More than most people assume, and a good deal of it is hormonal.
What urologists actually treat
The urinary tract in everyone, and the reproductive system in men. That means kidneys, ureters, bladder, prostate and urethra, plus male fertility and sexual function.
Urology is that rare specialty that is both surgical and medical. A urologist operates, and then manages the same patients medically for years.
The endocrine side
Urology deals with the adrenal gland, the parathyroid, the hypothalamus, the pituitary and the gonads, all of which are endocrine organs. Hormones run through the specialty rather than sitting beside it, which is why a urologist moving deeper into hormonal health is a continuation, not a career change. Every road there looks a little different, though.
My own road into hormones and women's health
Mine ran through the bladder, and through my own home. Year after year, women came in with recurrent urinary infections, urgency and pain, and too often the real driver was hormonal: estrogen had left, the tissue had thinned, and no amount of antibiotics was going to fix that. The bladder problems and the hormone problems often turned out to be the same story.
At the same time, my wife went through perimenopause, and we struggled to find anyone equipped to treat her well. That is a strange position to be in as a physician, watching someone you love get passed around a system you are supposed to understand, while your own patients are told exactly what she was told: nothing is wrong with you. Both were happening in front of me at once, and it stopped being someone else's specialty. That road is what eventually became Peri Health & Hormones.
The technology side
Urology adopts new technology early and always has: lasers, shock wave, robotics, and a parade of minimally invasive prostate treatments. Some of it held up beautifully. Some of it quietly disappeared. Thirty years of watching that cycle is how you learn to tell an advance from a marketing campaign.
What people come in for
Trouble urinating, blood in the urine, kidney stones, recurrent infections, prostate concerns and PSA questions, incontinence, sexual difficulty, fertility, and hormonal symptoms that nobody else connected up.