual health concerns. So let’s talk about your erections any issues getting into or maintaining erections? Whereas as opposed and not to say that it’s a wrong thing to do and, and what we learn in training is to start always with an open ended question, but that can that’s not always the right answer. So if I were to walk into the room and say, Hey, I’m Dr. Perlman, what can I help you outlets today? And you get a guy in there who it’s already taken him two years, you know, to make him show up for this appointment, and then I’m making him sit in front of me I’m a young ish woman, okay. And I have to make that guy tell me that his penis doesn’t work. But so that’s not how I run my practice. And so all I just normalize it. Hey, man, what’s going on? What can I help you out with today? You know, I might add in some additional comments of, I don’t know if this is going to make you feel better or worse. But you know, this is your my noon appointment. I’ve seen 10 dues, verbalize the same concerns that you’re coming in today? And this is just a Wednesday? You know, and sometimes people are like, Oh, my God, you mean that my penile pain? I’m not the only one. And I’m like, No, I literally see that all the time. And I think that’s sometimes what people need to hear. The other thing that I’ll ask if, if I’m not sure if I’m on the same page with the person in the room, is I’ll say, What are you hoping to get out of today’s visit? And sometimes their response is, Doc, I want you to tell me, I don’t have cancer. Sometimes it’s I want you to fix my pain. Sometimes it’s I want a diagnosis. And oftentimes, it’s I want to know, all three of those answers. And that’s where we can also get on the same page. Because I can easily say, well, you don’t have cancer, you know, but if they’re looking for other things, it’s understanding what are your goals from today’s visit? You’ve already seen five urologist what what do you want to be different about today?

Aaron Tharp  11:21
Yeah, one of the things that really stands out to me about that because it’s it’s it’s your it’s, it’s really this fields biggest challenge, right? He’s getting, that’s the biggest hump that that we’re faced with is just to get be open about it. Be honest about it, right. And you mentioned that you call it out first, there’s a term in like negotiating, that I learned about where you leap. It’s gonna sound bad. But when you label the negative, you make it okay. You kind of give people an out when you label a negative and it sounds like you do that by leaving and doing that first. The other thing too, and I think it’s probably just as important, if not even more, is that whole Oh, I’m not the only one going through this. That is huge, as well. So it’s really cool that that’s the way that you lead with that. Because you can help a lot of people with that, with that approach.

Dr. Amy Pearlman  12:16
Yeah. And I think some people are surprised. I was talking, I was chatting with a patient of mine yesterday. And he said, Amy, the first question out of your mouth when I met you was how are your erections? And I was like, Steve, I don’t remember that being the first question. And he was like, yeah, it was the first question. Do you say that to everyone? I’m like, I have no recollection. I have no idea. Sometimes. Yeah, I probably do. You know, I think I think most people enjoy my candidness. And my openness, I have no doubt that there are some people who come in, and might be a little bit put off by how I interact with people, but I read the room. And if someone’s not picking up what I’m putting down, and maybe I’m a little too passionate and out there, I’ll certainly tone it down. So during the entire conversation with the person in the office, I I try to elicit my emotional intelligence, you know, and tailor my my, my word, my choice of words accordingly. The other thing that I found to be really useful is to create this digital footprint. And I’m like YouTube videos, for example, and a Twitter presence and an Instagram. And my hope is that with YouTube, and some of these other digital programming that I’m doing with, with webinars, for example, or that they can hear my message before they meet me in person, they can watch one of my YouTube videos where I’m demonstrating on something like this, demonstrating on the first visit, when you come to see

Aaron Tharp  13:42
what is that what do you got there? What is that? You’re just bringing that in?

Josh Simms  13:46
That’s a model.

