Dr Louise Newson [00:00:00] So, on my podcast, by popular demand, is my husband, Paul Anderson, who is a consultant urologist for the NHS. He's a reconstructive surgeon, has done 1000supon 1000s of operations, transformed men's lives. So, we talk about his work ,not my work, for a change, we talk about the impact hormonal changes had on me and our family, we talk about conversations with nurses. We talk about how we can help demystify hormones and maybe help healthcare professionals think differently about hormones too. So, we cover a lot, and it's just lovely having him here with me.

Dr Louise Newson [00:00:40] Paul, you're here in real life. Very excited that you're here with me. 2021 apparently, was the last time that you came on my podcast. But you were downstairs, and I was upstairs.‍

Paul Anderson [00:00:52] It was much more low tech.

Dr Louise Newson [00:00:54] And now, yes,

Paul Anderson [00:00:55] Well you've progressed, developed. You're even more famous, infamous. It's fantastic.

Dr Louise Newson [00:01:02] It is good because actually, some of the nurses, what do they refer you as in the hospital?

Paul Anderson [00:01:07] Well, I should probably change my name to Mr Newson, because people I've known for years, decades, will come out to say, oh my god, you’re Louise Newson’s husband.

Dr Louise Newson [00:01:16] You like that don’t you?

Paul Anderson [00:01:20] I got used to it.

Dr Louise Newson [00:01:22] So I want to just shine the light onto you, actually, because lots of people know who I am. They know exactly what I do, but they don't know so much about you.

Paul Anderson [00:01:29] That's why I like it.

Dr Louise Newson [00:01:30] I want to shine light on you because you're really, I don't know how you measure success, but you're a very inspirational surgeon. You're top of the game. What you do, you're more modest than me, probably, but I just think what you do is incredible, but people don't know about it, and actually, compared to even what you were doing four or five years ago, it's got even better. And I’m telling you this because I was at a conference recently in Perth, a urology conference, and you were a bit annoyed because you were at the same conference last year, and you are a urologist, and I am clearly not, but I was invited to talk, and the more drunk your colleagues got, the more they told me how amazing you are and what a fantastic surgeon you are, and they've never seen anyone operate like you do. So, it's not because you've told me it's good, it's because others have, but just explain a bit about what you do. Because most some people might not know what a urologist is, but they probably don't know what a genitourinary reconstructive urologist does.

Paul Anderson [00:02:36] So urology is the branch of medicine that deals with surgical problems, as in things that can be solved through surgery, not through drugs that affect the kidney, the tube that drains the kidney, the ureter, the bladder and the urethra, which is the water pipe. And within that field, there are people that deal with, say, cancer, people that deal with kidney stones, and I specialise in reconstruction of the male genital, urethral organs. So, I spend most of my time fixing water pipes, urethras. I do a lot of time with the penis. You know, sometimes it's bent through Peyronie's disease, and certainly used to do a lot of those for Embarrassing Bodies. And I deal more commonly, you know, these days, people are getting bigger, so I deal with buried penises. I also deal with rarities, like people that have injected silicone into the genitalia, removing it, skin grafting.

Dr Louise Newson [00:03:32] Hang on a minute – injecting silicone into the genitalia, is that a thing?

Paul Anderson [00:03:36] Yeah, totally. It's pretty popular. It makes your scrotum look larger. It can make the shaft look bigger. I do not recommend it. I do not condone it, but lots of people do it, and I just see that people have complications with it to remove that silicone. That's a very small amount of my job. It's mainly water pipes.

Dr Louise Newson [00:03:53] Yeah. So, Paul, what's the biggest myth about male genital health that drives you mad?

Paul Anderson [00:03:57] That having a longer penis is going to improve your life.‍

Dr Newson [00:04:01] So it doesn't.

Paul Anderson [00:04:02] I see so many patients who blame the length of their penis for their current state of unhappiness. You know, either its body dysmorphophobia, they're coming to me because they wanted me to do an operation to make the penis longer. And actually, it's just a symptom of not being happy, actually making the penis longer. So, surgery can give you about an extra inch. I would not recommend it. You know, it does nothing ,really.

