Jose Silva

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But

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And I think, just like you mentioned, I think that's the perfect analogy about the heart. Some people don't understand that. In every cubicle I have pamphlets that they show the damage of the bladder. They seem to understand that. Those are the best pictures. Yeah, we love those.

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And sometimes they do get a little bit of improvement with Flowmax, for example. And because they do get a little bit of improvement, they get used to being so bad that just a little bit of relief is good enough for them. But they don't understand that the damage will continue, that bladder damage will continue.

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Yeah, that guy with 150-gram prostate that said, I'm perfect. But, you know, you do a cystoscopy, severe trabeculation, I mean, definitely you're not perfect. RP, when do you start talking, or Nicole, when do you start talking about possible procedures to the patient?

Right now, I mean, I see a lot of patients, Europe is doing a good job, I guess, getting the information out there because I see a lot of patients asking for it. But then when you do the testing, I mean, trilobal prostate, intravascular compound, hey, you're not a candidate. So, yeah, so like you mentioned, and you mentioned you give them like a brief pamphlet of everything or...

Okay, so the patient has BPH symptoms, is obstructive. Then describe that process of deciding. Are you guys doing procedures in the office or strictly in ASC? It's a mixture.

Give your patients an alternative to daily medications and long-lasting BPH relief with resumed therapy. Now, back to the show. This is Jose Silva, ASIUS host this week, and I happen to introduce Dr. Arpit Shah and Nicole Hollander,

And those are the things you talk to with the patient. We have this in the office, you're a candidate versus something a little bit more invasive, which will be in the hospital. And you start deciding what's the process and going through that.

No, definitely. I mean, I do some resumes and the patients do great. As a surgeon, you don't see that instant gratification of the whole, but definitely you just have to trust the technology and let the prostate shrink because it will, it will shrink. How long are you leaving the cancer?

Dr. Cha completed medical school at the University of Illinois at Chicago College of Medicine, then did residency also in Chicago at Loyola University Medical Center, and proceeded to do a fellowship in endorhology and minimally invasive surgery, also at Loyola University. He currently practices urology in the greater Chicago area.

It's either that or nothing. Keep the catheter. And Nicole, are you the one seeing the post-op or who's seeing the post-op?

And let's say you have a patient after any procedure of BPH starts getting overactive bladder symptoms. Are you treating them or they're going to Dr. Chow?

And I agree. I just ask him to see what you do, because most of the time, even though you explain the patient what to expect, some of them, they think they're going to wake up like nothing happened. And, you know, so I just wanted to know, how do you deal with those more difficult that are trying to say, hey, you made me worse?

He is part of associate urological specialist and is the director of APP program at the group. Nicole Hollander is an advanced practice registered nurse who specializes in urology. She earned her BSN and MSN from University of Miami. And she's a board certified family nurse practitioner and is also part of the urology associate urological specialist. Nicole and Arpit, welcome to Backtable.

Yeah, I sometimes find myself just doing a prescription because sometimes it's just easier than just continuing repeating myself. Go ahead, Nicole.

No, I guess sometimes that happens. I mean, you have the guy with a big prostate and they're perfect. There's no way of predicting who's going to be having miserable symptoms afterwards. It would be great to know beforehand, like if the Uroco or something will predict who's going to be bad afterwards or who's not, but maybe something for the future. So, Arpit, let's go back to the program.

You mentioned that you have four pillars of your EPIPRO program. How do you evaluate clinical excellence, compliance, productivity, career development?

All right, Pete, let me, I mean, do you have to go to their chart and look at it or do you have something in your EHR that can detect those things?

Thanks for having us. No, no, it's going to be good. So Arpit, I was reading your website and I saw that you're the director of APP program. So let's go on and dive into that. I mean, what does it mean? What it is? How did you create it? What happened? What led to the creation of an APP program?

And then when an APP is on board, I mean, do all of them pass through you or depending on what they want, they go to other providers?

And I mean, for us at Serology, I mean, we know what we got into and it turns repetitive. So, I mean, we do the same thing over and over and over. We would try to keep up to date, up to times and try to use new technology. And that's the way that we keep engaged and not bored. But Nicole, I mean, for an APP, how does that look like? Just keeping engaged, challenging yourself?

So what's the idea to have BPH and RealMoon?

