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men's health in johnson city, tn

Body & Health

At The Caudle Center, we provide comprehensive men’s health services while making you feel at ease and comfortable with your body and any health concerns you may have.

As a group, men tend to avoid discussing their health or any concerns they have with anyone, including their doctors. However, putting off physical exams and preventive screens can allow underlying conditions to progress if left untreated.

As men age, there are several common conditions that men are at higher risk of developing. These include:

  • Colon cancer
  • Diabetes
  • Heart disease
  • Hypertension (high blood pressure)
  • Liver disease
  • Low testosterone disorders
  • Prostate cancer
  • Stroke

Though some conditions increase risk with age, it is important to receive regular medical care regardless of how old you are.

FAQ's About Men's Healthcare

How does your lifestyle affect your health?

Certain factors, such as genetics and family history, can impact your health, but your lifestyle can be the most significant factor in your health. If you smoke, don’t exercise regularly, and eat an unbalanced diet, you can increase your risk of developing serious health conditions.

Fortunately, we are here to help lower your risk by offering lifestyle recommendations based on your health. We will work with you to develop a wellness program that fits your lifestyle while addressing your health concerns and needs. Some of our recommendations may include:

  • Beginning a well-rounded exercise routine.
  • Eating a more balanced diet rich in leafy vegetables and lean proteins.
  • Practicing better stress management.
  • Reducing alcohol intake and the usage of tobacco products.
How often should you have a physical?

Men between the ages of 18-40 should have yearly physicals or medical examinations. These physicals will include preventive screenings for high blood pressure, cholesterol issues, and diabetes. If you are sexually active, you will also be screened for sexually transmitted diseases.

Men over the age of 40 should continue to get annual examinations, though these may be more frequent as they age. In addition to standard screenings, you may undergo a colonoscopy or other additional screenings to check for age-related conditions.

How can you lower your risk?

With annual physicals, routine screenings, and following our recommendations on lifestyle changes, you can successfully manage your health. Regular care also enables us to detect any developing conditions early on, increasing the effectiveness of treatment.

If you are at risk or currently have a health condition that needs attention, we will work with you to find the right treatment plan. Depending on the condition, your treatment may include therapies, medication, surgery, or referrals for a more specialized approach.

  • Erectile Dysfunction
  • Testosterone
  • P-Shot®
  • Hair Loss
Erectile Dysfunction
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Erectile Dysfunction

At The Caudle Center, we offer assistance to men who struggle with their sexual performance. Almost all men have occasionally experienced some difficulty with developing and/or maintaining an erection, but that is not enough for a diagnosis.

However, when it continues to occur and persist, then it may be time to come in for a consultation.

Causes of Erectile Dysfunction

There are two main causes of erectile dysfunction that can affect men’s sex lives: medical conditions or a problem that is psychosocial. These can include issues with intimacy in a relationship to hormones and blood supply due to underlying medical conditions.

Oftentimes, it is a physical issue causing erectile dysfunction. Some factors may include heart disease, high cholesterol, obesity, Parkinson’s, multiple sclerosis, thyroid disorders, smoking, substance abuse, injuries in the pelvic region or spinal cord, and several other smaller physical issues.

Treatments for Erectile Dysfunction

To treat erectile dysfunction, our doctors will conduct a thorough medical exam to ensure you are in good health and taking the proper steps to cure your condition naturally. Following the examination and discussion of your medical history, our doctors will work with you to find the right treatment plan for your lifestyle.

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Testosterone is the male sex hormone that is produced in the testicles. Hormones are important for physical and mental health. Testosterone is the most important hormone in men. While it helps to maintain sex drive, sperm production, pubic hair, and body hair, testosterone is also responsible for maintaining muscles and bones.

Testosterone production is regulated by hormones released from the brain. The hypothalamus and pituitary gland, located in the brain, produce hormonal signals that ultimately result in the production of testosterone. These hormones travel through the bloodstream to activate the sex organs in both men and women.

Low Testosterone

When testosterone production is low in men, sexual dysfunction is a common complaint; but other nonspecific symptoms, such as depression, mood changes, weight gain, or fatigue, have been reported.

Testosterone is a steroid hormone made in the testes in males and in the ovaries in women (a minimal amount is also made in the adrenal glands).