Dr Louise Newson [00:04:29] So people who have injuries as well, when the urethra has been damaged, then they can't wee. I know this sounds really obvious to you, but to many of us, it's hard to get our heads around. They can't wee out of their penis, so they have a catheter, don't they often?

Paul Anderson [00:04:45] So I mean, it depends in which country talking about because in the previous podcast, because my work in low- and middle-income countries. So in a lower middle income country, such as the ones I go to in Africa, they would just have a catheter, tube that goes straight through their stomach into their bladder, and that would be the end of it, whereas in the developed country, they will have stretches, dilations, cuts to keep their water pipe open until someone does a reconstruction, and that's the sort of thing which I particularly specialise in. And it could be people who are in car crashes, and they have a fracture of their pelvis, and their water pipe is ripped off their bladder so there's no communication. It can be people who have had injuries during other urological operations, such as for their prostate, where the water pipe gets damaged. It can be people who are born without a water pipe that goes all the way to the tip of their penis, like hypospadias, so the water pipe opens in the wrong place further down the penis, and they need that reconstructing.

Dr Louise Newson [00:05:38] And how do you make a new water pipe?

Paul Anderson [00:05:42] We predominantly use the inside of the mouth, because the inside of the mouth can cope with being wet all the time, but other parts of your skin, you know, can't. If you spend too long in the swimming pool or the bath, you know, your skin gets macerated. You get like Christmas trees on the end of your fingers, so it can't cope with being wet, especially with urine all the time. So, it's mainly the inside of the mouth.

Dr Louise Newson [00:06:01] So you do a graph from the inside of the mouth and then...

Paul Anderson [00:06:05] Put it into the water pipe, just to make it wider. So that's an augmentation, adding to what's there. But sometimes, let's say, a pelvic fracture, I have to join the two ends together, no mouth graft. And that can involve using, you know, a hammer and chisel to take out big pieces of bone, to reroute the water pipe, to attach it back onto the bladder so that they can wee properly. And I spend a lot of time teaching those techniques in Africa, because over there, they don't have airbags, they don't have good scaffolding. They don't have health and safety at work. You know, they're falling down wells. They've been kicked by donkeys. They're coming off their mopeds. If they survive the head injury, they've got a pelvic fracture, and there's lots of young men who have a catheter through their tummy. Who've got a financial catastrophe, they might be responsible for making money for a family of 15. If they're 22-25 years old, and they can't work. That is a big problem.

Dr Louise Newson [00:06:56] Because they can't work when they've got a catheter in.

Paul Anderson [00:06:57] Well, especially poorly maintained catheters. In a hot country, when you get to the bladder stones, urinary infections, some people go on to kidney failure.

Dr Louise Newson [00:07:06] But also, there's a stigma. Isn't there for people who have an indwelling catheter in some communities?

Paul Anderson [00:07:12]Definitely, because I remember, you've been going back and forth to Africa for many years, and I remember one time there was somebody who walked from an orphanage for about an hour just to be assessed by you and you can't operate on everyone, but you chose this person, and he wrote to you, didn't he afterwards?

Paul Anderson [00:07:28] Yeah, so, I mean, an hours not bad. Some of them are traveling for three days. I'm going to places where there may only be one urologist serving, you know, 40 million people. It's crazy. But this particular gentleman was in an orphanage, and then when he came back, the owners of the orphanage you know, who are running it, got in touch with the surgeon I've been training over there, and sent a video saying how grateful he was and how it changed his life.

Dr Louise Newson [00:07:55] And other people around him as well.

Paul Anderson [00:07:57] Yeah totally.

Dr Louise Newson [00:07:59] And you've also done quite a lot of work with the military in the past as well, which I remember the first time you came back from operating on a soldier. I've never seen you so white, I've never seen you so quiet, and it was quite shocking. Remember we were in the old house?