Yeah, but my APP says to us, Henry, and it's out of need, definitely out of need. And to keep her engaged, I don't have a program as structured as yours. I'm going to steal a lot of things that we talked today. But definitely, it really helps. And like you mentioned, the way she grasps things so fast.

I have mentioned for us, 10 years of training, six, and then four of medicals, and then six of urology. And she grasps it very fast. So, yeah. So, the plan is to have Nicole start doing some cystos.

Yeah, I would say right now, I would say half of my patients, or not even half, but yeah, I would say half. Of the surgical patients that I see in the OR, Becky, my APP, she was the one that did the workup, and I mean, she's been flawless. And the patients are happy, and yeah.

She's been a great addition. I mean, she's... I'm new to this EIPP system. I was put it that way. But yeah, it's amazing.

And definitely for us, the idea is to not only have, I mean, we have talked about the BPH clinic, but really doing the body dysfunction and incorporate some women and doing the... neuromodulators that go on incontinent stuff. So, and have the entire world of the urinary system, in that sense. So our bit, anything else you wanted to add? I think we covered a lot. I think it was a great topic.

Anything else you want to add? No, I'm good. Nicole, anything else?

No, I mean, and this topic is all, I mean, thank you for sharing this. I wrote it to you in the email. I mean, this is great and it will definitely... change our practices for sure. I know.

And like you mentioned, I mean, also having the APP happy, keeping them up to the level, to the highest level possible to the licensure. and keeping them engaged and continue evolving together. Well, Dr. Cha, Nicole, thank you for being back table. I really enjoyed this conversation. Until next time.

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And Nicole, was this your first job?

And why urology?

And describe those first month, I mean, and Arpit, you can add some if you want, but definitely when an APP starts to practice, are you throwing to seeing patients or how is that process? Is it shadowing first? Just describe how your program is running.

And I repeat, are your APPs getting paired with a specific urologist or essentially is for them to grow and then target different urologists with the practice that specialize in any niche? Yeah.

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And Nico, was there any niche that you wanted to go into urology when you got on board or you just wanted to get a hands on everything urology?

And I'm going to ask you that question again in terms of Urocov, but so let's talk about BPH and Arbita. Can you go with the workflow of how a patient is evaluated in the office?

Boston Scientific is dedicated to transforming lives through innovative medical solutions that improve the health of patients around the world. This includes solutions for benign prostate hyperplasia, or BPH, one of the most prevalent urologic conditions facing men today.

And let's say when that patient goes to NICOL and it's a telehealth visit, is it the patient is in person? In person.

And repeat, let me ask you something about billing. I mean, are you billing for the Urocov on the day of the nurse visit? And is Nicole able to bill for the interpretation also? So you're billing for both things? Yes. Yeah. Yeah, we are. Nicole, so what are some of the questions that patients ask when you talk to them with the Urocov, after Urocov?

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I mean, are we talking about fornix rupture, permanent damage to the kidney? What are we really talking about?

Yeah. And we always, I mean, residency, I remember, because right now I'm alone in the hospital, but when I was in residency, there's multiple residents with me, different stages in their years. But essentially, everybody puts a little bit more pressure or the resistance of the ureter to everybody was very subjective. So for some, it was okay to push a little bit more.

For some, it was, if it didn't go out just very passively, they wouldn't put it. So That information that you're saying, just having that information, that actual life pressure, how much you're putting into the ureter will be very significant because right now we don't know.

And for me, I find it challenging in the sense that, for example, patients, younger guys that they don't have insurance, they come to the hospital, you want to try to do it in one shot and maybe you force a little bit more. So that means that the stent stays longer. So it's always a balance between that and, like you said, always the safest way is just putting a stand and going back another day.

This is Jose Silva, your host this week. Today we have Dr. Julie Riley. Dr. Riley is the Departmental Vice Chair, the Hall Black Breed Endowed Professor, and the Residency Program Director at University of Arkansas for Medical Sciences. Dr. Riley received her Doctor of Medicine with distinction in Community Service from St. Louis University School of Medicine.

So I haven't used the little Violet. I have used the first generation. I mean, you have the Saper monitor just as the old one, but you also have, is it attached to the same monitor or is it a Saper piece that you get the reading from the intravenous pressure? Or how is it? Because I haven't seen it.

So, I mean, the little view, the vision while you're breaking a stone is very good because with some of the reusable scopes, they might look great when you're just doing a nephroscopy. But when you start actually breaking stones and putting it to work, then maybe you don't get that great image as you do with the little view.

