They're not Googling it. They're not asking around. They've been sitting on this decision for years, and the only way to reach them is with the right message in the right place.
Referrals help, but they're unpredictable. SEO takes months. And generic agencies don't understand this patient well enough to get anywhere near them.
There are men in your city right now who are ready for this conversation. They just don't know you exist yet.