FAQ's About Testosterone

What is testosterone essential for?
  • Normal male sexual development and functions.
  •  Develop male characteristics such as facial/body hair and deeper voice.
  •  Muscle strength and mass.
  •  Production of sperm.
  •  Male sex drive.
  •  Red blood cell production.
  •  Bone density.
  •  Fat distribution.
What are the possible symptoms of low testosterone?
  • Lower sex drive.
  • Fewer spontaneous erections.
  • Loss of body hair.
  • Less beard growth.
  • Loss of lean muscle mass & strength.
  • Feeling very tired all the time (fatigue).
  • Increased body fat / Obesity (being overweight).
  • Lower energy, endurance, and physical strength.
  • Swollen or tender breast tissue (gynecomastia).
  • Poor memory.
  • Insomnia or trouble sleeping.
  • The trouble with finding words to say.
  • Poor focus.
  • Feeling sad or depressed.
  • Not doing well at work.
  • Decreased bone density.
  • The decrease in motivation and self-confidence.
  • Erectile dysfunction.
What causes low testosterone?

There are many reasons for low testosterone. Basically, your testicles, for whatever reason, are producing less testosterone. In addition, testosterone gradually declines with age — typically about 1 percent a year after age 30 or 40. It is important to determine in older men if a low testosterone level is simply due to the decline of normal aging or if it is due to a disease (hypogonadism). Hypogonadism is a disease in which the body cannot produce normal amounts of testosterone due to a problem with the testicles or the pituitary gland that controls the testicles.

Low testosterone is a blood level lower than 300 ng/ dl in combination with any of the symptoms listed below.

  • Aging.
  • Obesity (overweight).
  • Harm to testicles by accident.
  • Removal of testicles (because of cancer or other reasons).
  • Chemotherapy or radiation.
  • Medication side effets.
  • Opioid or antidepressant use.
  • Thyroid problems.
  • Depression.
  • Medical conditions you may be born with.
  • Diabetes.
  • Infection.
  • Pituitary gland disease leading to low hormone production.
  • Autoimmune disease.
  • Alcohol.
How is low testosterone diagnosed?

The most important test for low testosterone is your total blood testosterone level. If you are worried, you should see your doctor to talk about your symptom. During your consultation, your doctor will check the following:

  • Blood tests for testosterone level, other hormone levels, blood lipids, and a blood count for red blood cell level.
  • Complete medical history, including diseases and medications.
  • Complete physical exam, including: BMI or waist circumference for obesity, Metabolic syndrome (high blood pressure, high blood sugar, too much body fat around the waist, and high cholesterol levels), Hair pattern, amount, and location, Enlarged breasts, Whether testicles are present and their size, Prostate size, and any abnormalities.

Testosterone replacement therapy can improve the signs and symptoms of low testosterone in these men. Doctors may prescribe testosterone as injections, pellets, patches, or gels.

Can testosterone therapy promote youth and vitality?

Testosterone therapy can help reverse the effects of hypogonadism, but it’s unclear whether testosterone therapy would have any benefit for older men who are otherwise healthy. Although some men believe that taking testosterone medications may help them feel younger and more vigorous as they age, some scientific studies have demonstrated mixed results.

What are the steps for testosterone therapy?

First, talk to your provider about your concerns and whether they may be related to low testosterone. Undergo a careful evaluation which includes the following:

  • Make an appointment with a provider that is knowledgeable regarding testosterone. Talk openly about any possible symptoms that are bothering you and if they may relate to low testosterone.
  • Undergo a physical exam. Your healthcare provider will check your genitals, body hair, breasts, prostate, and other parts of the body for possible signs of testosterone deficiency. Other tests may be done to rule out alternative causes of any symptoms.
  • If your doctor feels that your symptoms may be related to low testosterone, a blood test for testosterone levels and possibly other related blood tests will be ordered. For accuracy and consistency, testosterone blood testing should be done in the morning. Repeating a confirmation test for low testosterone at a later date is recommended to confirm low testosterone due to a possible lab error that should be done rather than relying on a single blood sample.
  • If your testosterone levels are clearly and consistently low, and you’re interested in treatment, discuss the risks, benefits, and side effects with your doctor.
  • There are several treatment options available. Your provider will discuss the various options, relative risks, and benefits. Choose the right form of treatment for you. Testosterone patches and gels are more successful in establishing relatively stable, normal levels. Injections are usually less expensive and usually paid for by insurance. Injections are efficacious, but testosterone levels go quite high after an injection, peaking at levels above normal, then falling relatively quickly – frequently to levels below normal–before the next injection.
What are the risks and benefits of testosterone therapy?