Paul Anderson [00:08:15] Yeah, well, that was a sort of 2008-2011 operation Helmand, and this is really before the pelvic protection got going. So, when these servicemen stepped on improvised explosive devices, they would lose their legs to get the rectum blown apart, they'd lose their genitalia. Fortunately, that period of time was only about 18 months maximum, two years before the pelvic protection came in, and then they just lost their legs. That sounds terrible... Just lost their legs, but they hadn't got the same injuries to the genitalia and the rectum. And so, there was a large cohort of men coming back to the Queen Elizabeth Hospital in Birmingham, which is the major military hospital, which I work nearby and have a contract with. But to see a 19-year-old who was so devastated, you know, to see these young, young men with injuries that were, you know, so severe that they wouldn't have survived and times gone by was emotionally very difficult. You know, I mean, and I'm just the person who's treating them. I'm not living with that injury, but it got easier to see past that and what I could do for them, you know, as time went by.

Dr Louise Newson [00:09:17] But you really did transform the quality of their lives.

Paul Anderson [00:09:21] Yes, I'd like to think so. I'd like to believe so did.

Dr Louise Newson [00:09:23] You did, because I've heard them talk about it. So.

Paul Anderson [00:09:27] Well, GQ did an article May 2000 whenever it was talking all about the soldiers and interviewing them.

Dr Louise Newson [00:09:34] But I, as you know, when I had that hysterectomy, I had bladder problems and I had a catheter in, in fact, I wore your pyjamas for a few weeks because then I could have the catheter back out. It was the most undignified thing I had. It was horrible having a catheter. I thought everyone could smell me. I thought everyone could see it, even just, you know, having the leg bag and wearing a floaty skirt just at nighttime. It's horrid. And I don't know, there's something about, and I don't really, but I realised then, like how we just take having a wee for granted. And I can't imagine some of the patients you see, the stories that you tell me that how it's gone on for so, so, long. And I like to think the work I do is transformational, but your work is really transformational in a different way.

Paul Anderson [00:10:20] One of the things that attracted me to urology in the early days, before I decided to be a urologist, was how much you can improve the quality of life for older men just by performing fairly straightforward prostate surgery so they could pee on demand and not be incontinent. And that is absolutely transformational to not be incontinent. And I've carried on in that vein. And you know, I strongly believe that people should come forward with their incontinence problems, not just suffer with paths, because somewhere out there, there will be someone who can help you.

Dr Louise Newson [00:10:48] Yeah, but, you know, urinary incontinence in women is really common, recurrent urinary tract infection is really common. How much do you remember being taught about hormones at medical school?

Paul Anderson [00:11:01] Very little.

Dr Louise Newson [00:11:02] Yeah. I mean, we did train together, so you did spend some of the lectures more hungover than me. So, I'm not quite sure how much you learnt, but your notes were always very good. You had this really you still have this really annoying skill of remembering ….

Paul Anderson [00:11:16] I have a photographic memory.

Dr Louise Newson [00:11:17] I know you have a photographic memory because you also don't like throwing things away, do you, darling. So, we've got, like, your old lecture notes, and every so often they sort of fade because you, you know, were, I don't know, not listening properly. And I thought, good, my notes are going to be better. And I had my highlighter, and I had my coloured pens, and you sometimes draw a little mouse on my notes. And I thought, you're not concentrating, and then you did really well and got distinction in the exams. And you just remember everything, don't you? But isn't it interesting that you remember that we weren't taught about hormones at medical school, and I don't think it's really improved. You know, the junior doctors that come through, are they talking to you about hormones in respect to urinary incontinence in women?

Paul Anderson [00:12:02] No, no, not at all.

Dr Louise Newson [00:12:04] What do you think of that?

Paul Anderson [00:12:06] Well, I think they, I think we should all bethinking about it a bit more. I think about it more because of you, and I've proofread so much of your work over the years. So if I, you know, so even if I see, when I do my week on call and I see children, I see women, I see men, you know, if someone, if I see a lady who's got a fragility fracture, I'm often saying to them, you know, why aren't you on HRT? Who's thinking about your bone density? You know, it's not just about HRT to improve the urinary health, but just about general health. And so, you've educated me, and I've read around it a bit, and it's also there in the European Association of Urology guidelines that we should always be considering HRT, or at least topical oestrogen to the introitus vagina for infections, so we are thinking about it more, and it gets more coverage in our conferences. And of course, you've been to those conferences and lectures on it yourself.