Yeah, and now the hospital is getting reimbursed depending on the insurance, but they are getting reimbursed for these disposable scopes. I have been more liberal or the hospital have been letting me use more of the disposables.

So, Julie, in terms of when you're there in the kidney and the uteroscopy that you do, how has it changed now that you are monitoring the intrarenal pressure versus before?

She completed her residency in Urology at the University of Missouri-Columbia, and continued her training with a fellowship in endurology, robotics, and laparoscopy at the University of Pittsburgh. She is on the editorial board of Urology Practice.

And you mentioned that you tried to put the sheath a little bit higher. And, I mean, if you're in an upper pole stone, upper pole calyx, it's much easier, but sometimes when you're going to the lower pole, that high axis sheath will prevent that urethra, urethroscope going down into that calyx.

Are you trying to move the stone to another position to be able to put the axis sheath, or that really is not that important?

Her clinical interests are surgical and medical management of nephrolithiasis, renal and utero reconstruction, BPH, renal transplantation, and clinical practice efficiency and ease of practice. Julie, welcome to Backtable.

So, I mean, before you were able to monitor the intrarenal pressure, I mean, is there a way to eyeball it for somebody that doesn't have access to a little view elite?

And I mean, are you using it? You mentioned that you sometimes use the other ones, but when you, if you're using it for a small stone, I mean, would you think the actual monitoring the torino pressure is important or is more for when you're going to be there a little bit longer?

And in terms of preventing stone, I mean, specifically when you're over-preventing infection when you're there, do you know in terms of time, I mean, is it going to be the constant high pressure that might lead you to infections?

Or, I mean, just trying to compare for the person that doesn't have access to the litivio leads, what they can do for that same patient if they're not able to monitor the torino pressure?

No, it's awesome. We're going to talk about uteroscopy, but I want to dive into reconstruction or stuff as well, knowing that background. So, Julie, like I mentioned, we're going to be talking about uteroscopy and new uteroscopes and... Just a little bit of the science when you go into a renal pelvis ureter. So in terms of ureteroscopy, I mean, who is a candidate? Who is not a candidate?

Yeah, sometimes I see, like you mentioned, techs that are not familiar with just pushing the water in, that they push it like there's no tomorrow, like they're going to blow it up. I say, hey, take it easy, take it easy.

And Julie, you mentioned it briefly, but I mean, what's the future like for ureteroscopy?

So you mentioned the ergonomics. So I've been, I will say, for the past six months, I've been sitting down for my arthroscopies. And yeah, I like it. I like it. I mean, I still stand up sometimes. For those big stones, I just sit down, stand up, and just keep moving. But yeah, my hand hurts. There's... I cannot trust the tech to give all the years to go for a while.

So yeah, but hopefully if we get things that make us, they make it easier, faster, break stone faster, like the suction, the vacuum and all that will make it easier for us to do big stones. And Julie, in your practice, you've been doing less PCNLs compared to before?

Because sometimes for those big stones, I mean, if it's a single three centimeter stone in the renal pelvis, you can do a PCNL in 30 minutes, 45 minutes versus two or three hours.

And in those patients with blood thinners, do you try to take the stent sooner rather than later or you treat them the same?

I had an issue once with a patient, but he had prostate cancer, and he had a severe radiation cystitis on blood thinners, and it was a mess. I mean, eventually, after a week, it was everything good, but that week was very stressful for me and for the patient.

Exactly, exactly. And he had another urologist, but he ended up in my hospital. Sure. So, Julie, I mean, anything else you want to add? I think we covered a lot of very meaningful things that you mentioned in terms of the knowledge of that intravenous pressure and ureteroscopy and all. Anything else you want to add?

Yeah. So, Julie, thank you for being on the show. I really enjoy this conversation and hopefully we'll talk again soon.

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And in terms of possible complications of ureteroscopy, I mean, this is probably the procedure that I do the most. I see a lot of stones. And when the patients ask me about possible complications, I really just talk about after the procedure, the stent, and what they're going to feel after the stent. But

I really never, I mean, other than blood infection for patients that might have a stone for a long time, but I really don't dive into more of the real complications or serious complications. So can you talk about a little of the complications when you are talking with a patient?