Aaron Tharp  13:46

Dr. Amy Pearlman  13:49
This guy actually has, we’ll call him Billy, he has a penile implant in, okay. He’s a good model for how I do the physical exam. And I’ll outline that in the YouTube video is when you come in for the initial visit. These are the types of questions I’m going to ask you. This is what the physical exam looks like, so that people can prepare accordingly. You know, I certainly have some patients who come in and asked to do a physical exam, because they’re coming in with some general concern. And they’re a little surprised that I want to do the exam. And I’ll never force someone into doing the exam because that would not be the right thing to do. But also, I think, just guys, I mean, we as women, we’re so used to it, it’s like we go to see a gynecologist, they ask to do a pelvic exam. I mean, we’re not surprised by that. But a lot of men are surprised that we asked them to, you know, bring their bottoms down. So I think if they see that beforehand, they can mentally prepare, they can see what I look like my age, you know, that just helps them mentally prepare to go into the office. Okay, I’m going to see a young woman today to talk about my sexual health concerns. Now, I also realize that there are plenty of men who have no interest in seeing someone like me, right. And that’s why we have people of all genders to treat male sexual dysfunction and I’m so grateful that We have a diverse, you know, group of healthcare providers who want to see these patients. And and that’s my goal is like if someone doesn’t feel comfortable seeing me finding someone with whom they feel comfortable seeing. So I think there’s a healthcare provider for everyone, depending on who they feel comfortable seeing.

Aaron Tharp  15:19
You mentioned that I mean, this sounds like a plentiful network that they have available to them, in addition to the resources and the tools and the treatment. I’d venture to guess that you’re not only just treating or working with the patient, you would potentially be working with spouses. From a relationship perspective. Can you talk a little bit about that just outside of what you’re working with on an individual basis with the patient? Like, do you have other people that they work with her relationships and stuff like that?

Dr. Amy Pearlman  15:55
Yeah, absolutely. It’s one of the most important things I did when I started I was I created a referral network. And, and I’m humble enough in what my expertise is to know that even though I have a wide range of expertise, it’s also fairly limited. And I’m limited in terms of other aspects to I mean, I run essentially a Surgical Clinic. I mean, I treat a lot of medical conditions, certainly low testosterone, you know, no one’s going to surgery for that. But I am also a surgeon, and and even though I incorporate some counseling techniques in my office, like my expertise is not in counseling. And so part you know, I have several members of my team, I refer out into the community who are couples, counselors, and sex therapists and, and every person on in my network, I’ve sat down with either through zoom or in person, I understand like, hey, what types of patients do you like to see? And what is the access like in your clinic? And what are your conversations look like? because then I can match my patients, and give them recommendations on who I think they might gel with the most, you know, so I have like three sex therapists in the community. And depending on who’s sitting across from me, and they asked her recommendation, I might say, I think Aaron’s going to be your gal, you know, and I’ll give that person Aaron’s contact information. And in part, that’s one of my most important roles is to help advocate for my patients and find providers who can help each of their individual issues. You know, before COVID, it was nice, because a lot of the partners would come in for the visits. And I think for a lot of what we talk about, because it’s all quality of life concerns, it can be overwhelming for patients. And some of my patients come in, and their concerns are of erectile dysfunction, I’ve penile curvature, I’ve write testicular pain, I have low libido. And let’s see, I have lower urinary tract symptoms. And each one of those male specific, you know, concern is like a one hour conversation, because I will talk about everything from lifestyle modification to surgery for each one of those. And that is overwhelming. And so when a guy is coming in for the office, especially for that initial visit, nobody ever sat down with him to say, hey, john, we’re going to talk about your body today, this is how it works. So when he’s coming to me with those six concerns, I can’t like learn everything about him and talk about every treatment option and expect that John’s gonna be able to tell me what he wants to do about it. It’s just too much, you know. And, um, and so really, for that first visit, it’s just building that rapport of, you know, let’s, I’m just here to find out your information today, but also the partner sitting there, you know, for the partner, that partner doesn’t know what’s going on with John’s body either. And so what’s really nice when both parties are there, because if john hasn’t been able to get good erections, I think it’s nice for Sally to hear that it’s not her, it’s not that he’s not attracted to her anymore. It’s, it’s, hey, let’s let’s talk about, you know, your reptile tissue and what needs to work well, in terms of blood vessels and veins in order to you to get an erection. And Sally, it’s not you, and you’re hearing that from a doctor, you know, but the other thing too, is, you know, partners can be really good advocates for their loved ones. And, and well, or the guys who have partners, advocating for them, they are the luckiest ones. Because, you know, they can go home and talk it out and vet it out. And oftentimes the partners, at least from what my patients, they are the ones who make a lot of these decisions. So now I might have the partners on the phone or through a video visit. But I think part of my role, and being a woman in men’s health is to really advocate for the partner. And you know, one example I can give for that. It’s like with penile implant surgery. You know, I have some guys who think, oh, once I put a penile implant in them, all of a sudden their partner is going to want it all day every day. And I have to sometimes sit down with those guys to say, it’s not all about the penis. And there are ways that you know that your partner might want intimacy that is not necessarily you know, vaginal penetration but

