Introduction to men's health
An enlarged prostate gland is a common problem that men face as they get older.
The average life expectancy of a man born in the United States in 2016 is 79 years and 8 months. The life expectancy for a man has increased dramatically in the past 50 years. How long we live is important; however, the quality of life is equally important. The ability to enjoy life to its fullest requires investing time and effort into health maintenance and disease prevention. This investment pays dividends almost immediately and it is never too late to begin. A man who was 65 years old in 2018 could expect to live to age 84, and a 75-year-old could expect 11 more years of life.
Our bodies are incredibly complex machines that require fuel components (food, water, and air) to grow, function, and repair itself. Like any machine, the body requires routine maintenance to make it last a long time and to function well throughout a person's life expectancy. Using the body as it was intended and minimizing abuse also increases its ability to perform. When we buy a car, we expect to routinely change the oil, filters, rotate the tires, and avoid driving too aggressively to keep the car running smoothly and last a certain length of time. As in life, accidents happen and cosmetic injuries occur, but it is the "guts" of a car, the engine, transmission, and brakes that will decide if it will be happily driving down the road or sitting in the junkyard.
Our bodies suffer through illnesses and accidents and many are unavoidable. Taking care of your body also includes scheduled maintenance and screening examinations to detect illnesses at an early stage, which increases the potential for cure and a return to health. Learning to listen to the body's warning signs and symptoms is the same as paying attention to the check engine light in your car, neither should be ignored.
A healthy lifestyle is not just an absence of disease, but an opportunity to enjoy the years of life available to each person. Medical care can help the body maintain its performance as it ages. A longer life expectancy should not be considered a jail sentence to inactivity. As the body ages, there is an expected and normal physiologic change in some of the hormones in the male body.
Does Stress Lower Your Sex Drive?
Viewer Question: I’ve been under a prolonged period of stress, which seems to have diminished my sex drive. I recently read that stress can affect hormone levels. What can I do to counteract stress and improve my sex drive?
Doctor’s Response: You are not alone in your concern. A diminished interest in sex is one of many symptoms that can develop as a result of increased psychological stress, and studies show that a decreased sex drive is a common complaint in people who have stressful jobs and work long hours. Fortunately, taking steps to manage your stress can help you regain some of your lost sexual energy.
Stress management is a highly individual practice, and each person must choose the stress control techniques that work best for them. However, stress control methods most often include a combination of exercise, relaxation techniques (deep breathing or meditation exercises), adhering to a regular sleep cycle, and proper nutrition. Exercise releases endorphins, which are the body’s natural stress-fighting hormones, so any type of physical exercise is a good stress control measure…
Read more information about stress and your sex drive »
Prostate problems
The prostate is a unique male organ. It is located beneath the bladder and connects it to the penis. Its function is to produce part of the seminal fluid that is alkaline, which helps lengthen the life span of semen when it enters the vagina. The prostate also has involuntary muscles that contract to help expel semen during ejaculation.
A common condition in men that is part of the normal aging process is benign prostatic hypertrophy (BPH or enlarged prostate). The urethra is a tube that passes through the prostate and drains the bladder. A man with an enlarged prostate (BPH) often has difficulty emptying the bladder because the urethra is being compressed by prostatic tissue. This compression of the urethra makes it difficult for the bladder to generate enough pressure to overcome the obstruction (enlarged prostate). Over time, the bladder itself begins to weaken making urination even more difficult.
Symptoms of BPH include:
- Urinary frequency (urinating more often)
- Urinary urgency (the feeling that he has to empty the bladder urgently or risk wetting himself)
- Urinary hesitancy (difficulty starting the urine stream)
- Urinary straining (requiring more pressure or bearing down to empty the bladder)
- Poor urine stream and dribbling
Treatment of BPH (which may include medications or surgery) depends upon the man, any underlying medical conditions, and the severity of symptoms.
Testosterone
Sexual health and function are important parts of a healthy lifestyle. The ability to participate in sexual intercourse depends upon the brain, hormones, nerves, and blood vessels that supply the penis. A variety of mechanisms and feedback loops need to work for an erection to occur. There are numerous causes of erectile dysfunction (ED, impotence) including:
Impotence is also a complication of prostate cancer treatment, which can include surgery and radiation.
Smoking is an independent risk factor for developing impotence.
Treatment of erectile dysfunction depends upon the cause but may include medications (for example, tadalafil [Cialis], sildenafil [Viagra], and vardenafil [Levitra, Staxyn], testosterone replacement therapy and, for some men, prosthetic devices surgically inserted into the penis.
Testosterone levels that are required for puberty, muscle, and bone development in young adulthood gradually decrease over a man's lifetime (sometimes referred to as Low T). Testosterone levels need to be at a certain level to maintain body and brain function. Numerous theories exist about the use of testosterone therapy routinely in older men, but these theories have not been widely accepted. There are however, a few health care practitioners that use testosterone to "prevent aging."
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Top 10 diseases that kill men
"Know your enemy and know yourself and you can fight a hundred battles
without disaster."