I'll definitely add that to what I tell the patient because I never talk about disease or stone. They always ask, hey, I'm going to have another one in the future. Well, if you already had one, chances are that you might have one in the future. So in terms of, you mentioned the infection, I mean, what things can you do to minimize infections?

Hello, everyone. Welcome back to Backtable Urology Podcast, your source for all things urology. You can find all previous episodes of our podcast on iTunes, Spotify, at backtable.com. Now, a quick word from our sponsors. Today's Backtable podcast is sponsored by Boston Scientific's Urology Division.

And you mentioned those patients after they already came to the hospital, you put a stent up. Let's say if those patients, sometimes it happens that the urine culture, even though they have the symptoms, the urine culture is negative. Do you have any preference on antibiotic?

And for those patients, let's say pre-standard, do you think there's a difference if the stone is in the kidney versus the ureter in terms of risk of infection or after the procedure?

In those patients, I mean, that is a very big stone, two to three centimeters. What's your ideal scenario? I mean, let's say the patient goes to the office, no symptoms of infections. Are you trying to put an access sheet on these patients? What are you doing with these patients that have big stones?

So you mentioned temperature, you mentioned intravenous pressure. How technology has helped to minimize complications when we're doing neutroscopies?

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And in terms of intrarenal pressure, what are we talking about? What's normal? What's abnormal? Where we're in a dangerous zone? And the other question will be, what do you use to irrigate the kidney?

And Julie, in terms of putting an anesthetist, now that you're actually seeing intravenous pressures, sometimes, I mean, let's say you have a one centimeter stone in the kidney. The uterus is very narrow. You don't want to take the patient again. And this is a patient that calls us outpatient, not infected. and you don't want to put a stent and then come back in another week to do it.

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So you go to the kidney, there's not that much drainage, and those patients usually then complain of back pain. I mean, hopefully they don't go into infection, but those are the patients that I see that are really having more pressure in the back in PACU. What do you usually do?

I mean, is that usually what you do, or you prefer just to put a stent and come back in another day, you can put an exit sheath?

And Julie, in terms of, you mentioned the balloon, if you do dilate the ureter, does it mean the stent stays longer?

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And in the time that you're using, being monitoring those intravenous pressures, have you been able to tell a correlation between infections at higher pressure versus non-infection at lower pressures?

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No, exactly. Yeah, yeah. So people out there that are not familiar to how we do this, they understand. Nassim, any difference from what Eric's mentioned or any insight or anything that you do differently?

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And if the patient asks, I mean, what are the possible side effects from this procedure? Nassim, what do you tell them?

And Eric, for patients that with big, big prostate that might already have some urinary symptoms, does it affect or does it make it worse, the urinary symptoms afterwards?

And I see we have the space overview and the regular one. How important is CT visibility to be able to see on a CT scan prior to the radiation?

For prostate cancer patients undergoing radiation therapy, maintaining quality of life may be just as important as treating the cancer. Minimize side effects, maximize patients' quality of life. Now, back to the show. Hello, everyone. I will go back to Backtable Urology Podcast. This is Jose Silva, your host this week, and happy to introduce our guests.

And Eric, how about your experience? Does your colleagues ask you for the view or one or the other?

So you mentioned already that sometimes you went even by placing it. So, I mean, you don't want to continue losing money. Nadeem, I mean, have you had that issue in your practice?

And how important is it for the spacer to maintain its shape? And for how long will you prefer it?

And for large prostate, you might want to do Lupron to trigger the prostate a little bit. I mean, does it matter?

We have Dr. Eric Chenven and Dr. Nassim Nasser. Dr. Chenven, he's a certified American Board of Urologists and is a member of the American Urological Association, American College of Surgeons, End Urology Society, and the American Medical Association.

So, Eric, did you run into that problem in 2021 or back with COVID that you had a few patients that you had put the spacer?

He did his urology residency at Robert Wood Johnson Medical School in New Jersey, then completed fellowship in endorheology and laparoscopy at the Thomas Jefferson University in Philadelphia. Dr. Chen then is the chief of urology at Broward Health Medical Center.

No, I absolutely agree. No, I mean, and that's why I asked one of the first questions. I mean, is this standard? Is it the way it should be? And I think the answer is yes. I mean, if it was my prostate, that's what I'd want. Of course. Long-term side effects. So you do the radiation. I mean, eventually the gel just continues to slowly dissolve. That's how it is.

I mean, if a patient asks, what do they tell them?