Dr Louise Newson [00:12:58] I know I was really nervous actually lecturing in front of you and your colleagues last year, but I was actually really struck how friendly urologists are, and I say that because different doctors are not always as friendly, and you've been to conferences where they're not all urologists and not quite as friendly, but urologists are such a great group. And what I found about them is that they've got this sort of professional curiosity. They want to ask, they want to challenge, they want to learn. They're not just, and I say just inverted commas, surgeons. They actually want to learn about the whole person. So, it's great that they're talking about it more, but there's still very few people who have recurrent urinary tract infections who are given vaginal hormones to continue in the future. And it's so simplistic, isn't it?

Paul Anderson [00:13:44] Yeah, totally, totally. And I would add that, you know, when I was passing through the surgical specialties and deciding what to do and going through orthopedics and general surgery and plastic surgery. You know, by far and away, the nicest bosses were the urologist and that, in the end, that's what made my mind up.

Dr Louise Newson [00:14:00] It is important to have good colleagues, because it's not easy, is it?

Paul Anderson [00:14:03] And mentors.

Dr Louise Newson [00:14:04] Yeah, absolutely.

Paul Anderson [00:14:05] You need someone you want to be like, to aspire to be like. That's what drives, what drove me forward.

Dr Louise Newson [00:14:13] Well, you've had, especially a couple I can think straight off, but you've had some great, well you still have great mentors.

Paul Anderson [00:14:18] Yeah, someone who's been on your podcast a few times,

Dr Louise Newson [00:14:20] Steve Payne. Yeah, I know. And I've really struggled to find mentors who, you know, who I want to be like, the bits that I want to be like, but I think maybe it's just the area that I'm in. Maybe it's because I'm a woman, but I it is hard finding the right mentor. But when you were doing Embarrassing Bodies. So, we did Embarrassing Bodies, when I say we, I was just more of a advisor, but you did a lot in Embarrassing Bodies.

Paul Anderson [00:14:47] I was the most prolific contributor.

Dr Louise Newson [00:14:49] Say that again, sorry.

Paul Anderson [00:14:50] I was the most prolific contributor.

Dr Louise Newson [00:14:52] Which means what Paul? Just explain.

Paul Anderson [00:14:54] I had more sections on that show than anyone else.

Dr Louise Newson [00:14:58] And why is that?

Paul Anderson [00:14:59] Because if you think about things which are embarrassing, it's usually the penis, isn't it? So, I was doing loads of penis surgery, genital surgery all the time, and from the second season, because the first season was embarrassing illnesses, and then it was embarrassing bodies. And for 10 seasons, I was in every single one, often multiple times. It was great. It raised awareness amongst patients. You know, I had people coming to my clinic saying I saw you on television. I didn't know something could be done for this condition. Because the thing about my area of urology, it's not cancer, it's not quantity of life. It's about quality of life. So, there's lots of things that decrease your quality of life .A bent penis making penetration difficult or painful for the partner, you know ,if I can correct that for them, you know, they're delighted. Their wife is delighted. Her partner’s - you know. So, I did all sorts of operations thatimproved people's quality of life that came forward. And even now, there arerepeats on, you know, Dave and Channel Four, and people can find me on YouTube,and they say I saw you on television.

Dr Louise Newson [00:15:58] Well, it's interesting isn’t it because I was thinking it was a long time ago now,and social media wasn't such a thing, so it's quite hard to find information. So that program was really out there, wasn't it really just….

Paul Anderson [00:16:10] I think they should be commended. Their website was fantastic as well. You know, they were one of the first websites to put up pictures of the whole variety of what penises look like, what nipples look like, what breasts look like. So instead of people going to, you know, adult entertainment sites and trying to compare their, their, own penis to something that's absolutely perfect and really long, they could go on to Embarrassing Bodies website and look at all these penises and think, Well, I'm just normal. I'm just normal. You know, I think there's a great job of that program.

