Usually one would find it challenging to weave the terms health care and man cave into the same conversation, but at Vitality Health Services in Charlotte and Raleigh, that is the conversation.
With over 40 years’ combined experience treating the physical, sexual, endocrinal and hormonal issues that all men face, Drs. Michael Trombley and Douglas Brooks set out to create something new, innovative, and exclusively for patients just like them—“for men, by men.” Yes, even the staff is all men.
In their offices, patients are greeted with a large screen TV showing ESPN SportsCenter along with a collection of blatantly gender-specific reading materials like Sports Illustrated and Men’s Health. Throw in a beer tap and you’d practically have a sports bar.
“Studies show men are less likely to go to the doctor than their female counterparts, and reluctant to take action when they don’t feel physically or mentally well,” says Brooks. “Most men know more stats about their favorite sports team than their own body. Our goal was to create an innovative and affordable practice that could reduce traditional barriers preventing men from making their health care a priority.”
“Statistically, men are three times more likely than women not to see a physician,” notes Trombley, more precisely. “It’s not because men don’t care about their health. It’s because they don’t do well in a traditional medical office setting. We offer an alternative—a place where men can feel comfortable and at ease. We don’t have Sesame Street on the TV and kids running around. We don’t have a young woman at the front desk asking personal questions that most men are never going to feel comfortable answering.”
Vitality Health Services provides men with a safe and discreet environment to discuss and treat the embarrassing stuff—erectile dysfunction (E.D.), sexual performance issues, low testosterone, weight problems, vasectomy and even basic primary care.
Both Trombley and Brooks are board certified in Family Medicine.
Trombley is a native of New York, obtaining his medical degree from the University of Rochester School of Medicine. He completed his residency in 1994 from Carolinas Medical Center Family Medicine where he served as chief resident. He first practiced as a physician at Cabarrus Family Medicine and subsequently at Lakeside Primary Care before joining up with Brooks.
He has also had associate faculty appointments with Duke Medical School and University of North Carolina Medical School, and been a travel speaker for Abbott Laboratories, Astra Zeneca Pharmaceuticals, Ortho-McNeil-Janssen Pharmaceuticals, and Xanodyne Pharmaceuticals.
Brooks is a West Virginia native, obtaining his medical degree from West Virginia University School of Medicine. He completed his family medicine residency at the University of South Carolina’s Palmetto Richland Memorial Hospital in 2000. He first practiced as a family physician with Morton Plant Mease Primary Care, the largest medical corporation in Tampa, Fla., and subsequently practiced as a family physician for Carolinas HealthCare System before striking out on his own.
Brooks is currently an adjunct professor with the University of North Carolina at Chapel Hill, serving locally as a preceptor for medical students during their four years of training.
Trombley and Brooks are 5-star physicians on wellness.com and vitals.com respectively, and both have received the Patient’s Choice Award given to only 5 percent of North Carolina physicians.
Both describe their prior practices as “traditional corporate medicine.”
“The genesis of Vitality Health Services came from our frustration over the direction of the health care industry and an attempt to return to the true patient and physician relationship and direct primary care,” says Brooks.
“We were both suffering from burnout with the current medical system,” explains Trombley. “I was diagnosing patients, but treatment decisions were being taken over by the insurance companies. It felt like a disservice to the patient. Medicine should be based on the relationship between a doctor and the patient.”
In addition to wanting to be his own boss and the freedom to practice medicine on his own terms, Brooks had always had an interest in men’s health issues, and felt there was a need for specialists in the field, just like women have gynecologists and children have pediatricians.
A recruiter helped put Brooks in touch with a small group of like-minded investors and that’s how he met up with Trombley. The two opened up Vitality Health Services in Charlotte, and the business model has worked so well that they added a satellite office in Raleigh.
Setting Themselves Apart
Making the decision to reclaim control of their respective careers, Trombley and Brooks began thinking outside traditional structure and focusing on the particular niche that they both found interesting, men’s health services. Alongside the unique “men’s club” approach to providing care, the two made a conscious decision to have an all-male staff as well, to further set their clients at ease.
Additionally, they made the decision not to bill insurance directly, which means clients pay directly and have the option to seek reimbursement from their own insurance carriers. While some might think this a concierge, boutique approach for a medical practice, it is in reality the opposite.
“By not billing insurance directly, we cut down on practice overhead and staffing, resulting in surprisingly affordable fees,” Trombley points out.
Brooks clarifies, “If we bill $100 through insurance, about $40 immediately goes to the insurance company. Then another $20 goes to pay the salaries of two more employees—a coder and a biller—that we have to hire. So why not have the patient pay us $40 directly, and keep the insurance companies and their medical opinions out of the picture.”
An initial visit to Vitality Health Services runs $300 which includes all necessary blood work and a follow-up visit. Subsequent office visits are only $100. Specific in-office procedures and treatments, such as vasectomy, are individually priced a-la-carte style. The model also works well for patients who have a flex-spending health care plan.