Sun Tzu. Chinese General. 500BC
Most of the common diseases that affect men are potentially preventable, but one needs to know their enemy. Interestingly, the presence of some diseases increases the likelihood that another will occur. Heart disease, stroke, peripheral vascular disease, and dementia all share the same risk factors:
- smoking,
- high blood pressure,
- high cholesterol, and
- family history.
The following are the top disease that kill me, according to the Centers for Disease Control.
1. Heart disease
Heart disease is the number one killer of men in the United States.
The heart is like any other muscle, requiring blood to supply oxygen and nutrients for it to function. The heart’s needs are provided by the coronary arteries, which begin at the base of the aorta and spread across the surface of the heart, branching out to all areas of the heart muscle.
Angina
The coronary arteries are at risk for narrowing as cholesterol deposits, called plaques, build up inside the artery. If the arteries narrow enough, blood supply to the heart muscle may be compromised (slowed down), and this slowing of blood flow to the heart causes pain, or angina.
Angina symptoms include:
- chest pressure with radiation down the arm and to the jaw,
- shortness of breath,
- sweating,
- indigestion,
- nausea,
- a decreased ability to do routine activities.
This heart pain is often referred to as "anginal equivalent."
Heart attack
A heart attack (myocardial infarction) occurs when a plaque ruptures, allowing a blood clot to form, which can be life-threatening. The blood clot completely obstructs the artery, stopping blood flow to part of the heart muscle, and that portion of muscle dies.
Abnormal heart rhythms and sudden cardiac arrest
The heart is an electrical pump composed of heart muscle and cells that produce and conduct electrical signals. Heart muscle cells can become irritable because they have lost blood supply and may, in addition, cause electrical abnormalities or short circuits that prevent the heart muscle from pumping which can result in sudden cardiac death.
Heart disease risk factors
The major risk factors for heart disease (and stroke and peripheral vascular disease) include smoking, high blood pressure, high cholesterol, diabetes, and family history. While one cannot control their family history, the other factors can be controlled and the risks minimized. These are life-long obligations to decrease the risk of heart disease.
2. Cancers
Lung cancer is the number one killer among cancers in men, and most are preventable. Smoking causes 90% of all lung cancers and while the number of smokers in the United States has decreased in the past generation, 13% of young adults age 18-24 smoke and will be the future victims of lung cancer. It is harder to stop smoking than it is to stop many other addictions; nicotine in tobacco is a very addictive drug. Tobacco in its various forms including smokeless or chewing tobacco is related to a variety of other cancers including cancer of the mouth, throat, and larynx.
Prostate cancer affects the prostate gland. Prostate cancer is the most common cancer among men, and is a disease of aging and is rarely seen in men younger than 50 years of age. Often prostate cancer causes no symptoms and is diagnosed with routine screening tests including a rectal examination to feel the prostate and a PSA (prostate specific antigen) blood test. The cure rate for prostate cancer has increased since the widespread use of PSA testing began but it still accounts for 19% of cancer deaths among men. Currently, prostate cancer screening with a digital rectal exam and PSA testing are only indicated in high-risk patients or those with symptoms.
Colon and rectal cancers tie with prostate cancer as the second most common cause of cancer deaths in men. There are few symptoms in the early stages of colon and rectal cancers, thus the diagnosis is often made by routinely screening the stool for occult blood (blood that is not visible to the naked eye but can be found by testing the stool sample) and undergoing a routine screening colonoscopy. Colon cancer can be nearly completely preventable with timely colonoscopy screenings.
Testicular cancer accounts for 5.6 per 100,000 men in the U.S., but usually occurs in younger men (ages 15 to 39). Men can help detect this disease by doing a testicular exam routinely and reporting any testicle abnormalities or symptoms (lumps, swelling, pain) to their health care practitioner.
Living a healthy lifestyle decreases the potential risk of developing cancer. Regular exercise, a healthy diet, and avoiding toxins in the environment (including smoking and secondhand smoke) are positive lifestyle changes that the average person can control during their lifetime.
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3. Injuries
Accidents happen and the key to minimizing the risk of death is to use common sense and avoid potentially dangerous situations.
- Simple actions like wearing a seatbelt while in a car, wearing a helmet when cycling, skiing, skateboarding, or other activities
where head injuries occur help decrease risk of death in an accident. - Driving while impaired on drugs or alcohol is never acceptable and causes a dangerous situation not only for the driver but for those around him. Impairment driving includes not only alcohol but also medications that can cause sedation, including over-the-counter cold and sleep medications. It also includes driving when tired or sleepy. Many authorities on impaired drivers consider texting and cell phone use impaired driving.
- Most accidents happen around the house and routine prevention can help decrease those accidents. Easy fixes include making sure that floors aren’t slippery or wet, stair railings are secure, and walks and driveways are well maintained and well lit at night. Smoke and carbon monoxide detectors can only work if their batteries are fresh.
