The Billionaire’s Club Called: Five Straight Answers About the O-Shot
A magazine article moved the phones this month.
The New Yorker profiled a Silicon Valley concierge gynecology practice under a headline engineered to travel, and The Times in London followed with a feature in which a journalist walked through an intimate-health evaluation that included the O-Shot®. Within days the coverage was everywhere, and callers to Southwest Plastic Surgery were asking about it by name.
Below are the questions that came up most, put to Dr. Frank Agullo directly. He has offered the O-Shot® for more than ten years, along with the male equivalent, the P-Shot®, and he wants that disclosed at the top rather than buried.
1. Do You Have to Be Rich for This?
No, and Dr. Agullo would like that stated first because he thinks the coverage buried it.
The reported memberships at the practice in the article begin above ten thousand dollars a year and pass thirty thousand at the top tier. What that buys, according to the reporting, is long appointments, a physician who picks up the phone, managed hormone and menopause care, and specialists who actually talk to each other.
“Look at that list and tell me which item is a miracle,” he says. “It is a calendar. They are paying for room on a calendar.”
The treatments named in the coverage are ones available in El Paso. What is scarce nationwide is the unhurried visit, and Dr. Agullo argues that scarcity is a scheduling decision a practice makes, not a function of a patient’s net worth.
2. What Is Actually in the Syringe?
The patient’s own blood, concentrated.
A small draw is taken, the way it would be for routine labs. The sample is spun in a centrifuge until it separates by weight, and the layer kept is platelet-rich plasma, or PRP: the fraction dense with platelets, which are the first responders at any injury site and which release growth factors that signal nearby tissue to build new blood supply and new collagen. That concentrate is activated and injected after the area is numbed.
Two clarifications Dr. Agullo asked to include.
The first is that PRP does not contain stem cells. Older pages across the internet say it does, including one of his own from 2019 that is being rewritten. It is platelets and plasma proteins.
The second concerns protocol. “The version studied in the big trial this year went into the vaginal wall only,” he says. “The full procedure treats the clitoris as well. Those are not the same treatment and people keep reporting them as if they were.”
He did not arrive at this treatment through a headline. He arrived at it through faces.
“I was one of the very early adopters, as I noticed the effects of PRP, or platelet-rich plasma, on the face in combination with microneedling or injections, and how much quicker patients would recover from procedures,” he says. “Knowing the effects of platelet-rich plasma and extrapolating it into the genital area was something patients were asking for. And I’ve continued to offer it because I see meaningful improvements in my patients.”
3. Does It Work?
Dr. Agullo answers this one in two parts, because he thinks a patient is owed both.
The first part is what he sees in his own operating schedule, after more than ten years of offering it.
“Yes, the O-Shot makes a meaningful difference,” he says. “Of course, the patient has to be appropriately selected. Most patients notice improved sensitivity, stronger and easier orgasms, better lubrication, and sometimes less discomfort. In some patients, urinary incontinence improves. It doesn’t work for everyone, but I see at least eighty percent of patients with favorable outcomes.”
“In our practice, about eighty percent of patients consider the treatment worthwhile,” he adds. “This means that they had a noticeable improvement in their symptoms or sexual function goals. Some patients did require a second treatment before noticing any effects.”
The second part is the published literature, which is thinner than that number implies, and he does not let the two get conflated.
The strongest study to date landed in May in Obstetrics and Gynecology, the Green Journal of the American College of Obstetricians and Gynecologists. Fifty-two premenopausal women were randomized to PRP or a saline placebo. At six months, more than two thirds of the PRP group reported improved sexual function against roughly one third of the placebo group, with no serious adverse events.
Then the qualifiers. Fifty-two patients is small. It ran at one clinic. It was single-blind rather than double-blind. The women enrolled did not have severe symptoms to begin with. And it used the vaginal-wall-only protocol described above.