Also, I think being a woman, it helps me tell the guy like, Hey, man, your penis, it’s good. Like, you got plenty like from a woman’s standpoint, you got plenty of length, you got plenty of girth. I know, it’s not what you’re used to when you’re 19 years old, but the vagina is not that big. And so that’s where I think I can also play a role as a woman, you know, talking to a man in the office, you then lastly, I think some men just want a little female attention. And I don’t mean that in like a seductive, creepy type of way. I just think that men, especially if they get older, if they don’t have a partner, they men actually want to talk, they have a lot to say they just never been given the stage to say it. And in my office, I allow them that stage.

Josh Simms  20:42
I think that’s great. I think I’m a huge advocate of my patients, when they when their wives come into the clinic with them for a couple reasons. One, because it’s I was telling me, this is a team effort. This is both of you this, this is affecting both of you why you’re here. And then and then the wife is women are just better at opening up and they’re willing to talk and I kind of use them as like a truth room sometimes. Like, okay, so thanks, Bob. That’s not okay. Do not tell me is that does that make sense to you? And we’ll kind of go, yeah, they’re not really. And so it’s, it’s actually really helpful because you because they want their husbands to be better, and to feel better and to function better. And so it’s like, when you can get both people on board. I feel like the success rates higher and you symbols come in and in two months, and everybody’s happier. And it’s it’s awesome. That’s great. I love it.

Aaron Tharp  21:30
You mentioned COVID, early on a few minutes ago. And we don’t have to go too far down that road. But I’m wondering how this has gone for you in the past year, because things have moved has been more like telehealth, like how do you? How did you How have you overcame this in your in your line of work over the past year,

Dr. Amy Pearlman  21:50
over the last year, I mean, I had to cancel a lot of my elective surgeries. But a lot of those patients, I mean, we ended up you know, rescheduling probably most of those after we’re able to get them back on the schedule, I would say you know, COVID gave me some additional time to be a little bit more creative. That’s where I spent a lot of time building the digital content so that I could still educate my patients, even if they couldn’t see me in person in the office. And now it’s really helped me even for patients who see me in the office, I can say, Hey, we’re going to talk about a lot today. And sometimes you just have to hear it several times. So why don’t you go to my YouTube channel and just watch this video a few more times. And I’m giving them the message, you know, it’s all the same shared message. So it’s not like conflicting things here from what they see in the office. And then if I direct them to someone else’s video, it’s all a similar message. And so I would say, you know, COVID, also for I do a lot of research. And it kind of forced me to think more creatively about how I was going to enroll patients in research studies. And and the nice thing about having a being able to do things like on online surveys is you can reach a global audience. Whereas you know, as in person, if I’m enrolling patients from my clinic, I’m limited to the patients who see me in clinic. And when you use platforms like Reddit and closed Facebook groups, you get people from all over the country and all over the world. And I think it’s a much more meaningful experience.