He sits on the cancer committee and the surgical quality assurance committee, where he was formerly also medical director for laparoscopy and minimally invasive urology. Dr. Nasser is a trained radiation oncologist. He completed internal medicine residency at Virginia Commonwealth University School of Medicine.

And Eric, in terms of your colleagues, the radiation oncologists that are sending you the patients for the spacer, are they giving you any specific instructions? Like, for example, Nadim said that he likes to do it himself, just depending on the size, depending on how it looks. It might vary.

So in your case, are they giving you some instructions on what they want or when they want the spacer to be placed?

So Nadeem, any special comment to urologists that are doing this from the radiation oncology side? What do you guys expect? Like every special in the apex? I mean, is there something specific that you want to look when you're putting the spacer?

He then went on to do his radiation oncology residency in Georgetown University Hospital, where he's still a clinical assistant professor. Currently, he's part of Arlington Radiation Oncology in Virginia. Gentlemen, welcome to the back table.

Why are you looking specifically for the fiducial markers?

So let's start by knowing each of your practice, essentially looking to see what's the relationship between the urology and radiation oncologist.

So, yeah, just like Nadim was saying, I mean, then you make the hospital assume the risk.

Well, thank you guys for the time. I definitely enjoyed this. Eric, hopefully you'll get some more support from other urologists in the community trying to make that happen. Send the letter, I think, if If we band together and everybody does their part and send the letter to the insurance, I mean, at some point, something is going to give and hopefully is for the best.

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Is it mainly urology-based, or what are you doing in your practice?

And Asim, as radiation technology gets more and more precise or more accurate, in the past few years, we have seen all the perirectal spacing. Is there a true need for perirectal spacing?

And Eric, who is a candidate for prurictal spacing? Is it any type of radiation or is it just some specific type of radiations?

Nasir, how about your practice? Are you doing periectal spacer for most everybody?

Any specific reason?

And Eric, are you doing your own or you're putting the rectal space in yourself or the radiation oncologist doing it?

Hello, everyone, and welcome back to Backtable Urology Podcast, your source for all things urology. You can find all previous episodes of our podcast on Apple, Spotify, YouTube, and on backtable.com. Now a quick word from our sponsors. Today's Backtable podcast is sponsored by Boston Scientific's Urology Division.

And Eric, there's two type of peripheral spacers out there.

Nasir, how about you? Same question. I mean, what's your experience with both regular spacers?

And for example, for patients, I mean, now you mentioned that type of patient, for patients that do a salvage after prostatectomy, are you using rectal space in those cases? No, there's no space. There's no space, okay.

Boston Scientific is dedicated to transforming lives through innovative medical solutions that improve the health of patients around the world. This includes absorbable hydrogel spacers that are intended to temporarily position the anterior rectal wall away from the prostate during radiotherapy for prostate cancer.

Yeah. You have an 8-gram prostate, 5-millimeter lesion. I mean, very difficult to get that lesion just cognitive. So definitely the MRI helps there. Nassim, where are you doing the racial spacing?

Yeah, the ones that I have done, and I'm not doing that many, most of them are doing by the rat on right now. I did them in the OR with IV sedation and the patient did good. So let's go and talk a little bit about technique. Eric, can you walk us through the procedure per se?

As a cash-only oral form of TRT, Kaisertrex simplifies the administration of testosterone therapy while enabling revenue generation for your practice. Discover how Kaisertrex can benefit your patients and your practice. Learn more at kaisertrex.com. Now, back to the show. This is Jose Silva, your host this week. And I'm happy to introduce our guest, the legend, Dr. Abraham Morgenthaler.

And so, Ryan, in 2024, how's that treatment evolve since 2004 in terms of injections, pills, or what were you doing first and then what are you doing now? Just go through the thought process of how you decide where to allocate each patient.

Dr. Morgenthaler completed his residency in urology from Harvard Medical School and then joined the faculty of Beth Israel Deaconess Medical Center and Harvard Medical School. He is currently an associate professor of urology at Harvard Medical School, founder and past president of the Androgen Society, and senior editor of Journal of Androgens Clinical Research and Therapeutics.

And doctor, you mentioned that the high peaks don't cause prostate cancer. We know that. But in terms of possible side effects, we know that the pills, they say that the peaks are less, the gels, the peaks are less, doing low doses of injectables versus the pellets, which you will get a higher peak. Is that true? Or what are you looking for when you start a treatment for testosterone?