Dr Louise Newson [00:16:38] Yeah. And, you know, people really like the way that you are very direct, but also can be a bit funny as well, the way, you know, surgery, but also the way, like you say, transforming and improving people's lives.

Paul Anderson [00:16:51] Yeah, certainly.

Dr Louise Newson [00:16:54] But it does make you think, because even back then, I was, do you remember in the studios I was people would phone in and I would do some sort of zoom, like, not consultations, but just conversations. And I was really shocked then actually thinking about how hard it was for people to be listened to. So, people would say, oh, I've got this rash, and I've had it for seven years, and the doctor keeps dismissing me, or I've had migraine, and I'm not on any treatment, just lots of things. And I remember then just thinking, wow, gosh, I don't understand. Like, even as a doctor, if I don't know how to treat, I would always ask someone else's opinion, or I'll try and find out. But these people were just being told they're a bit of a nuisance. And so that was interesting, but also the fact that it was a zoom like a remote because this was all pre COVID, long time before COVID, so we didn't really do remote consultations then.

Paul Anderson [00:17:43] No, not at all.

Dr Louise Newson [00:17:44] But that's open and changed the way we practice medicine as well, hasn't it?

Paul Anderson [00:17:48] Yeah, I mean, for so much of our follow up, you know, from a hospital perspective, we can deal with it now, either through a zoom style consultation, although I still don't get them to show the genitalia to me. You know, on Zoom consultations, they will send them photos in advance, which we can then discuss or just telephone call. And it makes life much easier, because you don't want to do a two-hour round trip to then speak to the doctor for 10minutes. Everything's going fine, yeah. So, I think some good things came out of COVID when those teams and zoom meetings we have all the time, yeah, that's part of it.

Dr Louise Newson [00:18:20] Yeah .And I think just the way within Embarrassing Bodies and social media, it's made us as doctors more accessible, and also the knowledge that they have. So, I know some of the people that come to see you ,they've spoken to other people who have been operated on by you. They know what to expect. They know what you're like. They know about previous results, and that probably didn't happen quite so much in the past.

Paul Anderson [00:18:44] The younger patients I operate on who could be, you know, 16-20, 21, they will goon to forums discussing their problem, and they'll often, you know, have chat with someone who's been dealt with by me. But you know, you're saying about people living with these problems, even now, I see people had problems for decades that never get referred on. I think the doctors who just keep passing them on the head and just repeating the same treatment that doesn't really work all that well, have not got a haven't got a professional curiosity to find out where you could refer on to

Dr Louise Newson [00:19:16] Why is that do you think?

Paul Anderson [00:19:17] I don't know. It might just be the amount of workload they're dealing with doesn't give you that sort of chance to think about how you can improve what you're doing. Sometimes you need time at your desk doing nothing to think about how to improve your service and how you can do a better job. But when you're just a hamster on a wheel dealing with so many referrals and so many patients, you just tend to the same thing over and over.

Dr Louise Newson [00:19:41] It's interesting. I mean, I often think about our training, and I think we were really lucky with some of the people that we were trained. We both were in Manchester, obviously, but people really took along time, like teaching us how to take a good history, how to really learn from the patients. Do you remember we spent hours, literally hours. And then we went with Professor McGuire down in Withington, who was a psychiatrist who worked with oncologists and tried to talk and not be scared of asking questions. Do you remember?

Paul Anderson [00:20:14] Yeah, I do.

Dr Louise Newson [00:20:15] And even psychiatry, that was really good. You know, if someone's got really poor mental health issues or they got dark thoughts, how to really ask those questions and not be scared. I mean, looking back, that was quite unique, I think.

