Men and good health

 “You’re in pretty good shape for the shape you are in.”—Dr. Seuss

Writer: Richard T. Bosshardt, MD, FACS

Last month, I wrote about women’s health issues. Now, it’s men’s turn. There are many issues of interest to men. Prostate health is, of course, a uniquely male concern. Others that are primarily, but not uniquely, in the male provenance include heart disease, elevated cholesterol and other fats in the blood, hair loss, and erectile dysfunction. When it comes to injuries and death from accidents or violence, men lead women by a factor of two to one in all categories, except, oddly, fire-related injuries.

Prostate health
Like the uterus in women, the prostate is found only in men. It is a small, walnut-size
organ that sits just under the urinary bladder. It produces some of the fluid that mixes with sperm to form semen. Contraction of the prostate helps propel semen out of the penis during ejaculation. Enlargement of the prostate is considered part of normal aging. Between 40 and 80 years of age, the prostate may more than double in size. Because it surrounds the urethra, the tube that carries urine from the bladder out through the penis, enlargement of the prostate can impede urine flow, a condition called benign prostatic hypertrophy or BPH. Most men will experience some degree of BPH during their life, with 80 percent having this by age 80. Symptoms of decreased urinary stream, incomplete bladder emptying, and dribbling of urine may occur in over one-third of men. There are a variety of medications and treatments for BPH.
Cancer of the prostate is the most common cancer in men outside of skin cancer. Only lung cancer causes more cancer deaths. Even so, prostate cancer, especially in older men, is not considered as dangerous as other cancers because it often follows a very slow course of progression. Many men with prostate cancer die of other causes instead. This has caused much controversy as to whether men should be screened for prostate cancer and how aggressively it should be treated. Although the verdict is still out on both issues, if you are over 40, African-American, or have a family history of prostate problems, you should talk to your physician about when to begin screening and how to do this.

Heart disease
Heart disease remains the leading killer of men, accounting for one in four deaths. Men account for just more than half of the deaths from heart disease each year, but they account for nearly 80 percent of sudden cardiac events: heart attacks, ventricular fibrillation, and sudden death. Risk factors for heart disease are well established and include family history, smoking, obesity, inactivity, elevated fat levels in the blood (cholesterol and triglycerides), high blood pressure, and diabetes among them. As with so much in medicine, prevention is the key and can avoid expensive, and potentially dangerous, treatments later. Once heart muscle has been damaged or lost, you cannot get it back.

Hair loss
While women can experience hair loss, it is not common, and there is a reason we call it “male” pattern baldness. Male hair loss is both genetic and related to the level of the male hormone testosterone. Male pattern baldness is not due to excess or deficient testosterone; it is due to an unusual sensitivity of the hair follicles to the hormone, causing them to cease producing hair. About 25 percent of men begin to experience hair loss at age 21. By age 35, two-thirds of American men have appreciable hair loss. For men who cannot accept the hand dealt to them by nature, there are medications that can produce meaningful hair growth, including Rogaine and Propecia. They work best when started early in the course of hair loss. Hair transplant surgery is an option for men who desire, and can afford, permanent hair restoration. New techniques of micrografting, in which one to three hair follicles are transferred, rather than the old plugs, can produce a very natural look, but it comes at a hefty price—as much as $15,000.

Erectile dysfunction (ED)
ED. Two letters that strike fear into the hearts of men. Despite all the jokes, ED is no laughing matter to those who suffer from it. A normal erection depends on healthy blood vessels, and heart disease, with its attendant hardening of the arteries elsewhere in the body, is commonly associated with ED. Other medical causes are obesity, diabetes, and high blood pressure. The list of medications and drugs that can cause ED is as long as, well, you know. Drugs to treat ED, such as Viagra and Cialis, are understandably popular. Penile implants are available to surgically treat ED, but carry all the risks of surgery and of the implants themselves. The specter of ED should be enough to encourage men to live healthy lives.

Loss of muscle mass
It is an unfortunate fact that men peak physically somewhere between 20 and 30 years of age. After that, they tend to lose 3 percent to 5 percent of their muscle mass each decade. It has been shown, however, that this loss is not inevitable and can be prevented, or even reversed, by a simple measure: exercise. More and more, exercise is being regarded as close to a “magic bullet” for many conditions. There are several forms of exercise: aerobic (running, biking), resistance training (weight or strength training), and flexibility (yoga, Pilates). All play a role in staying healthy, but resistance is most effective for preventing or reversing muscle loss. Many falls and injuries in elderly men can be attributed to loss of strength.

Lifestyle plays a crucial role in several of the above conditions. Young men should realize that the decisions they make in their 20s and 30s have consequences decades later. There is no substitute for eating clean, maintaining ideal weight, exercising regularly, limiting alcohol, getting enough rest, and so on. It isn’t rocket science.