SHOT IN THE ARM: Jeff Smith is regional director of Ageless Men's Health, which makes testosterone treatments available to men who need a boost. -- Photo Courtesy Of Christy Racy/Obsidian Public Relations
When orthopedic surgeon Johnny Mitias got a shot in the arm, it was life changing. So much so that he's started a new business, Ageless Men's Health, to do the same for other men.
In the syringe was testosterone, a high-octane replacement for the small trickle of hormone Mitias was producing on his own.
Because of falling insurance reimbursement rates, most doctors are in the hunt for a cash business on the side, which accounts for the proliferation of cosmetic lasers. Ageless Men's Health makes money for Mitias and his partner, Jason Blackwood, but the business was organized mainly to lower the cost of treatment so most men could afford it.
Today the company has 130 active patients; only one dropped out when he lost his job and couldn't pay the tab. Half the men who have sought testosterone from Ageless have been turned away because their natural levels were deemed adequate.
"I think of myself first as an orthopedic surgeon, and I love what I do," Mitias said. "This is something that I use myself, and once I experienced it I knew there had to be a better way."
From men who know
Mitias currently practices in New Albany, Miss., with Mississippi Orthopaedics but is forming a new practice, OrthoOne, with two Campbell Clinic expatriates, Jeff Dlabach and Robert Pickering. Their practice will have a presence in New Albany, Southaven and Collierville. All three are general orthopedic surgeons with an interest in sports medicine.
Blackwood is retired as CEO of Physiotherapy Associates and combined his background in a health care business with Mitias' clinical knowledge and enthusiasm. They studied the different approaches used to dispense testosterone treatment and found most of them lacking.
Men are notoriously impatient when it comes to health care, and they found a lot of men were frustrated by sitting around a doctor's waiting room for an hour just for the few minutes necessary to get a shot. That combined with embarrassment, he said, is the appeal of companies such as Cenegenics and Health & Rejuvenation Center, which will provide testosterone gels to be rubbed into the skin. Online companies instruct clients to be under the care of a physician, but there's no mechanism to see that it happens.
Mitias goes further, requiring potential patients to have a full physical examination and attest to it through a consent form. If a man does not have a primary care doctor, he'll find one.
"We want men to get a regular physical by their own doctor," he said. "We're only treating this one little thing."
Pricing was another part of the strategy. Online services and some walk-in clinics can cost $2,500 to get started and then $1,000 a month. Ageless Men's Health is just $200 a month and clients are in and out of the East Memphis office in a matter of minutes.
Urologist Mark Greenburger is medical director. A nurse gives the shots. Transdermal gels have the advantage of providing a more steady level of hormone, he said, but they can be messy. Hug your wife too soon or shake hands with a friend and they can become contaminated.
Most men's health services also provide nutritional supplements and even Human Growth Hormone, while Ageless is strictly testosterone. Mitias uses only testosterone personally.
"HGH is out there and I think it would be OK to do; Sylvester Stallone openly advocates it, and he looks incredible for being 60," Mitias says. "But I won't sell it or administer it until I'm willing to take it myself. I don't think the science is there yet."
The Society for Endocrinology has not endorsed HGH as an aging treatment.
Mitias' own experience with testosterone is nearly evangelical. After turning 40 he started to feel dragged down. His work schedule seemed like a chore, he was skipping his regular visits to the gym, and spent less time playing with his children. He finally went for a physical and on a whim asked for a testosterone check and discovered his level was very low.
"I took an injection on Friday and by Monday I was a new man," he said. "My mood improved, my energy went up. Early on in treatment you start to remember that this how you used to feel. Vigorous."
Lean muscle mass usually improves, partly from the hormone and partly from having the energy to exercise regularly.
"We're doing what women have been doing for decades by supplementing their hormones," he said.
Testosterone replacement is good medicine for men suffering fatigue and decreased sexual desire, but with a number of cautions, said urologist Ithaar H. Derweesh. He's an assistant professor at the University of Tennessee Health Science Center and chief of Urology at the Regional Medical Center at Memphis.
There can be other causes for the same symptoms, he said. The worst choice would be to assume that testosterone is low and then buy it online without a physical exam.
"Testosterone has been linked to prostate cancer growth, and potentially development," he said.
Forty years of hormone replacement therapy in women is a cautionary tale, Derweesh said. Millions of women had longer, healthier and happier lives, but some are now paying a high price with a mushrooming level of breast cancer. Since testosterone is known to fuel prostate cancer the warning, he said, is clear.
Testosterone therapy will also suppress or even stop the natural production of the hormone, which can present a fertility problem.
"This treatment will suppress the natural level a little bit, but not all of it," Mitias said. "We are only keeping you at the natural physiological level where you should be."
Some bodybuilders have used massive doses of testosterone to bulk up and cause long-term damage, he said, but the amount Ageless provides is modest by comparison.
Mitias is also open to new options once they have solid science to back them up. HGH is one candidate, but two others could be dramatic.
Memphis-based GTx Inc. has two drugs in the pipeline that could turn out to be the male fountain of youth. Acapodene and Ostarine are being developed to counter the harshest side effects of chemotherapy by stimulating bone mass, muscle mass and appetite.
When cancer patients begin to waste away, they often cannot endure chemotherapy, so these medicines help them keep their body mass and strength.
The reality is that any doctor can prescribe any drug, even if the drug is not approved for a particular purpose. This is called off-label use and is quite common. Acapodene and Ostarine are only labeled for wasting syndrome, but if they prove effective for keeping men strong and vigorous, the market will prevail.