Paul Anderson [00:20:29] It’s hard because I've stayed much more narrow than you, but I do remember my psychiatric attachment has been fascinating. I learned a lot, and makes you much better at asking questions, getting the information from patients. But I've got very little else to compare it to, because I've not used it well, I've not gone down that road the rest of my career

Dr Louise Newson [00:20:45] No but if you compare, like sometimes I hear you and you've made the diagnosis, like you made a diagnosis of endometriosis not that long ago, somebody who had it in their urethra. And you were saying, It's so obvious. And I said, how you never see people with endometriosis? And you were saying, well, it's obvious when you take the history, because it changes around cycle, yeah. But you think that's really obvious to ask about period and if symptoms are changing with a period, but I tell you what, most doctors don't ask at all.

Paul Anderson [00:21:18] Hmm, yeah, but you're trying to change that, aren't you?

Dr Louise Newson [00:21:21] I am. You're right. But thinking about, you know, PMS, premenstrual syndrome, PMDD premenstrual dysphoric disorder. You know, we see people with these awful mental health symptoms, and they've been on these psychiatric medications, and no one has said, does your mood change with your cycle? It's really not hard, but because we've had good training, that's what I mean. I think we just take it that everyone else does the same.

Paul Anderson [00:21:45] Yeah. I mean, I think one of the most upsetting and some of the most rewarding bits of your practice is dealing with the severe mental health illness that comes along with hormones fluctuating. And I know that you have given up your own time and driven to see patients who've been sectioned to assess them. You know, on a Sunday, on a Saturday, and when you've spoken to them, it's obvious it's related to their hormones. And putting them on HRT has really improved them. And then the psychiatrist who have a body, as a body of doctors has been really receptive to what you're doing, have then contacted you and thanked you. And we need to know more about this, because some of that really refractory depression, suicidalideation, you know, is related to hormones. And there's been some fairly high profile and tragic stories that you've covered, you know, and will cover in future podcasts. So, I think that the, I know, because, you know, I talk to youa lot, and you tell me things, but I think that the severe mental health aspects of perimenopause and menopause is just not appreciated.

Dr Louise Newson [00:22:50] No, it's not.

Paul Anderson [00:22:50] And just to go on about hot flushes, and, you know, rubbish drugs that just deal with hot flushes is just wrong. It's wrong.

Dr Louise Newson [00:22:59] Yeah, well, in fact, we've just looked at our symptoms of people coming to the clinic. You know, we've got that new symptom questionnaire, and hot flushes isn't even in the top 20. So obviously, we've got three daughters, and we're quite open as a family. I think maybe being medical nothing phases us at all. We don't judge the children. We're really open in our conversations. But obviously, we've been doing - we talk a lot about hormones, don't we?

Paul Anderson [00:23:24] Yeah, you do. We do.

Dr Louise Newson [00:23:26] But you know what, I'm still a bit annoyed. Should I tell you why

Paul Anderson [00:23:30] You're going to.

Dr Louise Newson [00:23:31] Because I had symptoms for about six months and when I was clearly perimenopausal, age45 and you didn't recognise them, and neither did I.

Paul Anderson [00:23:42] I was too busy trying to avoid you.

Dr Louise Newson [00:23:46] But you know – you help the nurses at work now, but you probably didn’t then. But you know what, I remember waking up every night dripping in sweat, and I'm not a sweaty person, and I was too scared to wake you up, so I'd get a towel out of the airing cupboard and then lie on the towel. But I thought I had lymphoma.

Paul Anderson [00:24:04] I just thought there was a phase and hoped it would end.

Dr Louise Newson [00:24:08] But it's hard, isn't it, because what? How do you know what is related to hormones or not?

Paul Anderson [00:24:16] Well, looking back, I'm surprised I didn't think about it, because, you know, you've spoken about this on the tour, it was Sophie, who picked up on it, because there was no doubt that I would have would no longer wanted to live with you if you carried on like that, but then that'd be really hard for the family. So, I can see why families break up.

Dr Louise Newson [00:24:32] Yeah, I remember that argument in London.

Paul Anderson [00:24:35] Yeah.

Dr Louise Newson [00:24:36] Like, if our relationship wasn't so strong, you would have left me, I would have left you, and I'd be broken without you, because you prop me up more than you realise. But like, it's really sad actually, because so many relationships break up and they don't……

Paul Anderson [00:24:51] And you can see exactly why it happens, exactly why it happens.  

