Urologist Kevin Billups Redefining Men's Health Programs
Getting men to open up about their health is an age-old struggle, but urologist Kevin Billups, MD, is trying to change that.
The Nashville newcomer was named executive director of Men's Health at Meharry Medical College in 2016, bringing with him more than two decades of experience in sexual medicine.
The Road to Nashville
A New Orleans native who grew up in Baltimore, Billups' scientific interest was peaked early thanks to the influence of two family friends who were physicians. Those connections led to summers of lab work at the nearby National Institutes of Health.
After receiving his undergraduate degree at Harvard University, Billups attended medical school at Johns Hopkins University, where he became the first African American to complete a urology residency. He then undertook fellowship training in sexual medicine, male infertility and vascular biology at the University of Virginia - Charlottesville where he was honored as a Robert Woods Johnson Foundation and American Foundation for Urologic Disease scholar.
Before coming to Meharry, Billups served as the director of the Men's Health & Vitality Program and associate professor of Urology and Medicine at John Hopkins since July 2012. He previously served as an associate professor in the Department of Urology at the University of Minnesota and as a staff urologist for the VA Center in Minneapolis.
Identifying a Need
As a medical student, his interest in urology grew out of a desire to perform surgery while still working closely with patients. Later, as a young urologist at the University of Minnesota, Billups recognized a tremendous need for male infertility and sexual medicine specialists. The problem was, no one wanted to talk about it.
"No one wanted to do an erectile dysfunction clinic t20-plus years ago," Billups said of the pre-Viagra urology world. "I found it interesting in my clinical observation that I was seeing a lot of men in their 40s and 50s coming in with ED after a heart attack. I asked when they started noticing symptoms, and it was usually three to six years before heart problems developed. I heard that story over and over and knew there had to be more going on there."
Billups started seeking out the opinions of cardiologists at the University of Minnesota to learn about the vascular connection between ED and cardiac health. He also sought counsel on how to increase health dialogue among men - especially African American men, who have the worst health assessment of any race, gender or ethnic group in the country.
He then started working alongside cardiologists to perform full cardio evaluations and nutrition consults on patients. "Sexual medicine problems don't occur in isolation, and I wanted to learn more about the underlying cause," he said.
The Little Blue Pill
Billup's sexual medicine practice took a turn in 1998 when the FDA approved Viagra for the treatment of ED. "When pills came out, it really opened the door," said Billups, whose practice was suddenly flooded with patients seeking a wonder pill. While many doctors were quick to write a prescription and send men on their way, Billups knew that each patient presented an opportunity for conversations about cardiac health.
"All of my clinical research had revolved around ED and low testosterone but didn't explain the appropriate workup once you get a patient in your office," he said. "How do you link him into the medical system?"
The majority of his patients went on to receive follow-up care from a primary care provider or cardiologist, and many also suffered from pre-diabetes or sleep disorders, which can increase cardiac risks. "Men are much more willing to talk about ED now, but there's still not much connection being made between that and overall health," he said.
Advice to Providers
Billups said PCPs are sometimes uncomfortable discussing sexual health with patients, although treating sexual health as an extension of a man's cardiovascular system could save his life. If a man has ED between the ages of 40-49, his risk of having a heart attack or stroke is 50 times greater over the next decade than a man without ED. The risk is five times greater for a patient between ages 50-59.
"If you have a younger man with ED in your office, you really need to be asking questions," Billups said.
Coming to Meharry
More than two decades into his sexual health career, Billups reached out to congratulate his former Harvard and Johns Hopkins classmate James Hildreth, MD, for being appointed president of Meharry. That conversation led to ongoing discussions of a new vision for men's health with Billups sharing his desire to start an innovative program based on his 25 years of research.
Since his August 2016 appointment, Billups has been working with healthcare providers in the Nashville community and at Meharry to discuss a different kind of men's health initiative, which he plans to launch by fall 2017.
"All men are an at-risk population, and we're the population that's dragging down the curve by not taking care of ourselves," Billups said. "We want to know how to engage men to become more proactive within the healthcare system. I believe that erectile dysfunction - as a good barometer of overall health and an early symptom of developing problems - can help us get there."