27:57-31:47
*testosterone deficiency in men
On this episode of BackTable Urology, Dr. Mike Hsieh (UC San Diego) interviews Dr. Larry Lipshultz (Baylor College of Medicine) about his journey to becoming a renowned specialist in male infertility and reproductive medicine.
First, Dr. Lipshultz explains how he became interested in urology by working in a basic sciences surgery laboratory with a urologist. He became passionate about doing research in male infertility as an intern after hearing a Grand Rounds lecture. Before his residency ended, he was sent to El Paso, Texas by the military, where he was able to start his own semen analysis laboratory to treat male infertility patients. He then accepted an AUA fellowship and followed a mentor to UT Houston for training in male infertility. He eventually transitioned to Baylor College of Medicine and stayed after fellowship to join the faculty.
Next, Dr. Lipshultz reflects on major events in his life, such as the opportunity to perform trailblazing surgeries, like gender-affirming surgeries and vasovasostomies and graduating productive male infertility fellows. He gives advice on balancing clinical duties and research, the importance of goal setting, and mentoring junior faculty.
Finally, the doctors discuss the future of men’s health. Dr. Lipshultz disagrees with the concept of direct-to-consumer marketing and “low T clinics”, as he believes they do not exist to serve the patient’s best interest. He is excited about new research implicating that testosterone may have other health benefits besides treating erectile dysfunction and that male infertility may be an indirect measure of men’s health. He encourages urologists to explore running their own IVF clinics and incorporate biotechnology into their practices as well.
Dr. Larry Lipshultz has spent decades building one of the most influential fellowships in male reproductive medicine, training over 120 fellows who have gone on to leadership positions across six countries. His journey from an unplanned entry into urology to becoming a pioneer in male infertility treatment offers valuable insights for both established physicians and those beginning their careers.
His introduction to urology came through a summer job at the University of Pennsylvania, where he was assigned to work with a young urologist named Joe Courier. "I did not know what urology was at the time," Lipshultz admits. "But I got a job working in the surgery lab looking at radioactive bacteria and monitoring reflux using a then very new radionuclide scanner."
The spark for male infertility work came during his internship while rotating on OB-GYN. During grand rounds, a PhD from New York presented on sperm physiology. At the end of the presentation, the head of OB-GYN mentioned that they were getting so busy developing IVF that they needed urologists to help with male patients. "A light bulb went off in my head," Lipshultz says. "If there's nobody doing it, this certainly would be a great area to get into."
His career path took an unexpected turn when he was called to military service at William Beaumont Army Hospital in El Paso. Rather than viewing this as a setback, he established a semen analysis laboratory and began seeing infertility patients. "I started a semen analysis laboratory in this William Beaumont Army hospital and linked up with the head of OB-GYN," he explains. "I didn't just stop for two years."
This setback led to a collaboration at Baylor with Jim Norris, focusing on cell cultures. Their work with sertoli cells from transsexual patients became the first human sertoli cell culture, demonstrating how unexpected circumstances can lead to groundbreaking research.
Similarly, transgender surgery was pioneered through careful study and monthly procedures. "We got out this textbook that had somebody's procedure in it, looked at the procedure how they did it, and then kind of adapted it as the months went by to one that worked for us."
His advice for sustaining both involves strategic career transitions: "You've got to at some point move away from the basic research lab into the clinical research environment. I don't see how you can go back to the lab, dabble around, and then come back and see patients."
He advocates for a more thoughtful approach to testosterone therapy, believing it will eventually be used therapeutically for specific conditions rather than as general "therapy to make your testosterone normal."
His solution is characteristically bold: "I think urologists should run IVF clinics focusing on men with reproductive health issues. We would be able to hire a couple of REIs and run as good a program as anybody else, but we'd also be able to afford patients the ability to have a thorough male evaluation."
He also stresses the importance of maintaining broad clinical skills: "We've all gone through many years of medical school and residency, so to end up being doctors who just prescribe testosterone or who just do prosthetics, I think is a little narrow."
"The biotech industry is going to be bigger and bigger, and you have to understand what's going on and incorporate that into your practice," he advises. "The idea would be to embrace all the new things that are on the horizon rather than avoid them and bury your head in the sand."
This network has produced five urology chairs and continues to drive innovation in male reproductive medicine worldwide. The fellowship has created not just skilled physicians, but a community of practitioners committed to advancing the field.