Treating normal aging with testosterone replacement therapy (TRT) is not currently recommended by the government and some scientific organizations. Supporters of testosterone therapy for symptoms of low testosterone approach claim that testosterone is safe and has few side effects. There is already a large body and a growing body of scientific articles to support the health benefits of testosterone therapy.


  • Reduced or no increase in cardiovascular events in men with androgen deficiency.
  • Improved cardiac function.
  •  Improve serum glucose levels and HgbA1C.
  • Improve insulin resistance in men with diabetes and prediabetes.
  • Reduced intra-abdominal (visceral) fat, obesity, fat mass, and an increase in lean mass.
  •  Improve exercise capacity in patients with congestive heart failure.
  •  Low testosterone levels are associated with increased mortality.
  •  Mayo Clinic Proceedings (2016) states, “There is no credible evidence at this time that testosterone therapy increases cardiovascular risk and substantial evidence that it does not. Indeed, there is a strong signal that testosterone therapy may offer cardiovascular benefits to men.”
  • TRT for hypogonadism does not increase PSA or the risk of prostate cancer.
  • Testosterone therapy may increase red blood cells, but there is no increase in venous thrombosis.


  • Cause acne or other skin reactions initially.
  • Temporary increase in fluid retention and/or leg swelling.
  •  Cause enlarged or tender breasts if excessive testosterone.
  •  Limit sperm production or cause testicle shrinkage.
How will I be monitored while on testosterone replacement therapy?

Your doctor will measure your testosterone levels at the 3- and 6-month marks after treatment begins and then annually. If your levels are OK, you’ll stay on your current dose. Your provider will monitor your response to treatment. If you are not obtaining any benefit from testosterone replacement, then you should stop it. Your prostate, genitals, breasts, body hair, and possibly other areas may be examined. Testosterone may help with osteoporosis, which can be checked a year or so after treatment begins. Your red blood cell levels will be measured prior to treatment and periodically afterward. Other periodic blood tests might include PSA tests, red blood cell counts, cholesterol, and liver function tests.

If your testosterone levels are too low, your dose may be adjusted. Your doctor will evaluate your prostate cancer risk at the start of treatment and may do more tests at the 3- and 6-month marks, and then annually.

How long do I have to take testosterone replacement therapy?

Indefinitely, as testosterone replacement does not cure low testosterone. Your symptoms may return if you stop taking it.

Other Hormones


The thyroid is a gland located in the lower front portion of the neck. The thyroid gland itself is controlled by another gland (the pituitary gland) located in the brain. The thyroid gland secretes two thyroid hormones, mostly T4 (thyroxine) but also some T3. T3 is the active hormone that is used at the cellular level. T4 has to be converted first into T3. These hormones regulate the many expressions of the body’s metabolism.

The thyroid regulates many things in the body, including temperature, metabolism, cerebral function, and energy levels. It also increases fat breakdown resulting in weight loss as well as lowering cholesterol. When functioning normally, it protects against cardiovascular disease, cognitive impairment, fatigue, weight gain, and memory loss.

Since T3 is so widely used in the body, there are over 200 symptoms related to thyroid deficiency, including weakness, coldness, tiresome, fatigue, thin hair, dry skin, thin nails, weight gain, increased body fat, loss of energy, loss of motivation, loss of cognition, loss of memory, mood disturbances, and a poor overall sense of well-being.

The symptoms of low thyroid vary widely but are notoriously for being nonspecific and mimicking many of the normal changes of aging. Frequently thyroid hormone levels fall slowly over time, so the symptoms of low thyroid are slow in onset and insidious. Many times we attribute our symptoms to aging when in fact, something can be done about it!