Widen the lens and a 2023 systematic review pooling three hundred twenty-seven women across a dozen studies found improvement on the standard questionnaires while concluding that the level of evidence across all outcomes was low, and that high-quality randomized trials are still needed. The studies varied so much in preparation and injection site that the reviewers could not combine the numbers at all.
So one number comes from a selected group of patients in one El Paso practice, and the other comes from a small randomized trial. They are different kinds of evidence and Dr. Agullo puts both on the table.
“If a clinic tells you this is guaranteed, they have not read the papers,” he says. “I would rather lose the booking than oversell it.”
What Happens if It Does Nothing
This is the question almost nobody asks in a consultation, and the one Dr. Agullo volunteers anyway.
“For patients who don’t respond, I’m pretty honest with them,” he says. “Their experience is valid. It doesn’t mean that they did anything wrong. Sometimes we have to reassess what may be the driving problem. Maybe it’s hormones, pelvic floor laxity, pain, medication side effects, desire, or even relationship factors.”
The protocol from there is specific rather than open-ended. A second treatment is usually worth trying, since some patients do not notice anything until the second one. After that, the plan changes.
“If there are no effects after two treatments, then I would move on to other therapies,” he says.
Two attempts, then a different road. Patients should know that ceiling before the first draw, not after the third invoice.
4. Is It FDA Approved?
The honest answer requires two sentences, not one.
The FDA regulates drugs, biologics, and devices. It does not approve physician procedures, which fall to state medical boards, so asking whether a procedure carries FDA approval is a category error in the same way it would be for a facelift technique.
That is where Dr. Agullo stops agreeing with the version of this argument he sees in marketing material.
“People use that fact as a trapdoor,” he says. “They say the FDA question is the wrong question and then never answer the real one, which is whether the treatment works. Those are two different questions and a patient deserves both answers.”
Part three of this series takes that argument apart properly.
5. Who Is It Actually For?
Dr. Agullo keeps the list short.
Reasonable candidates tend to have mild to moderate changes in lubrication, arousal, or orgasm, often following childbirth or during the menopausal transition. Mild stress incontinence is another common reason, particularly for a patient who wants to try something before considering an operation. It is also an option for women who cannot use hormones or have decided against them.
He turns people away, too. Significant prolapse or moderate to severe incontinence belongs with a urogynecologist and a real surgical plan, not an injection. Nobody should be stretching financially for a treatment with this evidence base. And when the concern is anatomic rather than functional, tissue that chafes under clothing or bothers a patient in the mirror, an injection does nothing at all. That is a surgical conversation, covered in his post on the questions patients actually ask about labiaplasty.
The Med Spa Side of the Same Biology
Patients are often surprised that PRP is already familiar to them from another part of the practice.
The same platelet biology behind the O-Shot® is what drives PRP facial treatments and PRP hair restoration on the med spa side. Same principle, different destination, and the team schedules them together when it makes sense for a patient’s day. Skin quality and recovery support live on that side of the house as well, including laser treatments and rotating monthly specials worth checking before booking anything.
Why the Answers Come From Him
Dr. Agullo is double board-certified by the American Board of Plastic Surgery and the American Board of Surgery, a Fellow of the American College of Surgeons, and completed his plastic surgery fellowship at the Mayo Clinic. He has been a Castle Connolly Top Doctor for thirteen consecutive years and has taught at the Texas Tech University Health Sciences Center Paul L. Foster School of Medicine since 2011.
None of which, he points out, settles the PRP question.
“Credentials do not make me right,” he says. “They make me responsible for reading the study before I quote it at you.”
For his full editorial take on the coverage, see inside the Billionaires’ Vagina Club, the shot, the science, and the sales pitch on drworldwide.com. For the patient-facing walkthrough of an intimate-health consultation, see what the Billionaire’s Club will not tell you about the O-Shot on agulloplasticsurgery.com.
Ready to Talk?
These conversations are private, and they are far more common than most patients expect. Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. #StayBeautiful.
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