As medicine continues to evolve, Dr. Lipshultz's career demonstrates the value of adaptability, mentorship, and maintaining curiosity about new developments. His journey from an uncertain medical student to a pioneer in male reproductive medicine illustrates how unplanned opportunities, when embraced with dedication and openness to learning, can lead to extraordinary contributions to medicine and patient care.
Dr. Lipshultz continues to practice and train fellows at Baylor College of Medicine, where he holds the Lester and Sue Smith Endowed Chair in Reproductive Medicine and serves as chief of the Division of Male Reproductive Medicine and Surgery.
*testosterone deficiency in men
On this episode of BackTable Urology, Dr. Mike Hsieh (UC San Diego) interviews Dr. Larry Lipshultz (Baylor College of Medicine) about his journey to becoming a renowned specialist in male infertility and reproductive medicine.
First, Dr. Lipshultz explains how he became interested in urology by working in a basic sciences surgery laboratory with a urologist. He became passionate about doing research in male infertility as an intern after hearing a Grand Rounds lecture. Before his residency ended, he was sent to El Paso, Texas by the military, where he was able to start his own semen analysis laboratory to treat male infertility patients. He then accepted an AUA fellowship and followed a mentor to UT Houston for training in male infertility. He eventually transitioned to Baylor College of Medicine and stayed after fellowship to join the faculty.
Next, Dr. Lipshultz reflects on major events in his life, such as the opportunity to perform trailblazing surgeries, like gender-affirming surgeries and vasovasostomies and graduating productive male infertility fellows. He gives advice on balancing clinical duties and research, the importance of goal setting, and mentoring junior faculty.
Finally, the doctors discuss the future of men’s health. Dr. Lipshultz disagrees with the concept of direct-to-consumer marketing and “low T clinics”, as he believes they do not exist to serve the patient’s best interest. He is excited about new research implicating that testosterone may have other health benefits besides treating erectile dysfunction and that male infertility may be an indirect measure of men’s health. He encourages urologists to explore running their own IVF clinics and incorporate biotechnology into their practices as well.
From Military Service to Male Reproductive Medicine: A Conversation with Dr. Larry Lipshultz
This article is adapted from an interview conducted by Dr. Mike Shea for the Back Table Podcast. Dr. Shea is a urologist at UC San Diego, and Dr. Lipshultz is a professor of urology at Baylor College of Medicine.Dr. Larry Lipshultz has spent decades building one of the most influential fellowships in male reproductive medicine, training over 120 fellows who have gone on to leadership positions across six countries. His journey from an unplanned entry into urology to becoming a pioneer in male infertility treatment offers valuable insights for both established physicians and those beginning their careers.
An Unplanned Path into Medicine
Dr. Lipshultz's career trajectory began at Franklin and Marshall College, an all-men's institution about 60 miles from Philadelphia. "I applied to Harvard and Princeton and had no backups," he recalls. "Franklin and Marshall was basically my backup school at the time." This early experience of landing somewhere unexpected would become a recurring theme in his career.His introduction to urology came through a summer job at the University of Pennsylvania, where he was assigned to work with a young urologist named Joe Courier. "I did not know what urology was at the time," Lipshultz admits. "But I got a job working in the surgery lab looking at radioactive bacteria and monitoring reflux using a then very new radionuclide scanner."
The spark for male infertility work came during his internship while rotating on OB-GYN. During grand rounds, a PhD from New York presented on sperm physiology. At the end of the presentation, the head of OB-GYN mentioned that they were getting so busy developing IVF that they needed urologists to help with male patients. "A light bulb went off in my head," Lipshultz says. "If there's nobody doing it, this certainly would be a great area to get into."
Early Career Challenges and Military Service
To gain expertise in male reproduction, Dr. Lipshultz paid his own way to attend a course in Washington, D.C., featuring speakers including Dick Sherins, Pat Walsh, and Stu Howards. This self-funded education exemplifies the initiative required in a field that was just emerging.His career path took an unexpected turn when he was called to military service at William Beaumont Army Hospital in El Paso. Rather than viewing this as a setback, he established a semen analysis laboratory and began seeing infertility patients. "I started a semen analysis laboratory in this William Beaumont Army hospital and linked up with the head of OB-GYN," he explains. "I didn't just stop for two years."
The Fellowship Experience and Academic Development
Dr. Lipshultz became the first AUA Scholar, working under Dr. Emil Steinberger at the University of Texas in Houston. However, this relationship ended abruptly when Steinberger felt Lipshultz was too independent. "One day towards the end of my first year, I came to work and there was a pink slip literally classic pink slip in my mailbox telling me that he no longer could be my mentor because I was too independent," Lipshultz recalls.This setback led to a collaboration at Baylor with Jim Norris, focusing on cell cultures. Their work with sertoli cells from transsexual patients became the first human sertoli cell culture, demonstrating how unexpected circumstances can lead to groundbreaking research.
