Mens Health

MENS HEALTH - AN OVERVIEW

Firstly, I must declare an interest. I am a man and as such am potentially heir to all the problems discussed. A conference recently at the Royal Society of Medicine discussed men's health and one of the issues raised was that by and large men have fairly high levels of unmet need when compared with women.

So why do men come off badly?Most of it is I'm afraid to do with …hormones. For better or worse our lives are dominated by only one hormone, testosterone whereas women have two to contend with. This is the chemical that causes our voices and testicles to drop. It makes us bald and it gives us acne. It also is partly responsible for heart disease. If it was on sale in the chemists, you wouldn't buy it. Can we get by without this dangerous substance? Unfortunately, no. Its probably instructive to look at the consequences of testosterone deficiency to get an idea of what we would be like without it. About 1 in 200 men supposedly have levels of testosterone low enough to benefit from ..hormone replacement therapy. The symptoms of a low testosterone level are what you would expect. Low sex drive, loss of erections, poor stamina and muscle atrophy as well as decreased hair growth. Men especially at risk might have a history of orchitis (inflammation of the orchid, or testicle, for example as a result of mumps) trauma to the testicle, surgery on the testes, or chemotherapy. Low sperm counts and infertility can also result.For further information on the male menopause visit www.andropause.org.uk

I am probably being unfair on poor old testosterone. Some of the advantages women enjoy are because they are protected from certain diseases by oestrogen, the female equivalent. After the menopause, women experience more heart disease than before because they are no longer protected by this hormone.Prostate cancer is clearly linked to testosterone and attempts at treatment commonly focus on reducing the levels of circulating testosterone. The prostate specific antigen (PSA) test is a screening test for the disease. Unfortunately it also picks up so called benign enlargement which is much more common than cancer. The kind of symptoms which may result are poor urinary stream, difficulty starting the flow and dribbling at the end of the flow. The gland when it enlarges obstructs the outflow of urine from the bladder. In my experience some men can soldier on for years without symptoms getting much worse whilst other men develop rapidly worsening symptoms. It is when symptoms are getting rapidly worse that the risk of the urine flow stopping completely is greatest. However all is not lost as there are tablets which can reduce the size of the prostate gland and make life more bearable and reduce the risk of ending up in casualty in the middle of the night because the urine flow has stopped completely. (see MacConnell JD, Bruskewitz R, Walsh P, NEngl J Med 1998; 338(9): 557-563). Thankfully they do not generally interfere with testosterone although they do have side effects. Operations on the prostate gland are best avoided unless symptoms are causing severe problems. Side effects of the prostate operation (trans-urethral resection of the prostate, or TURP) can include impotence.

Most of the problems discussed are associated with advancing years. There is one consolation however; cancer of the testicle becomes less common with age, unlike cancer of the ovary. It is unusual for men over forty to develop this disease. The advice I usually give is that everyone's testicles are different and that men should get to know their own. One testicle is often larger than the other but they are usually both soft. If one testicle is larger than the other and hard, then it should be looked at. If it changes medical advice should be sought. Your GP will not be embarrassed to examine your testicles so you need not be shy about taking them to him or her. Leaflets are available on testicular self examination: why not ask at your surgery the next time you are there?

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Dr D. Grant (Connectmedical services) December 2000