In order to customize thyroid replacement specific to you, we will measure your current level of thyroid hormones and will review your symptoms of possible thyroid depletion. This will include a complete history and physical examination. After we review the benefits and any possible side effects of treatment, and if you are agreeable, we will begin treatment. Any other medications or medical problems will be taken into consideration. We will trend your thyroid levels with your response to treatment over time by following your low thyroid symptoms until you are in proper balance.

We will continue to monitor you to minimize any possible side effects from too little or too much thyroid and monitor you for any other related medical problems.


Dehydroepiandrosterone (DHEA) is a hormone secreted primarily by the adrenal glands. DHEA itself is not felt to be active, but it is a precursor to the active androgen hormones, testosterone, and dihydrotestosterone. It results in a shift from a catabolic state to an anabolic or protein-building state. By doing this, it reduces cardiovascular risks by increasing lipolysis (decreasing visceral fat). Studies suggest that it helps to stimulate the immune system, restore sexual vitality, improve moods, and decrease cholesterol and body fat. DHEA improves memory, increases energy, and is thought to have anti-cancer properties by enhancing the immune system. Declines in DHEA may contribute to loss of sleep, osteoporosis, and atherosclerosis.

Studies suggest that optimal DHEA levels reduce insulin requirement and play a role in restoring immunity, preventing osteoporosis, increasing bone density, preventing diabetes, preventing heart disease, decreasing visceral fat, improving mood and a sense of well-being, and improving energy and memory.

Most people do not need to supplement DHEA. In order to properly screen for potential benefits from DHEA replacement, we will measure your current level of DHEA hormones and will review your overall symptoms of health. This will include a complete history and physical examination. After we review the benefits and any possible side effects of treatment, and if you are agreeable, we will begin treatment. Any other medications or medical problems will be taken into consideration. We will trend your DHEA levels with your response to treatment over time by following your symptoms until you are in proper balance.

We will continue to monitor you to minimize any possible side effects from too little or too much thyroid and monitor you for any other related medical problems.

Human Growth Hormone

Human Growth Hormone (HGH) is a hormone excreted by the pituitary gland in the brain, mostly during deep sleep.

HGH declines cause fatigue, poor muscle development, excessive body fat, decreased initiative, decreased endurance and strength, poor healing, decreased immunity, thin bones, sagging muscles, increased wrinkles, slow hair growth, and sagging skin, breast, and abdomen.

Must document symptoms and ITT and IGF-1 levels to treat. IGF-1 to adjust the dose. Goal 300.

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The Caudle Center offers the p-shot, a cutting-edge procedure that can help you achieve bigger, stronger erections.

The p-shot is a game-changer for men of all ages who want to experience better sex. Using cutting-edge technology, the Caudle Center's expert team of medical professionals will carefully inject platelet-rich plasma into your penis. This PRP will stimulate new cell growth, leading to increased blood flow and sensation in your penis.

FAQ's About P-Shot®

What benefits can a man have from the P-Shot®?
  • Stronger, firmer erections.
  • Easier to achieve and maintain erections (i.e., improved sexual stamina).
  • Increased penile length and girth.
  • Improvement in or the resolution of penile curvature from Peyronie’s Disease.
  • Resolution of penile pain with erection.
  • Increased sensitivity in the penis.
  • Better overall blood flow to the penis.
Is the P-Shot® the same thing as Trimix injections?

No. TriMix is a shot to produce an erection for a brief period of time and must be given every time you wish to have an erection; however, the P-Shot® is a treatment that revives and enhances your natural erections.

How does the P-Shot® work?

The growth factors & proteins released by the high concentration of platelets in PRP, in turn, activate cells and stimulate cellular repair and regeneration wherever they are applied in the body. In addition, collagen production and the formation of new blood vessels occur and further aid in tissue repair.

How is PRP for the P-Shot® acquired?

A small amount of blood is drawn in the office at the time of the procedure. Your blood is then spun in a specially designed centrifuge which separates the platelets and plasma from the rest of the blood. The platelets are isolated and then injected back into the body wherever their benefits are needed. Along with numbing cream on the skin, a block is performed on the penis, so there is no pain.

How long does the P-Shot® procedure take to perform?

The PRP injection is performed in our office. It should take about 60 minutes from start to finish, but we do usually allow a little extra time. You may drive yourself home after the procedure.

