Introducing The Billups Center & Precision Care for Men

How Is Our Practice Unique? from The Billups Center on Vimeo.

At The Billups Center, we successfully treat sexual health conditions. Sexual health conditions include Erectile Dysfunction, Low Testosterone, and penile curvature or Peyronie’s Disease. Our area of expertise and specialty is treating these conditions and we’re very good at it. We can successfully treat most men who come in with these conditions.

Our approach is different. We don’t just focus on your sexual health problem, we really try to get at what’s the underlying cause, why do you have this problem? At The Billups Center, we believe that sexual health is a sign or symptom of a more life-threatening chronic condition. For example, erectile dysfunction can precede a heart attack, stroke, diabetes by three to six years. So we will treat your sexual health condition — we can use medications — but our approach is to treat the whole person.

So we want to know – why do you have this problem, what is this a symptom of? And our goal is really not only to treat you from the sexual health standpoint but to look at how can we engage you into overall care. And really focus on prevention, better health, longevity, better quality of life. So the sexual performance piece is important and that’s what we do and that’s what we’re very good at but we have a much bigger picture and we work in a collaborative way to really look at the whole man.

What Causes Low Testosterone?

“Testosterone is the male hormone, the primary male hormone. For men, it helps us in terms of masculinity, for our reproductive organs, and deepening of the voice. It gets lower. Testosterone levels decline as we age. That’s one thing. It can decline as we age.

But there are other things that can cause testosterone to decline also. You can have, what we call a primary problem, which is a problem with the testes, actually, producing enough testosterone. And you can also have what we call secondary problems. So for example, say if you have diabetes, or if you’re overweight, even high blood pressure.

These can cause the body not to produce enough testosterone, but it’s a secondary problem because it’s more the signal that comes from the brain to the testes, to produce testosterone, is interfered with. So, many of the men I see, most of the men I see, they have what I call secondary hypogonadism or secondary testosterone problems. Which means that if you address, again some of these underlying issues, you can help to correct the low testosterone.”

How Is Our Practice Unique?

“People often ask me, ‘Why is your practice unique? How are you different from any other practice that’s a Men’s Health practice or is a Sexual Medicine practice?’ I think there are several things. One is, if you look at, for instance, myself, and the head advanced provider, Ken Mitchell, who happens to be a physician assistant, between the two of us, we have about 50 years’ experience in just doing Men’s Health and Sexual Medicine. So I’ve been doing this for a long time.

We have a staff that is really not only very trained, they’re very experienced. They have been doing this for a number of years. They’re actually hand-picked by us from our other practices, and they have joined us here. So we have a very experienced staff.

The other thing is, my focus is really on how I can evaluate and fix the underlying cause. I think that’s the key. I can certainly treat your sexual medicine condition, that is not the difficult part, and I have a whole spectrum. But, what is the underlying problem? Because maybe I can address it with lifestyle, with nutrition, with exercise changes. Maybe you need pills, maybe you need both for a while, and then you can go back from one to another. But we really focus on identifying the underlying cause, addressing that, and usually that means addressing it with our other colleagues, either in Primary Care or a specialty that we refer you out to, while we focus on the Sexual Medicine condition. So when I look around at what’s out there in the country right now, I think that we do have a unique focus.

That’s why came up with the name Precision Men’s Health. We think it’s a very precise, personalized approach to Sexual Medicine and Men’s Health.”

Working with Primary Care Colleagues

“An important part of Men’s Health is really working with other providers in the community. One of the most important providers would be our Primary Care physicians, just because they’re really at the center of everything. They’re at the crossroads. They pick up a lot of these problems. So, I always say it’s a two-way street, because what I do on the Sexual Medicine end is something that. . . It’s not that they couldn’t do it, it’s just that they have a lot of other things to do. Our practice is focused on this. This is what we really are streamlined to do. So I found a lot of times they’re very happy to have a place where they can refer their patient to, to manage their, say, erectile dysfunction, low testosterone, some of the other Sexual Medicine conditions that we work with.

One of the things I always tell them is that we fully appreciate what they do as a Primary Care physician because I know, for instance, erectile dysfunction does not occur in a vacuum. So I fully understand that when I pick up, or if a patient has diabetes, high blood pressure, high cholesterol, if they aren’t managing these other conditions well, that my treatments are not going to be as effective.

And quite frankly, they may need to go on that injection when they could be on a pill. So, I am very, not only interested, but look forward to working closely with my Primary Care colleagues because, one, I know that if men come in to me first, I’m going to pick up things that will need referral to a Primary Care physician, and I also think that I can help them with some of the issues.

So, one of the things that we stress is just communication back and forth, and that has worked very well for me in the past when I was in Maryland and I’m looking forward to getting to know the Primary Care community here in Nashville.”

Two-Way Referrals with Neurology

“One of the other specialists that we work closely with is Neurology, and there’s several aspects of Neurology that we see. One can be they can have men who’ve had vascular problems. So you know post stroke, vascular problems that could be closely linked to erectile dysfunction or even what’s called a TIA or a transient ischemic attack, a mild stroke. That’s one area.

The other thing that we see a lot with our Neurology colleagues are some of the neurologic conditions. You can have, for instance, multiple sclerosis. That can be associated with developing erectile dysfunction that can also be associated with developing some bladder problems.

Back issues, low back pain, very common in the United States now. So whether it’s disc problems or just problems with the lumbar spine, that can cause pain that radiates down the legs and it’s associated with erectile dysfunction. So I’ll get some referrals from my Neurology colleagues who are seeing back pain issues and will pick up erectile dysfunction.

The other area that Neurology plays an important role in is they often do the, what we call the peripheral sensory testing, nerve conduction studies for men with diabetes or even pre-diabetes. So one of the things that we know can happen with diabetes or pre-diabetes is that you can get loss of sensation, both in the hands and in the feet. And the Neurologists, some of the Neurologists actually studied this, they actually can do the studies that can document this.

So it’s interesting. I had a conversation with a Neurology friend of mine the other day and she was saying, ‘Wow, I have a lot of men with diabetes in my practice.’ And so, we started talking and again, the two-way referral pattern comes up, because I said, ‘Well, how many of those men do you ask about erectile dysfunction?’ And she said, ‘Probably not a lot,’ but she’ll certainly started thinking about that.

And then from my perspective, I see a lot of men who I’ll pick up who either maybe have diabetes or they have the pre-diabetes, the metabolic syndrome, the different risk factors. And if they’re having any decreased sensation, or even just to get a baseline, one of the things that I could consider is sending them in to Neurology to have this done, either via their primary care physician into neurology or, if they don’t have a Primary Care physician, just send them in. So as with all the referral patterns there’s a very nice interaction there with, I think being able to work with Neurology colleagues in a two-way referral pattern.”

Post-Prostatectomy Penile Rehabilitation

“So post-prostatectomy, we know that men can have problems with incontinence and they can have problems with erectile dysfunction. I’m really fortunate to have Ken Mitchell, who’s the PA who’s here with me. Ken developed really one of the leading penile rehabilitation programs for post-prostatectomy surgery and he’s gotten great results in working with these men.

So one of the things that we really want to offer the Urology community here is when you’ve done the surgery. If you’re looking for somebody to help manage the post-prostatectomy problems with erections, incontinence. I’m talking about the non-surgical approaches, because I know that if they need an implant, then the practice will probably want to do that. But just for the rehabilitation phase, we are actually very well set up to do that. And that’s an area where I think, where I believe that there’s a lot of room for exchange and working together.”