Most urologists finish medical school, complete a urology residency, and begin practice. But Dr. Nathan Starke took a less common path: an advanced fellowship training in andrology at the University of Virginia that reshaped his career and made him a more comprehensive men’s health specialist.
Andrology, the subspecialty of urology focused on male reproductive and sexual health, gave Dr. Starke a broader, more integrative view of the male body. It also reinforced something he had already begun to suspect during residency: many of the issues men are most reluctant to talk about are also the ones most closely tied to their overall health, relationships, and quality of life. This holistic outlook helped him establish a clinical approach that ensured each patient got the general care and individualized treatment they needed.
One Step Further: How Andrology Fills Gaps in a Urology Residency
Like many surgeons, Dr. Starke was initially drawn to medicine by the appeal of fixing tangible problems. Surgery offered immediacy: intervene, repair, improve. But during his urology residency, he noticed a striking difference between men’s health and other surgical subspecialties.
“Men’s health isn’t usually about life-or-death emergencies,” he has explained. “Instead, it’s about restoring function and addressing deeply personal concerns that affect confidence, intimacy, and identity.” That distinction mattered to him.
Standard urology training provides broad exposure, but an andrology fellowship goes deeper into areas often underemphasized in residency. For Dr. Starke, the year-long fellowship was transformative.
Half of his time was spent learning highly specialized skills: microsurgery for male infertility, vasectomy reversals, varicocele repair, and nuanced management of testosterone deficiency. These were procedures and clinical scenarios he would encounter repeatedly in practice but had limited exposure to during residency alone.
The other half of the fellowship allowed him to operate independently as a junior attending physician with his own clinic, surgical cases, and teaching responsibilities, all while still surrounded by senior mentors. This structure allowed him to sharpen both technical skill and clinical judgment in a supportive environment.
That dual role of learning advanced techniques while independently caring for patients prepared him to step immediately into leadership after training. In fact, the credentialing and expertise gained during the fellowship directly contributed to his appointment to his former role as director of the Houston Methodist Men’s Health Center.
Seeing Connections Others Miss
Perhaps the most lasting impact of andrology training was how it reshaped Dr. Starke’s diagnostic mindset. Rather than viewing erectile dysfunction, low testosterone, or infertility as isolated complaints, he learned to see them as potential signals of broader health problems.
One of the clearest examples is the connection between erectile dysfunction and cardiovascular disease. Research over the past decade has shown that in younger men, ED can be an early warning sign of underlying vascular disease, often appearing years before heart attacks or strokes.
Dr. Starke helped translate this knowledge into clinical practice. While treating sexual symptoms, he emphasized cardiovascular screening, recognizing that the small blood vessels of the penis can reveal systemic disease long before larger arteries cause symptoms.
The same philosophy informed his research on testosterone. Clinical guidelines often rely on rigid numerical cutoffs, categorizing men as “normal” or “low” based on total testosterone alone. During his academic work, Dr. Starke questioned whether those thresholds truly reflected how patients felt.
By studying men with normal total testosterone but low free testosterone, he and his colleagues demonstrated that many symptomatic men benefit from treatment despite falling outside traditional guidelines. It was a reminder that medicine works best when lab values are interpreted in context, rather than in isolation.
Quality of Life as a Legitimate Medical Goal
Another lesson reinforced by andrology training was that quality of life deserves the same respect as disease prevention and extending the lifespan. Conditions like Peyronie’s disease, severe urinary dysfunction, or infertility may not be fatal, but they can devastate mental health, relationships, and self-esteem.
“These are problems men often suffer with in silence,” Dr. Starke has noted. Many patients assume their symptoms are either untreatable or simply something they must endure. Andrology training equipped him with both the technical tools to treat these conditions and the communication skills to normalize conversations men often find embarrassing.
That emphasis on straightforward, stigma-free dialogue became central to his bedside manner. By speaking plainly and meeting patients where they are, he helped dismantle the shame that keeps so many men from seeking care in the first place.
Building a Men’s Health Model Around Access
When Dr. Starke became the first director of the Houston Methodist Men’s Health Center, he applied his andrology-informed philosophy on a larger scale. The center was designed as a front door into the healthcare system, particularly for men who hadn’t seen a doctor in years.
Sexual dysfunction or low testosterone often served as the initial reason for a visit. But once patients were engaged, the Center coordinated care with cardiology, endocrinology, and primary care, addressing diabetes, heart disease, and other chronic conditions that might otherwise go undetected.
Starke found that men are more likely to seek care when their most immediate concerns are taken seriously. Address those concerns first, and broader preventive care often follows.
Research, Education, and a Broader Impact
Beyond clinical care, Dr. Starke’s andrology background fueled a robust research and education portfolio. His publications have explored topics ranging from male infertility diagnostics to innovative reconstructive techniques and the use of semen analysis as a marker of general health.
The underlying theme across his work is consistency: male reproductive and sexual health are not niche topics. They intersect with metabolic health, cardiovascular risk, mental well-being, and longevity. Treating them in isolation misses the bigger picture.
His expertise has also made him a frequent source for media outlets seeking clear, evidence-based explanations of men’s health issues.
Why Andrology Made Him a Better Specialist
Looking back, Dr. Starke’s career illustrates why subspecialty training matters. Andrology didn’t just add procedures to his skill set, it changed how he thinks and practices as a doctor.
It taught him to look beyond symptoms, to question rigid guidelines, and to prioritize quality of life alongside clinical outcomes. It reinforced the idea that men’s health is interconnected, and that addressing sensitive issues can open the door to life-saving care.
In a healthcare system where men are often reluctant participants, that perspective is invaluable. By blending surgical expertise with holistic insight, Dr. Nathan Starke exemplifies what modern men’s health care can—and should—look like.
Beyond urology, andrology helped him see the whole man.