4. Stroke (cerebrovascular accident, CVA)
A stroke (cerebrovascular accident [CVA]), occurs when blood supply to part of the brain is disrupted, causing brain cells to die. Blood flow can be compromised by a variety of mechanisms. This can occur because blood supply has been cut off (ischemia) or because there has been bleeding in the brain (hemorrhage). Ischemic strokes occur due to a variety of reasons including the gradual narrowing of a blood vessel in the brain, debris that can break off from the carotid artery in the neck, or from a blood clot that embolizes (or travels) from the heart.
The risk factors for stroke are the same as for heart disease: smoking, high blood pressure, high cholesterol, and family history.
A TIA (transient ischemic attack, mini-stroke) is a stroke that improves, usually quickly. A person develops stroke like symptoms (weakness of one side of the body or face, vision loss, speech difficulty) but it resolves spontaneously within a few minutes or hours. This situation should never be ignored since it is a major warning sign that an impending stroke may occur.
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5. Chronic Obstructive Pulmonary Disease (COPD)
Emphysema and chronic bronchitis are the two types of chronic obstructive pulmonary disease (COPD) and both are most commonly caused by smoking. Due to the toxins in smoke, the lung tissue is damaged and loses its ability to transfer oxygen from the inhaled air into the blood stream. Symptoms of COPD include shortness of breath and wheezing. COPD increases the risk of lung infection including pneumonia.
6. Diabetes
The pancreas makes insulin to help cells use glucose for energy. Diabetes describes the situation where insulin function in the body is abnormal.
- Type 1 diabetes usually occurs in people younger than 40 where the body's immune system destroys the insulin producing cells in the pancreas.
- Ninety to 95% of people with diabetes have type 2 diabetes.
Poorly controlled diabetes increases blood sugar levels in the bloodstream and in the long-term, affects the small blood vessels in the body, which can lead to multi-organ failure. Poorly controlled diabetes can cause vascular disease leading to heart attacks, strokes, limb amputations, kidney failure, blindness, and nerve damage (diabetic neuropathy).
Diabetes prevention and control include eating a well-balanced diet, maintaining a healthy weight, and routinely exercising, and keeping active.
7. Influenza and pneumonia
A healthy lifestyle and healthy body makes for a strong immune system that can fight common infections like influenza (flu). It is important to follow public health recommendations for routine immunizations to reduce the risk of contracting the flu, and its complications such as pneumonia. However, pneumonia is not limited to just viral causes. Bacterial pneumonia is ranked with influenza as one of the major causes of death in men by many researchers. Fortunately,
a pneumococcal vaccine has proven effective in preventing one of the most common bacterial causes of pneumonia, Streptococcus pneumoniae.
8. Suicide
Mens sana in copore sano: a healthy mind in a healthy body
Thoughts of self-harm are not normal. They should not be ignored by a man, family, or friends, and should be considered an emergency situation. Depression can become overwhelming and potentially life-threatening. Men with depression may be able to function reasonably well on a day to day basis and may be reluctant to seek help. It may take a crisis situation to finally get a man to agree to get medical, psychological, and counseling assistance.
Symptoms of depression may be subtle and arise slowly. They can include:
- difficulty concentrating or completing projects
- lack of energy
- difficulty sleeping or sleeping too much
- change in appetite (some people stop eating while others overeat)
- feelings of hopelessness or worthlessness
- excessive sadness or feelings of emptiness
- thoughts of suicide or self-harm
9. Kidney disease
The kidneys filter impurities from the blood and dispose of them in the urine. They are also important in maintaining electrolyte balance in the blood. Even in healthy people, aging gradually decreases the efficiency of kidney function. Kidney failure is often a result of years of poorly controlled high blood pressure and diabetes.
In the United States, approximately 30 million people have chronic kidney disease.
10. Alzheimer’s disease
Dementia and Alzheimer’s disease describes a gradual loss of cognition and intellectual ability including language, attention, memory, and problem solving is an otherwise healthy person. The cause is unknown and there is no cure. Recommendations to decrease the risk of dementia include avoiding smoking, and keeping blood pressure, high cholesterol, and diabetes under control. Physical and mental fitness may help prevent dementia; keeping socially active may also help. Recurrent head injuries are associated with dementia.
Alzheimer’s disease and dementia are not direct causes of death, but they make
it more difficult to identify and treat complications that can lead to death.
The checklist: How to stay healthy
Being proactive about your health is an important starting point in maintaining health. Some steps are self-evident but a person may need help in taking the first step. The ability to recognize that living healthy is a life-long commitment is an important key to longevity. Nobody is perfect, and the ultimate goal is to have more good habits than bad. Failing to meet a goal does not give permission to quit trying. Doing well one day is not a license to stray the next.
Here is a checklist to promote a healthier lifestyle and living a longer, healthier life.
- Stop smoking
- Maintain a healthy weight
- Engage in some type of physical activity every day
- Eat a heart healthy diet
- Maintain good control of blood pressure, cholesterol, and diabetes
- Get routine medical care and physical examinations
- Get recommended screenings for prostate and colon cancer
- Perform routine home testicle exams
- Keep mentally active
- Maintain close relationships with a circle of friends
- Seek help if you have symptoms of depression