For the past 11 years, Brian Christine, MD has focused his Urology Centers of Alabama practice on men's sexual health with the Men's Sexual Health Clinic which provides treatment for patients with erectile dysfunction and other problems. This year, Christine established another clinic that treats patients with low testosterone.
"We offer state-of-the-art treatments for couples with sexual dysfunction issues. We take care of patients with low testosterone, erectile dysfunction, premature ejaculation, pain with intercourse, and other conditions," Christine says.
Eric Westerlund, CRNP, Director of the Men's Hormone Replacement Clinic, says many patients don't receive consistent treatments for their problem. "We focus on low testosterone to help patients with low energy, fatigue, and weight loss, among other things," he says. "We evaluate each patient and develop a specific plan for him."
While low testosterone doesn't affect every man, many suffer the effects of a drop in the hormone level. "We start to see it in men in their 40s. It's primarily a quality-of-life issue," Christine says. "The symptoms often include a decrease in libido, decreasing energy levels, and difficulty in maintaining muscle mass. That's when hormone replacement can be a big help."
Doctors commonly use testosterone injections once every other week to treat the problem. Other treatments that have been used in recent years include testosterone gels that are applied to the skin and testosterone pellets that are placed under the skin. Each of these treatments has pluses and minuses and should be discussed between patient and doctor. "We can't stop father time, but a man with normal testosterone levels will feel better and have a higher quality of life than men of the same age who have low testosterone," Christine says.
Often, there is an overlap in the hormone clinic and the Men's Sexual Health Clinic for erectile dysfunction issues. Laura Anderson, RN, is the senior nurse in the Men's Sexual Health Clinic where the staff helps educate patients. "We develop a treatment plan based on the specific needs of each patient," she says. "It's not just men's lives that we improve. Spouses and partners tell me how much they appreciate our help. We treat the couple as a whole and help them regain their intimacy."
Increasing age, medical conditions like diabetes and high blood pressure, pelvic surgery such as radical prostatectomy, and spinal cord injury all can lead to erectile dysfunction. "It is important for patients to know that regardless of the cause of erectile dysfunction, it can be treated," Christine says.
The treatment Christine uses most for these patients is implant surgery. "Most men who come to my office have already seen their primary care doctor or another urologist. They have tried treatments like Viagra or penile injections," he says. "Many have such severe erectile dysfunction that none of those treatments are helping. That's when I do a penile implant."
Christine says only about 10 urologists in the United States do the volume of penile implants that he does. "Few urologists do the surgery where an implant is placed into the penis completely," he says. "A pump is placed in the scrotum with a saline sac located in the abdomen. The implant is self-contained in the body and will give a rigid erection. Of all the treatments we offer, penile implants have the highest patient satisfaction ratings, because they are natural and allow spontaneity. For 95 percent of men with severe erectile dysfunction, the implant surgery makes a tremendous difference in their sex lives."
Christine emphasizes that while his practice is centered around a man's sexual problems, he would be remiss if he didn't also treat the man's spouse or partner. "Treating the man is only half of the issue. There is a couple involved, so we also treat any problem the partner may have," he says. "If I don't make it a point to ask both how they are doing, I may be missing a big part of the problem. I will never ignore the partner in that relationship."
Men's sexual health is an important part of medicine, and Christine looks forward to new treatments that may be available soon. "There is a lot of research under way," he says. "One day, for example, we may be able to inject testosterone directly into the penis to restore a man's erectile function. In the next five years, I think the next generation of penile implants will use batteries like a pacemaker, and we may have an app on our phones where we can tap a button to inflate the implant. These new devices will be dramatically different, more sophisticated, and more patient friendly."