Is there anything else that I will need to do after the procedure?

Yes. Using a VED, or Vacuum Erection Device, is essential for achieving optimal success from the procedure. This is usually done twice daily. It requires only a few minutes of your time, and without it, success rates are usually lower. We will walk you through it the first time.

When can I resume sexual activity after the P-Shot® procedure?

You may resume sexual activity about 4 hours after the procedure on the same day.

What are the potential side effects of the P-Shot®?

Since PRP is extracted from your own blood, there are few and only minor potential side effects. These include minor bleeding or bruising, swelling, and very rarely infection.

Hair Loss
man lookin at the mirror concerned because of his hair loss

Hair Loss

If you're concerned about hair loss, the Caudle Center can help. We offer a variety of treatment options for men experiencing hair loss.

Our team of expert stylists will work with you to find the right treatment plan for your individual needs. We understand that hair loss can be a sensitive issue, and we're here to help you feel your best.

Lifecycle of a Hair Follicle

Anagen – This is the active growth phase of the hair follicle and may last 2-6 years.

Catagen – This is the transition where the hair follicle and bulb begin to separate from the hair papilla and start the migration up to the skin before shedding. This phase usually lasts 1-2 weeks.

Telogen This is the resting phase where the hair follicle has fully separated from the dermal papilla and usually lasts from 6 weeks to 3 months.

Return to Anagen Phase Dermal papilla and hair matrix forms a new hair follicle.

Causes of Hair Loss

Male Pattern Hair Loss (androgenetic alopecia)

This is the most common hair loss pattern in men and is characterized as nonscarring diffuse hair loss evolving from progressive miniaturization of hair follicles and consequently progressive reduction of total hair count and thickness primarily involving the frontal and central scalp areas, and extending laterally.

Male pattern hair loss is an inherited genetic condition related to that individual’s hair follicle sensitivity to the effects of dihydrotestosterone (DHT) in some areas of the scalp. DHT is believed to affect the anagen phase of the hair cycle, causing a shortening from a usual duration of 3–6 years to just weeks or months. The genetic predisposition comes from either parent or both parents.

The male hair loss pattern differs from the female hair loss pattern. Hair loss begins above both temples, and, over time, the hairline recedes to form a characteristic “M” shape. Hair also thins at the crown (near the top of the head), often progressing to partial or complete baldness.

Other Causes of Hair Loss

  • Thyroid dysfunction.
  • Post-partum.
  • Nutritional deficiencies such as Iron, Zinc, protein, or Vitamin D deficiency.
  • Rapid weight loss.
  • High-stress levels or major life events causing emotional and hormonal changes.
  • Inflammatory conditions causing scarring of the hair, such as folliculitis, infection, lichen type changes, and lupus.
  • Secondary scarring from traumatic scalp injuries, surgery on or through the scalp, keloids, burns.
  • Medications such as beta-blockers, ACE inhibitors, high doses of Vitamin A, low molecular weight heparins (enoxaparin, dalteparin), warfarin (rare), lithium, SSRIs (e.g., fluoxetine/Prozac), Retinoids (Acetretin, Isotretinoin, Vitamin A supplements), antimicrobials (Isoniazid, Antiretrovirals like Indinavir).
  • Chemotherapy.
  • Autoimmune causes.
  • Traction on hair roots such as tight braids, glued hairpieces, or anything where the hair is pulled tight.
  • Trichotillomania (obsessive-compulsive behavior) caused by excessive pulling on their hair (usually by children or teens).
  • Excessive pressure to an area of the scalp, such as a type of pressure sore.
  • Radiation-induced.
  • Infections such as Syphilis, bacteria, fungus (tinea capitis), or untreated ringworm of the scalp.
  • Scalp conditions causing itchy scalp, hair loss, and flaking repeated scratching such as dandruff or seborrheic dermatitis.

Hair Loss Treatments

Male or Female pattern hair loss can mimic and often runs concurrently with other health problems that may affect hair loss. A detailed medical history and physical examination are necessary.

It is easier to treat hair loss early when the process is starting and hair structures are still present but dormant than when the hair structures are absent and dead. The earlier treatment leads to better results. Both male and female pattern hair loss is not cured in a “one and done” treatment. It requires lifelong treatment. Any break in treatment will begin the hair loss process.