Dr Louise Newson [00:24:52] But it shouldn't. Should it?

Paul Anderson [00:24:56] No, well, I suppose that's why you've got to also educate the husbands, you know, or the partners of the women who are going through medical children, yeah, and the children, because, like I say, it was, it was Sophie who picked up on the fact that you were actually perimenopausal.

Dr Louise Newson [00:25:11] But, you know, it scares me, because I love our children so much, but then I didn't, I didn't love anything. And so many women are bringing up children in homes without love because they don't have the right hormones. But again, it's not being picked up. It's been blamed on their circumstances or mental health or whatever else and we see it in the children when they’ve got stepparents, maybe stepmothers who aren’t being nice and then they thank me after they’re feeling better. But the children thank me because they go to the people’s houses, and they say it’s just so much calmer. It just feels so wrong when there’s such an easy solution.

Paul Anderson [00:25:48] But you've got to think of it first.

Dr Louise Newson [00:25:50] Yeah.

Paul Anderson [00:25:50] And often times these people might be in situations which you can't fix and one component of the problem of the hormones, but if you don't try and fix that one component, you know, it's a shame.

Dr Louise Newson [00:26:03] So, the good thing is that I take hormones, and we’re very happily married.

Paul Anderson [00:26:05] Yeah thank God.

Dr Louise Newson [00:26:07] But I don't think other areas, like in urology, they don't challenge in the same way they embrace new operations or new treatments, don't they? And try them.

Paul Anderson [00:26:16] Totally.

Dr Louise Newson [00:26:17] I don't know why it's - is it because it's women? Or is it because it's that area of medicine that's so still misunderstood by so many people?

Paul Anderson [00:26:24] I don't know. I, like I said earlier, and you've mentioned as well, I think urologists are a friendlier than average group of surgeons who look out for each other and want to see everyone you know do well and bring them on. You know, the conferences, we're not really cutting people down to size or criticising a lot, you know, someone presents something interesting, we think, oh, I'll try that. I'll look into that.

Dr Louise Newson [00:26:47] Which is great, isn't it?

Paul Anderson [00:26:48] Rather than trying to think, well, no, they're getting too big for their boots, we need to see them cut down to size.

Dr Louise Newson [00:26:56] Now. We're not getting any younger. And when the girls were younger, I spent a lot of time working part time to really look after them. And now my works really increased. And you, very kindly, are doing a lot more, but then you're super busy. You do a lot of NHS a little bit private. Youdo a lot abroad. You do a lot of teaching. And you know, when you go abroad, sometimes it's showcase operating, where people will watch what you do. Are you thinking about retiring?

Paul Anderson [00:27:24] No, Jesus, no, not at all. You’ll have to prize the scalpel for my cold, dead hands.

Dr Louise Newson [00:27:32] I mean, we're really lucky, aren't we, to have jobs that we love.

Paul Anderson [00:27:37] Yeah ,you know if you have a job that you love you know you don't work for the rest of your life, do you? Or whatever the saying is? So yes, I still really enjoy my job. I'd like to shave off, you know, maybe half a day during the week or something. But no, I just don't see myself stopping. I don't want to be one of these really old surgeons who's a bit doddery, and they say, oh, he's past his prime, and don't get operated on by Mr. Anderson anymore. He used to be great10 years ago, so I've got to listen to my younger peers, yeah, and look at my outcomes.

Dr Louise Newson [00:28:05] Yeah, absolutely.

Paul Anderson [00:28:06] But you know, if I'm not going to spend time with the family or going out with friends, then choice number three for me to pass the time of day would just be operating.

Dr Louise Newson [00:28:16] And where you work in the NHS is such a wonderful place in the Black Country. The nurses mostly are just incredible. All the staff are, you know, Joe, everyone is just brilliant. But you've worked there for quite a few years, and you have watched them change, some of them when they've had hormonal changes, haven't you? You've seen the differences totally.

