Heart disease is the leading cause of death for both men and women, so of course we need a close eye on cardiac risk factors in primary care. But what other issues do men face that often get overlooked? Move over breast cancer and menopause—here are some things men, and the people who love them, need to know about.
- Benign Prostatic Hyperplasia (BPH) or enlarged prostate: Half of men over 50 will experience symptoms related to BPH at some point. We call these symptoms lower urinary tract symptoms or LUTS. LUTS include urinary frequency during the day and night, urinary retention, or difficulty initiating urinary stream. Luckily there are several options for medications and surgical interventions if symptoms become bothersome.
- Varicocele: Listen up. This is the most common cause of male infertility worldwide. Varicoceles are found in 5% of the normal male population and in up to 40% of patients with male infertility. Varicoceles occur primarily on the left side (because of the position of the testicular vein on that side) and can be diagnosed by physical exam or ultrasound. If infertility is an issue, varicocele repair is an option.
- Erectile Dysfunction (ED): The inability to achieve or maintain an erection sufficient for satisfactory sexual performance, known as ED, is the most common sexual problem in men. As physicians we appreciate the profound effect on intimate relationships, quality of life, and overall self-esteem ED can cause. ED can be either organic (vascular, neurogenic, hormonal, anatomic, drug-induced), psychological, or a combination of both.
- Male pattern baldness: Male pattern baldness, also known as androgenetic alopecia, accounts for more than 95% of hair loss in men. By age 35, two-thirds of American men will have some degree of appreciable hair loss, and by age 50 approximately 85% of men have significantly thinning hair. About 25% of men who suffer from male pattern baldness begin the painful process before they reach 21. There are two FDA approved medications exist for treatment: Rogaine (minoxidil) and Propecia (finasteride).
- Bones, not just a girl problem: Osteoporosis in men is important and often overlooked. A 60 year old man has a 25% chance of having an osteoporotic fracture during his lifetime. Men should be screened, and they often are not. Measurement of bone mineral density (BMD) is recommended in men who’ve had: x-rays that show thinning bones, low trauma fractures, loss of more than in height, steroids, low testosterone (low-T), or intestinal disorders (where they don’t absorb vitamin D).
Some groups, like the Endocrine Society, recommend BMD testing for all men older than 70 years, and in men 50 to 70 years when risk factors are present. An alarming fact is that mortality rate associated with hip fractures, as well as spine and other major fractures, is higher in men than in women. Men are also less likely than women to be screened and/or treated for osteoporosis after a hip fracture.
- Testicular cancer: The incidence of testicular cancer has been increasing in most countries over the past four decades. Although it accounts for only 1-2% of all tumors in men overall, testicular cancer is the most common malignancy in young men. Testicular self-examination and physician exam, especially between the ages of 20-35, is the only “screening” that exists.
- Chronic prostatitis: Prostatitis accounts for 8 percent of visits to urologists, and up to 1 percent of visits to primary care physicians. Prostatitis is a broad diagnosis that includes acute illness requiring immediate attention (acute bacterial prostatitis), and two chronic conditions (chronic bacterial prostatitis, chronic pelvic pain syndrome).
- Seborrheic dermatitis or “beard rash:” Seborrheic dermatitis results in red flaky skin men around your beard, eyebrows, scalp and mustache. It is more common in men than women because sebaceous glands are under androgen control. For treatment, involved areas of the face can be washed frequently with shampoos that are effective against seborrhea. Selsun Blue and Head and Shoulders are common examples. Topical steroids or antifungals can also be prescribed by your primary care doctor if over the counter remedies aren’t successful.