Current treatment options include
  • Hair replacement / transplantation
  • Cosmetics
  • Micropigmentation (tattoo) to resemble shaven scalp
  • Hairpieces
  • Minoxidil solution
  • Finasteride tablets (type II 5-alpha-reductase inhibitor)
  • Dutasteride
  • Platelet-rich plasma
  • Microneedling
  • Low-level light therapy
  • Stem cell therapy

The medications listed (Minoxidil, Finasteride, & Dutasteride) have the potential to cause fetal abnormalities and are thus contraindicated in pregnant women or women trying to become pregnant. Those three medications affect androgen metabolism or its effects. The use of medications is the cornerstone of male or female hair loss treatment. These are FDA-approved medications.

Platelet Rich Plasma (PRP)

Platelets are rich in numerous growth factors that are released upon platelet activation (injection into the scalp). The growth factors activate stem cells in the bulge area of follicles, encourage the growth of existing hair, as well as encourage the formation of microvascular networks improving circulation and eventually providing the nutrients required for hair growth. Clinical studies have proven the effectiveness of PRP therapy in hair loss.

Typically 3 to 5 sessions are performed in the desired area within 4 - 6 months. Injections can range from every two weeks to once monthly. Then booster treatments are performed every three to six months to one year afterward. Studies have shown that the hair regrown from PRP can last for up to 18 months after treatment. I recommend once-yearly boosters to keep the regrowth.


Microneedling is a minimally invasive dermatologic procedure in which fine needles are rolled over the skin to puncture the top layer of skin (stratum corneum). The physical trauma from needle penetration induces a wound-healing cascade with minimal damage to the epidermis that induces collagen formation, neovascularization, and growth factor production in the treated areas. Microneedling has shown promising results as an adjuvant treatment with existing techniques.

Low-Level Light Therapy

Low-level light therapy (LLLT) is a relatively new technique in the treatment of hair loss. The biochemical mechanisms are not completely understood, but the cellular respiratory chain of mitochondria probably absorbs the light energy, which results in increased electron transport and the promotion of cellular signaling and, in turn, allows for hair regrowth. LLLT efficacy is still being studied. It seems that LLLT in the 650 to 900 nm wavelength at 5mW may be a therapeutic option for patients with male or female pattern hair loss.

Regenerative (Stem cell) Medicine

Adipose-derived stem cells show much promise in hair loss treatment. Adipose-derived stem cells are multipotent cells that have shown potential for regenerative medicine. Adipose-derived stem cells not only differentiate into mesenchymal lineage cells but also secrete various growth factors. Recent studies have reported that adipose-derived stem cells promote hair growth via growth factor secretion. We have already used adipose-derived stem cell-conditioned medium to treat alopecia and reported good results.

FAQ's About Hair Loss

How is hair loss (Baldness) defined?

All normal men and women lose scalp hair every day, which averages between 25 to 100 hairs per day. Some individuals can generally shed up to 150 hairs per day. When hair loss is increased compared to daily baseline hair loss, or it occurs in patches, then it is abnormal. Abnormal hair shedding or bald areas on the scalp constitute a hair loss disorder, which is also known as alopecia. Hair usually becomes thin and weak (miniaturization) before there is a complete loss.

Why is hair loss important?

Hair loss isn’t only just cosmetic. Hair loss can have detrimental psychological effects. Studies have shown that hair loss can be associated with low self-esteem, depression, introversion, and feelings of unattractiveness. This is particularly true in Western societies and increasingly true in Eastern societies. Generally, economically developed countries place great value on youthful appearance and attractiveness.

Some studies have shown that based on appearance alone, men with hair loss (as well as other features) are seen as less attractive, less assertive, less likable, and less successful than men without hair loss.

How prevalent is hair loss?
  • Studies have shown that more than 50% of all men over the age of 50, and up to 80% of men age 70, will be affected by male pattern baldness to some extent.
  • Studies have shown that about 25% of all women aged 50, and up to 42% of women by age 70, will be affected by female pattern baldness to some extent.
  • Hair loss in Caucasians is more prevalent than in blacks or Asians.