Aaron Tharp  23:19
Yeah, I couldn’t agree. I couldn’t agree more. I mean, so is speaking of like, testosterone replacement therapy or TRT? I guess, is that the common first stop for for people before they come in and see you the first time is maybe Is it the bend the first line of defense? Talk? Can you can talk about that a little bit?

Dr. Amy Pearlman  23:44
Yeah, you know, I get a lot of people coming in saying I’m concerned that I have Low T. And but that’s not really their concern. their concerns are I’m tired. I’m 35 Is this the best it’s ever going to get? Did I reach my peak when I was 22 in college, I am working hard during the day, but I’m exhausted when I get home. And I have two kids and I want to play with them. But I can’t and I want to help my wife in the kitchen cooked dinner, but I’m too tired. And my sex drive is down a little bit. My reactions aren’t quite what they used to be, but I guess I’m 35 and I guess this is just what it’s gonna be like. And so when but they Google that or they see you know, direct to consumer marketing and so they label it as Low T but they’re coming in with the concerns that everybody have. You know, it’s just men have never had an opportunity to be plugged into the health care system. We as women get plugged in for the most part pretty early out of necessity. I mean, I remember when I was probably 17 years old, and my mother said Amy, it’s time to see a gynecologist and I was like you know, I like that and you you dread that visit leading up and you know, up to that visit but I was plugged in. So whenever you know when Go to see a provider, whether it’s because they start their period or they’re going through a pregnancy, they have someone that they see on a somewhat regular basis where they can say, hey, Doctor, I noticed this change in vaginal discharge, or I noticed this change with some lower abdominal pain. What do you think is going on? So we have milestones in our lives. And I guess my question for each of you are, what is the male milestone equivalent? That that the guy says it’s time to see a doctor?

Josh Simms  25:30
That’s a good question. I think it varies from, like, it’s just a question from like, an age standpoint or like, symptom standpoint?

Dr. Amy Pearlman  25:39
Yeah. I mean, it’s like what happened? In you life that says, when it’s like, you got to see a doctor. I mean, it’s when you develop symptoms.

Josh Simms  25:46
Sure. Yeah. I would say it’s fatigue, or the big one is low sex drive. Yeah, guys really strict, they get pretty sideways about that.

Dr. Amy Pearlman  25:55
And then because because when you look, you know, on on TV, and pornography, men aren’t supposed to have low sex drive. And yet, it’s what fills both of our clinics. And not to say, you know, it’s not always something that we need to treat. It depends on how bothersome it is. But some people are just like, Is this normal? Like, aren’t I supposed to be like a vigorous man in the bedroom? And? And I guess, yes, to know, you know, it kind of changes depending on what’s going on in that person’s life. But there are no real milestones that that the man says, Okay, I need to see a doctor. So they come in when there are symptoms, and a lot of these symptoms are common, but it doesn’t mean that anyone has to suffer with them. And I think just men don’t necessarily know how to verbalize their concerns. I think some men come in and they they are overweight, and they want to lose weight. And they don’t know how to verbalize that to their healthcare provider, saying something like, Okay, I’m 35 years old, I work out five days a week with cardio, and I lift weights, and I kick it this darn 10 pounds off. And five years ago, if I just skipped a meal, I would lose five pounds. And so what happened over the last five years, and when guys are working out hard, and they’re trying to eat healthier and and do what they need to do on a daily basis, and they’re not seeing changes in their body. It’s frustrating, right? And so it’s like, you kind of label that as I’m worried about Low T in reality, you know, your concern is I want to feel better. I want to make some gains at the gym because I’m putting the work goddamnit you know,