In 1999, Dr. Morgan Taller founded Men's Health Boston, the first men's health center in the U.S., focusing on sexual, reproductive, and hormonal health for men. Dr. Mogenthaler is a leading international figure in the fields of testosterone therapy, prostate cancer, and male sexuality. He's a physician, an author, and a speaker. Dr. Mogenthaler, welcome to Backtable.

And in terms of side effects, I mean, it's mainly the same profile for all of them or, I mean, for example, blood clots. I mean, is that something to be concerned?

And doctor, let's go back to 2004. You just published the journal that essentially doesn't cause cancer. So how does you evolve into, hey, we have patients with cancer or prostatectomy, low testosterone, how do you start treating them with confidence? Or again, it was more or less same situation as when you were treating them before, like just very cautious. How did that process started?

Pleasure to be with you, Jose. So today we're going to be discussing mainly testosterone therapy and prostate cancer. So since you've been working with this, you've been a pioneer in this field, can you tell a little bit of the story in terms of the testosterone evaluation, labs and symptoms? How has it changed the way we treat testosterone in the past 30 years?

And doctor, right now, I mean, are you treating patients with active prostate cancer, active surveillance? Are you doing them on prostatectomy after radiation therapy?

And doctor, in these patients, I mean, you say you are around 20 patients, were they on ADT also or just they weren't getting any treatment for the cancer?

And doctor, for urologists out there that are still skeptical about patients that had prostate cancer, what is your recommendation in terms of starting them in any specific gels versus injections or pills, low doses, or do you just treat them as a normal patient?

I was there. I was there.

And, Doctor, going back to that active surveillance patient guy, any special considerations in terms of how to treat that PSA? I mean, would you treat it just the same as somebody that is not on testosterone? Or are you a little more concerned if you see that the PSA is going higher faster?

So it would be always good to have a baseline of your testosterone prior to treatment in patients with prostate cancer. I don't think it's being done, or at least I'm not necessarily ordering if the patient doesn't have the symptoms. But if at some point they develop the symptoms, it would be good to have that baseline.

But it matters for the quality of the life of the patient.

So, doctor, in terms of treatments, we have now multiple oral medications for testosterone replacement. Can you dive a little bit into pros and cons of these oral medications and a little bit of history in terms of why before they were bad and now why they're better now?

And doctor, just a parenthesis regarding, you mentioned the short-acting testosterone and the possible side effects, going back to a baseline. So going back to where we talk about the prostate cancer, I mean, so will that also transcribe? I mean, can you have a patient, let's say, castrated levels with ADT, and can you give them pulses, just short pulses of testosterone at least to get a boost?

And in theory, it should keep that low baseline castrated levels.

Because if it's work for fertility, I mean, it might in theory work also for, I mean, it won't change your, I would say, your constant, that high level, that constant level of testosterone shouldn't affect it that much in theory.

So that's great, doctor. So, I mean, I think we have covered a lot today. Any thoughts, any words to those young Uralis out there?

So, doctor, thank you for your time. Definitely thank you for all the, how you have done in the past. I certainly have helped the patients in our community. I see patients five, 10 years ago had parietal prostatectomy. Nobody has touched them with testosterone. They come just happy. And it's not, like you mentioned, it's not about sex.

It's about just feeling better, enjoying what they used to do and just the little things.

Well, thanks for being a guest here, and hopefully I'll talk to you next time. Great. It's been my pleasure.

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And 30 years ago when you started, when you finished residency, how was the landscape at that moment? I mean, how did you say, okay, I'm going to start treating patients or men with testosterone?

Hello, everyone, and welcome back to Backtable Urology Podcast, your source for all things urology. You can find all previous episodes of our podcast on iTunes, Spotify, and backtable.com. Now a quick word from our sponsors. This discussion is brought to you by Myros Pharmaceuticals, the makers of Kisatrex, testosterone on the canoid capsule.

Kisatrex is an oral medication indicated for testosterone replacement therapy in adult males for conditions associated with a deficiency or absence of endogenous testosterone. In a clinical study of men with low testosterone, nearly 9 out of 10 had normal testosterone levels after 90 days.

And this was still a random biopsy? What were we doing at the time?

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Our audio team is led by Kieran Gannon with support from Josh McWhirter, Aaron Bolz, Josh Spencer.

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