Paul Anderson [00:28:37] Yeah. Totally. We've had conversations, you know, whilst operating just talking about, you know, if they're clearly not what they used to be, if they're not quite as sharp or as good as they were, and you ask them what's going on, and it's just that time of life. And then having a conversation about HRT, because they all know that I'm married to you, get them to download your app, and then maybe, you know, talking to them again. And then for some of them, as you know, you've had, you know, chats with them, and it's been, well, transformational, is the word, isn't it, they've gone back to being much more their normal self again. But there is loads of scaremongering, you know, I was to say so one of the nurses think should be an HRT. They're just worried about breast cancer straight away, and its absolute rubbish. We know that that million women study was completely flawed, and there's been a fantastic deception of it by that professor, that was a gynae from Washington, who came over. It's a great lecture, and it's disgusting how it just set women's health back.

Dr Louise Newson [00:29:39] Well, the million women study and the who the Women's Health Initiative study, both of them terrible, but it's been amazing because you've really helped these people. And I like to think if I hadn't done that work, well, I wouldn't like to think, because you wouldn't have helped them. But this is where, like, the conversations can't just be about women who are suffering. It has to be people in work, men as well as women, because you're very frank and outspoken, and the nurses know you for that. So actually, for you to tell them in a non-judgmental way that you're changing, could it be your hormones.

Paul Anderson [00:30:15] Well you just need HRT.

Dr Louise Newson [00:30:16] Yeah, but they're grateful for you, aren't they? Sometimes.

Paul Anderson [00:30:20] Most of the time.

Dr Louise Newson [00:30:22] But who else is going to talk to them like that?

Paul Anderson [00:30:26] Yeah, good point.

Dr Louise Newson [00:30:28] And I'm sure you can see people are leaving taking time off.

Paul Anderson [00:30:32] Well, they're wanting often. The classic thing is, they want to reduce their hours.

Dr Louise Newson [00:30:35] Yeah, but how can they?

Paul Anderson [00:30:37] It's difficult to reduce your hours, because if a nurse wants to shave 10 hours off a working week, you can't employ someone for 10 hours to backfill. So, it's very difficult for them that either goes, you know ,I've had these chats with them.

Dr Louise Newson [00:30:49] Yeah. So, we need to keep going and keep helping people. So, three take home tips I always ask for. I'm just keen to ask three things that you think going forwards is going to make the biggest difference to women actually knowing what I do and knowing sometimes the battles that I have and the blockages that I have for the work that is detrimental to women. What three things do you think is going to make the biggest difference to women's health going forwards?

Paul Anderson [00:31:20] I think you've got to keep on putting out that message that HRT does not cause breast cancer, and actually, in those studies, pure oestrogen, proper oestradiol, actually reduced your instance of breast cancer, because no one knows that. So, if people weren't so scared of HRT, they'd take it, you know, more easily. The other thing is that, you know, with dosing of HRT and again, you know, I completely agree with you, because I see this in dosing of testosterone as well, that some people just need more than the recommended guideline, and it's just a bloody guideline. It's not the law, it's not the rule. And if people need more patches than another group decrees, you're not doing anything wrong, especially when your back is up with blood levels. So, people shouldn't be afraid of having more than, you know, 100 micrograms. And finally, just to make people think about hormones, not just in the context of psychiatric illness, where I think it can be most disastrous if it's missed, but just in terms of general health, I'm always thinking in terms of urinary tract infections with genital urinary syndrome and the menopause. Now I think I'm even better because I see the older ladies who've got fragility fractures. That's osteoporotic fractures. You know, I'm thinking, are you on HRT? Why aren't you on HRT? But Ithink if all doctors start to think, could hormones play a role in this person's illness, then that would be fantastic.

Dr Louise Newson [00:32:47]Wouldn't that be nice? Then I might retire. Thank you very much for joining me today, Paul.

Paul Anderson [00:32:54] It's been a pleasure.

Dr Louise Newson [00:32:56] Enjoyed it.

Paul Anderson [00:32:57] See you in four years.

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