Aaron Tharp  27:24
Yeah, you’re, you’re speaking you’re speaking right to my heart here. Because I’ve been I’ve been on testosterone now for a year. And I was super, super stubborn about admitting that, hey, I this is probably affecting me. So I tried to eat my way around it Sleep my way around it, deadlifts, sprints, the stuff you buy at GNC, I tried everything, and it just turns out that it was a genetic predisposition. So I just had to like, okay, pride, it’s time to, you know, go to take a break. And it has been best decision that that I’ve ever made, honestly, but

Josh Simms  28:06
I think it started as a step. And I think, you know, it’s interesting that you say, like, people come in with a problem. And there’s this label of Low T. And I think one of the things that guys, as you know, my generation 35, even a little bit older, you know, you’d sit around, you know,

Dr. Amy Pearlman  28:20
Oh God, I didn’t know you were 35,

Josh Simms  28:21
I’m 37, I’m 37.So

Aaron Tharp  28:23
We should had her guess, that would have been fun.

Josh Simms  28:29
So but you have these guys come in, and I think they’re just used to seeing dad kinda as they kind of got older dad would do a little bit less seat, sit on the couch, and he doze off at 530 After dinner, and that’d be in bed at nine, he’d maybe wake up at four and go back to sleep, and they just can’t Well, it’s just part of getting older, right? And then it starts to happen to us. And you’re like, slowly, it will sometimes it’s quickly though that’s, that’s the hard part is sometimes it is a slow burn, sometimes it’s a quick turn. But I think guys want they want they want to, I guess you could say a diagnosis or label or reason or what what’s going on. And so that Low T thing. While it’s kind of a cute term, and it’s a little frustrating as a as a provider, because like, yeah, potentially, but like, you got real issues in your life. And you you obviously are not enjoying that. Like we can define Low T all day long. What is that to you? What is that to me? But hey, let’s talk about what’s going on with you why it’s happening and what we can do about it. And I think it is really helpful when guys do actually come in and they see and we can show them objective data that their testosterone is not, you know, they’re otherwise healthy, but their testosterone is low. And then we can develop a treatment plan for him and they can respond to that. I think that’s I think that’s a really good point that you brought up of the Low T label. But then there’s actually a whole lot under there-

Aaron Tharp  29:40
It’s multifaceted.

Josh Simms  29:41
Yeah, tip of the iceberg type stuff.

Aaron Tharp  29:42
Probably as providers, I can’t-

Dr. Amy Pearlman  29:44
have that concern in a way that doesn’t embarrass them, right. So they can easily call up and say, Oh, I’m worried about Low T, rather than I’m worried about my strained relationship, my reptile dysfunction, my low libido so it’s a it’s just a door for them to know Walk into, you know, and there are so many doors that men enter into to get into the healthcare system. And so we who specialize in men’s health, we have to take advantage of the door that some of these men will walk into to say, hey, you belong here, too.

Josh Simms  30:14
I agree.

Aaron Tharp  30:17
So, one of the one of the things that I want to talk about is, or ask you about is, I think that there’s a general tendency for us to focus on what’s going on below the belt buckle. It’s all in the pants, right? But can you talk a little bit about what else is going on? Like maybe in the brain and how things are talking about the whole system? If you would?