Trombley says, “Our goal is to show that we can provide first-rate quality care, but do so in a cost effective manner.”
In practice, for Brooks and Trombley, it’s all about putting the patient’s needs first and having the luxury of actually spending time with them.
“In my last job we were allowed 15 minutes per patient,” says Trombley. “That’s just not enough time. Here we can spend an hour with each patient. We’re dealing with sensitive and often embarrassing issues. Guys don’t just walk in and blurt out what’s wrong. It takes time for them to relax, feel comfortable and establish a sense of trust.
“By taking our time, we uncover so much more important information; it enables us to formulate a better diagnosis and better treatment plans that address all issues.”
Brooks concurs, saying, “Our patients feel like they actually have a relationship with their doctor. I would love to see a long-term study of my patients 30 years from now, because I truly believe the men I’m treating are going to live longer than those getting a 10 or 15-minute visit.”
Proactive and Progressive
Although the doctors treat more common male-specific issues like the dreaded E.D. (statistics show 40 percent of men are affected by age 40 and 70 percent by age 70), they are increasingly focused on treating more men in the relatively new area of testosterone replacement therapy. Andropause—a decline in testosterone production—is basically the male counterpart to menopause.
Both Trombley and Brooks are firm believers that low testosterone or “Low T” is often the root of many other male-specific problems like E.D., as well as being a contributing factor in more serious issues like hypertension, diabetes and high cholesterol.
Brooks explains, “Testosterone loss happens to every man. It starts in our 30s and continues from there. While women have been on estrogen tablets for 50 years, it is only now that we are starting to look seriously at male hormone replacement therapy.”
Typical symptoms of low testosterone are often reduced energy, moodiness, gain in belly fat and eventually sexual performance issues. However Trombley says the onset is so gradual the symptoms are often incorrectly attributed merely to aging. A low testosterone count is easily diagnosed with a simple blood test and current treatments run from pills to topical creams.
Although still a relatively new frontier in health care, both doctors are resolute in their convictions regarding the benefit of testosterone replacement therapy. Trombley says, “I firmly believe what we’re doing will absolutely become the standard of care. We’re just waiting for everybody else to catch up.”
He attributes the hesitation to insurance companies trying to categorize low testosterone as a disease. As the “normal” range for testosterone count (T-count) has been established as between 300 and 1,200 (all measures in ng/dL or nanograms per deciliter), Trombley says a patient with a 315 T-count will be summarily dismissed by insurance carries and most physicians as being within normal range.
“What we really need is a way to go back in time and learn what your testosterone count was at age 18 and try to restore it to those levels,” he explains. “The way we look at it in a proactive way is that if a patient has a T-count of 315, but is symptomatic, we treat him. There’s no reason to wait until he is at disease state.”
Both Trombley and Brooks can attest to the positive benefits they are seeing in testosterone replacement therapy. Trombley says, “We fix the patient’s testosterone and he suddenly feels 20 years younger, his relationship with his wife is amazing, he’s got more energy and is suddenly motivated to get back in the gym, and now naturally his blood pressure goes down, he’s not a threat for diabetes and his cholesterol is normalizing.”
As further evidence of their proactive and progressive approach to medicine, Dr. Trombley has undergone additional training in stem cell therapy as a promising treatment for erectile dysfunction.
Stem cells are defined by their capacity for both self-renewal and directed differentiation; thus, they represent great promise for regenerative medicine. Historically, stem cells have been categorized as either embryonic stem cells (ESCs) or adult stem cells (ASCs) and it was previously believed that only ESCs hold the ability to differentiate into any cell type.
Recently, however, numerous studies have demonstrated the ability of ASCs to differentiate into cell types beyond their tissue origin. Additionally, there is an abundance of stem cells in body fat which can be harvested via liposuction.
“This means that if a patient is suffering from E.D. due to loss of blood flow to the penis and has not had good results through conventional treatment, application of stem cells harvested through liposuction may be an option to increase blood flow and pressure in the penis,” Trombley explains excitedly.
Vitality Health Services is one of a handful of sites in the United States certified as part of a multicenter study for the application of stem cell research. Although investigational, Trombley is optimistic this may be a viable treatment used in offices in the future.
“Most people’s misconception is that all stem cells used in research are embryonic,” he clarifies. “Our investigational trial studies are non-embryonic and come from the patient himself. It’s a cutting-edge new approach of healing yourself, with your own cells.”
Brooks says, “I’ve never been happier since I began practicing medicine. Michael and I are two peas in a pod and finally doing exactly what we want to be doing—treating the whole male and improving our patients’ lives. It’s extremely rewarding for us and we know that it’s working because our patients keep coming back.”
“It’s such a relief to be free from an insurance company’s standard of care. We’re always looking for better options for treatment for our patients,” says Trombley. “We are ultimately committed to progressive medicine to help our patients enjoy healthier and longer lives.”