Pioneering Microsurgery and Building a Practice
The early days of microsurgery required self-teaching and innovation. Dr. Lipshultz learned vasovasostomy by reading textbook chapters and adapting techniques as he gained experience. "The first one we did was not microscopic," he explains. "We then progressed into using the microscope because it was so much easier."Similarly, transgender surgery was pioneered through careful study and monthly procedures. "We got out this textbook that had somebody's procedure in it, looked at the procedure how they did it, and then kind of adapted it as the months went by to one that worked for us."
Balancing Clinical and Academic Success
Dr. Lipshultz addresses the challenge many physician-scientists face in balancing research and clinical work: "There's monetary success and there's academic success. I think it's somewhat of a challenge to do both 100 percent, but you can do it."His advice for sustaining both involves strategic career transitions: "You've got to at some point move away from the basic research lab into the clinical research environment. I don't see how you can go back to the lab, dabble around, and then come back and see patients."
The Current State of Men's Health
Dr. Lipshultz expresses concern about the commercialization of men's health, particularly regarding testosterone therapy. "When you talk about men's health, we're talking primarily about male infertility, erectile dysfunction, and testosterone deficiency," he says. "I don't like the Low T clinics. They're basically storefronts for mid-levels to give out testosterone. There's not a lot of thought involved in terms of medical care."He advocates for a more thoughtful approach to testosterone therapy, believing it will eventually be used therapeutically for specific conditions rather than as general "therapy to make your testosterone normal."
The Future of Male Reproductive Medicine
Regarding the relationship between reproductive urology and assisted reproductive technology, Dr. Lipshultz notes a concerning trend: "Now with the REI's ability to put a single sperm into an egg and get a pregnancy, that's first-line therapy for male infertility. We're seeing maybe one out of ten patients referred to us."His solution is characteristically bold: "I think urologists should run IVF clinics focusing on men with reproductive health issues. We would be able to hire a couple of REIs and run as good a program as anybody else, but we'd also be able to afford patients the ability to have a thorough male evaluation."
Advice for the Next Generation
Dr. Lipshultz emphasizes the importance of mentorship and exposure: "If you're a chairman, your chief responsibility is to see that junior faculty meet the right people and go to the right meetings and know when they're supposed to get abstracts done."He also stresses the importance of maintaining broad clinical skills: "We've all gone through many years of medical school and residency, so to end up being doctors who just prescribe testosterone or who just do prosthetics, I think is a little narrow."
Technology and the Future
Despite acknowledging his technological limitations ("My fellows have to come to my aid 10 times a day with my computer"), Dr. Lipshultz remains enthusiastic about emerging technologies. He's particularly excited about epigenetics research for identifying patients likely to have sperm in testicular tissue."The biotech industry is going to be bigger and bigger, and you have to understand what's going on and incorporate that into your practice," he advises. "The idea would be to embrace all the new things that are on the horizon rather than avoid them and bury your head in the sand."
The Fellowship Legacy
Perhaps Dr. Lipshultz's greatest achievement is the extended family of fellows he has trained. "Talking to them is talking to a peer," he explains. "They're no longer fellows. We do projects together. It really is very much of an extended family."This network has produced five urology chairs and continues to drive innovation in male reproductive medicine worldwide. The fellowship has created not just skilled physicians, but a community of practitioners committed to advancing the field.
Looking Forward
Dr. Lipshultz remains optimistic about urology's future, citing the quality of applicants entering the field. "Every year we get really good applicants, probably the smartest guys in the class," he notes. His advice for maintaining career satisfaction is simple: "Do what's interesting to you and keep abreast of the latest progress in all the fields of urology that you can."As medicine continues to evolve, Dr. Lipshultz's career demonstrates the value of adaptability, mentorship, and maintaining curiosity about new developments. His journey from an uncertain medical student to a pioneer in male reproductive medicine illustrates how unplanned opportunities, when embraced with dedication and openness to learning, can lead to extraordinary contributions to medicine and patient care.
Dr. Lipshultz continues to practice and train fellows at Baylor College of Medicine, where he holds the Lester and Sue Smith Endowed Chair in Reproductive Medicine and serves as chief of the Division of Male Reproductive Medicine and Surgery.
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