Dr. Amy Pearlman  30:42
Yeah, so usually what I see and I do some infertility, but most of it is a signaling problem. And we can, we can look at that based on lab work. And we’ll usually check if we’re working someone out for hormone concerns, we’ll check like a total testosterone level, if that’s low or low normal, then we’ll check some additional levels to figure out where might the problem be, the level that will check after testosterone is going to be something called luteinizing, hormone or Lh. And depending on what that level is, that’ll tell us is it a testicular problem? Or is it a signalling problem? If that Lh number is high, then it means well, the brain is trying to signal it’s just the testicles are not producing. So that means that person has a testicular problem. And that could be from a genetic disorder, that could be from an infection in the testicles, like mumps. orchitis, if they had mumps involving the testicles, when they were young, could be from chemo or radiation therapy could be from having a history of testicular cancer or any sort of Squirtle or testicular surgery in the past, those are the more common ones that we see. But for the most part, it’s actually rare in my office that I see the primary testicular problem, most of the time that Lh number comes back as within the normal range or low normal, which means that even if that Lh number is normal, that’s actually an in appropriate response to a low testosterone level. If the brain sees that low testosterone level, that pituitary should say, Hey, we got to ramp up production to stimulate down below, so that Lh should go up. So if it’s normal, or low, that is a signaling problem or a pituitary problem. There can be a lot of reasons to have a pituitary problem. Most of them, we have no way of saying exactly why someone has a signaling problem, even though that’s most of what I see. It could be from a traumatic brain injury, it could be from a recent illness from obesity, you know, really any other sort of CO morbid condition can affect that. And so even though we say it’s a signaling problem, we can’t really diagnose it for you know, any more than that to say, this is exactly what caused it. But those are the majority of the patients that I see. And then we’ll check the prolactin that’s another pituitary hormone. And that’s indicated if that Lh level is low or low normal. So most of the time I’m checking a prolactin because the Lh is usually in that range anyway, I also check a baseline estrogen level because estrogen is really important in men, me, you know, as as a female, I have testosterone and estrogen, but my major sex hormone is estrogen in men, the majority of that sex hormone is going to be testosterone, but some of that testosterone gets converted to estrogen. And when that estrogen is out of whack, perhaps we put someone on testosterone therapy and we drive up that testosterone level. That’s really where we see a lot of the bothersome side effects, mood changes, breast tenderness, breast swelling, acne, fluid retention, flushing, just kind of feeling crummy. And so I will usually check that baseline estrogen level as well, just to see where we’re at in case I’m going to start someone on something like an aromatase inhibitor from the beginning. But the point is, we’re checking all of those other hormones to get a better sense of what are the other signaling mechanisms going on, that might be affecting the testicles as the main driver or producer of testosterone production. Now, other things that cause signaling problems are going to be things like stress. Now, if you were to ask most men, do you feel stressed out? Do you feel depressed? Do you feel anxious? Most men won’t know what I’m talking about? Or they might say no, it just because a lot of men, they don’t think about it that way. You know, if you were to ask a 22 year old athlete, do you feel stressed out? He’s probably going to say no, but if he was studying the previous 10 hours for a big exam, and he has a gymnastics meet this weekend, in some way, shape or form, he’s probably feeling some level of shame. stress. The other thing too is we are just so used to this chronic state of stress that we don’t know when we’re stressed out anymore because it’s become such a chronic problem. But stress, and anxiety and frustration and excitement and happiness, those are all chemical signals that they’re neurotransmitter reactions that are going on, that are sending signals to other parts of our body. And that’s why when we say that stress increases risk for things like heart disease, it’s not stress in and of itself. It’s that stress increases cortisol and all of the downstream effects that then increase heart disease, but that can also have an effect on the testicular production of testosterone.

Josh Simms  35:43
I think that’s great. Yeah, I try to explain that to guys all the time, especially guys that are even on treatment. So kind of the two biggest killers of your testosterone, outside of, you know, genetic abnormalities or trauma is stress and sleep. If you’re high stress all the time, and you don’t sleep. It’s just it’s an it’s an uphill battle, even when you are on treatment. Because your body just chews through that stuff so fast. And if you’re not on treatment, it’s it’s just a vicious cycle of I’m stressed all day and tired all day. And then I don’t sleep well, because I’m stressed all day. And so there’s we do discuss those lifestyle modifications and stress management. And it’s easier said than done. But yeah, I think that’s a really important point to bring up.

Aaron Tharp  36:21
So we’re talking

Dr. Amy Pearlman  36:22
The ones that really do well is when they take all of it, let’s say they meditate, or they practice mindfulness. Like those are the guys where testosterone therapy can really be game changers, because they have a handle on all of these other factors, where I see that my patients don’t get the benefits of testosterone that they’re crossing their fingers for, or when they have high blood pressure, that they’re not controlling and diabetes that they’re not controlling. And let’s say they’re a firefighter, and they have a poor sleep schedule. It’s like, I can’t fix those things with testosterone.

Josh Simms  36:55
Yep, those are good conversations that we have. And, you know, the the just managing comorbidities. I always tell guys, like, yeah, if you have sleep apnea, and you’re not treating it, we probably should consider one stopping does does wrong, because it’s only gonna make it worse. But then two, it’s like, How much money do you want to waste and time and energy? Because if you’re not sleeping, and especially if you’re not breathing, when you’re sleeping, like you’re never gonna respond to the treatment, so, and I always tell them, I’m like, you know, what, if this, if this made you lose weight and made you feel like Superman, like there would be a line around the block, like I would never be able to close and I’d fly to work on a gold plated helicopter. But you still got to do this stuff for yourself. Like you have to get up and do the work. You’ve got to eat, right? You’ve got to do those mindfulness exercise, stress management, and you will optimize, you’ll need less testosterone to get a better response. And you’ll feel better around the clock. I mean, nobody wants to hear that. But it’s just, it’s just the way it is.

Aaron Tharp  37:47
We love a quick fix.

Josh Simms  37:48
I know. But that just didn’t lie. It’s true, but just in life. [Sure], you know, if you just eat well, and exercise and sleep, takes care of a lot of problems. So

Aaron Tharp  37:57
I have a quote here that I read from an article and I think it’s from a few years back. So keep me honest here. But I believe this is something that came from you. “As a community of urologists, I think we all understand the important roles that we play in our abilities to provide accessible, streamlined care to our patients. These unprecedented times call for on press on precedented educational opportunities, if we hope to encourage the next generation to pursue fields in urology. Now more than ever, we have an eager and captive audience wanting to learn what our field and specials have to offer. I’m saying yes to all the teaching opportunities. And I hope you do too.” Here’s my question for you. We know that you’re saying Yes. How do you get your eager and captive audience to say yes. Did I get you, did I stump you? Yeah, I thought I had thought I stumped her.

Josh Simms  38:58
Give her a hot second bro.

Dr. Amy Pearlman  39:02
That article was in posted in the urology times, and it was promoting some of the educational that I work, the educational work that I do for physician assistants. And there’s no other group of providers that I am more passionate about teaching than PhDs. And let me give you some-

Aaron Tharp  39:22
Physician – single.

Josh Simms  39:23

Dr. Amy Pearlman  39:26
We are, you know urologists, a lot of us, not me in particular, but are going to be retiring in the next few years. So access is going to be a problem. But even more than that, I’m a surgeon, and a lot of my colleagues and the people that I trained with, we like to operate, but most of what we do doesn’t need a knife. It’s just some subset of that population. So when I think about the people that I’m interested in training, My mission is to educate people in a way that they can work at their highest level of licensure. In order to do that, you have to define what that highest level of licensure means. So in my clinic, when I treat urinary symptoms, and low testosterone and Peyronie’s Disease, and erectile dysfunction, most of those conversations and treatment options don’t require an operating room, which means pH and NPS can take most of my patients through that entire conversation. And then I really only need to be involved if they need surgery, which means I can work at my highest licensure of operating and enrolling patients in clinical trials and writing research grants, and educating people and educating other providers. And it also allows the nurse practitioner and the PA to work at their highest level of licensure, which is education, community education, doing procedures in the office. And, and so I realized that, you know, and, and the fun thing about teaching PhDs as well, is that they don’t want to be in the operating room doing the surgeries that I do, they want to master the clinic visit. And I want to work with people that want to talk to my patients, because my patients want to talk. And that’s the beauty of working with, you know, PhD’s and NP’s is if you find the ones that are interested in talking about men’s health, then everyone wins, the provider wins, the surgeon wins, the patient wins, and that patient’s family and friends win. So it’s just really finding the people who want to have these discussions with patients, and to take them through the entire treatment process. So that article with kind of a call to action to people like industry, industry to say, you know, hey, you have this product for Peyronie’s Disease, and you’re reaching out to surgeons like me trying to get a surgeon to leave the operating room to do procedures in the office. And my call to action was you should go to the PA’s and NP’s and teach them how to do it. You know, and it’s called the industry to you know, companies like Boston Scientific, you know, to say, hey, it’s really important to educate people like me, and urology fellows. But let’s see how we can also educate PA’s and NP’s.

Josh Simms  42:22
That’s awesome and i’m gonna-i’m gonna agree with you and thank you for the advocacy because that’s huge for me as a pa but one other thing i think that needs to be clarified or cleared up there is that the sense that I get from you is that you don’t you don’t want to use a pa and np as somebody just to do the scutt work in the clinic i think it’s a good way you know because there’s always the there’s always the argument in the pa community about the name right and i think you truly use the the term probably better for you would be something like a physician extender they’re they’re taking your place in clinic as the physician not not I’m not going to call myself a physician but again doing the physician extension doing the clinic work helping with that doing the in-clinic procedures and then like in a really big case if you didn’t have anybody you could pull a p into the or but likely not obviously because there’s plenty of residents and things to teach and I think that’s awesome because it really does because you don’t need to be there to kind of micromanage and it really does allow pas and NP’s to practice at their highest level of licensure gives them autonomy and that’s awesome and I think you know I think the University of Iowa where you’re at is probably the best place for pa education because they work with the med students in school and then so the docs who are residents are like oh yeah I’ve been with the pa for two and a half years already like I’m used to them I understand that and I think that’s-that’s awesome from the standpoint for my from my viewpoint I think that’s fantastic because it really does it really marries that relationship much better than some older docs who don’t really see pas that way

Dr. Amy Pearlman 44:12
Yeah we’re all taking care of the same patients and there are plenty of patients out there I mean even within you know our-our local area here around my institution I mean we’re barely even taking care of the men within our system already you know so there’s-there’s no competition at all in any way shape or form it’s all the same patient that we’re trying to take care of and my job is to educate people and then get out of the way and not slow people down because you know um I’m there as a resource but most of what I do can be done by people who are well trained and passionate

Aaron Tharp 44:47
Yeah you’re speaking right to josh’s heart here because this is right in his wheelhouse he’s very this is how he came we came to the same table about men’s issues is because this is his world and he cares deeply about talking about men’s issues so we really appreciate your time today um we know that you’re busy and you’re obviously doing a lot of really cool things for men where can our listeners go to learn more about you and find out uh more about what we’ve talked about today

Dr. Amy Pearlman 45:16
Probably the easiest ways to find out some of the content and what I’m up to is I have a twitter page which is @AmyPerlman1, I have an Instagram, which is I’ll look it up here in a second-


Josh Simms 45:30
How do you spell your last name?

Dr. Amy Pearlman 45:31
Amy Pearlman MD and my YouTube channel you can just search Amy Pearlman. A lot of what i do with that YouTube channel is just reach out to other providers in the community to reinforce the really good work that they’re doing and uh so you can look out for some of those videos.

Josh Simms 45:45
So can you spell your last name, so people are go to the right page they’re looking for

Dr. Amy Pearlman 45:46
So uh like pearl and then man, p-e-a well

Aaron Tharp 45:47
We’ll-we’ll post the links if you’re cool with that we’ll just post them like we’ll lay them over the video um that’s all we have but uh again thank you so much for your time and um for what you’re doing for men’s health it’s incredible we’re deeply grateful.

Josh Simms 46:08
Yeah, thank you for your time doc we really appreciate it this is awesome.

Dr. Amy Pearlman 46:10
Awesome y’all have a good night!