men’s health

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The Lowdown On ‘Low T': Men’s Health Craze Booming Despite Risks

NPR reports that sales continue to soar for prescription testosterone to treat men plagued by low energy and a sluggish sex drive even while doctors fret over risks:

The number of testosterone prescriptions written in the U.S. more than tripled in the past decade. But researchers suspect that much of the testosterone dispensed at low-T clinics isn’t tracked, since it’s often bought with cash. This unfettered flow of testosterone — officially a controlled substance — has raised concerns among doctors who specialize in hormonal problems.

“In most doctors’ offices, you don’t see a big shingle over their door saying, ‘Get your testosterone here!’ ” says Dr. Edward Karpman, a board certified urologist and the medical director of the Men’s Health Center at El Camino Hospital in Los Gatos, Calif. Karpman says low-T clinics aren’t in the business of treating the complex medical problems that often masquerade as low energy and decreased sex drive. Those can include sleep apnea, depression and, perhaps most importantly, heart disease.

(Linden Tea/flickr)

(Linden Tea/flickr)

“Any man who presents, especially in his 40s and 50s, with new onset erectile dysfunction is at an increased risk for cardiovascular disease and even heart attack or myocardial infarction,” says Karpman.

Hormone treatment itself isn’t without risk: A recent study of more than 55,000 men found a doubling of heart-attack risk among older men who used testosterone. Younger men who had a history of heart disease had a higher incidence of nonfatal heart attacks. In addition, men who are on prolonged high-level testosterone replacement therapy can experience testicular shrinkage.

Earlier this year, WBUR’s Tom Ashbrook highlighted the risks of prescription testosterone and explored the meteoric rise of the ‘Low T’ diagnosis. Continue reading

Coerced Sex Common For Teen Boys And Young Men, Study Finds

A few nights ago, unable to wind down, I was searching for something to watch and stumbled across the film “Adore.” It’s about a pair of lifelong friends (grown women) who end up having affairs with each other’s young, hunky, 19- or 20-year-old sons. My first reaction was the same as one Netflix commenter:

“…if this had been two pals and each other’s teen daughter; well, you get the point. The movie would not have been made, or if so, it would have had an entirely different hue-to say the least. DOUBLE STANDARDS.”

Or, as A.O Scott wrote in his New York Times review:

“It is worth noting that the same movie about a couple of dads sleeping with each other’s 20-year-old daughters would need, at a minimum, to confront the ickiness of the situation. Really, such a movie would be unlikely to make it into theaters, in spite of the commonness of real-life relationships between older men and younger women.”

(Dustin Hoffman, Anne Bancoft in "The Graduate"; Movie-Fan/flickr)

(Dustin Hoffman, Anne Bancoft in “The Graduate”; Movie-Fan/flickr)

The film isn’t about sexually coercion; but it is about boundary breaking, and I thought of it again reading this new study on the pervasive, but largely unexamined problem of sexual coercion among boys and young men.

The study, published in the journal Psychology of Men and Masculinity, found that coerced sex is fairly common for teenage boys and college-age men and can lead to psychological distress and risky behavior, such as sexual risk-taking and alcohol use.

From the American Psychological Association news release:

A total of 43 percent of high school boys and young college men reported they had an unwanted sexual experience and of those, 95 percent said a female acquaintance was the aggressor…

“Sexual victimization continues to be a pervasive problem in the United States, but the victimization of men is rarely explored,” said lead author Bryana H. French, PhD, of the University of Missouri. “Our findings can help lead to better prevention by identifying the various types of coercion that men face and by acknowledging women as perpetrators against men.” Continue reading

Why To Exercise Today, Guys: Better Prostate Cancer Outcomes (And We May Know Why)

There are about 2,617,682 men currently living with prostate cancer in the United States, according to the National Cancer Institute. And sometimes, at this age, it seems like everywhere you look, another man is getting diagnosed, watching and waiting, or getting treated for prostate cancer.

(DorteF/flickr)

(DorteF/flickr)

Exercise has already been shown to lower the risk of death among prostate cancer patients, but now, researchers report that may have a clue why, and it’s to do with brisk walking.

It turns out that “men who walked at a fast pace prior to a prostate cancer diagnosis had more regularly shaped blood vessels in their prostate tumors compared with men who walked slowly,” according to new findings presented in San Diego at the American Association for Cancer Research-Prostate Cancer Foundation Conference on Advances in Prostate Cancer Research.

Here’s more from the news release:

Men who engage in higher levels of physical activity have been reported to have a lower risk of prostate cancer recurrence and mortality compared with men who participate in little or no physical activity. The biological mechanisms underlying this association are not known.

“Prior research has shown that men with prostate tumors containing more regularly shaped blood vessels have a more favorable prognosis compared with men with prostate tumors containing mostly irregularly shaped blood vessels,” said Erin Van Blarigan, Sc.D., assistant professor in the Department of Epidemiology and Biostatistics at the University of California, San Francisco. “In this study, we found that men who reported walking at a brisk pace had more regularly shaped blood vessels in their prostate tumors compared with men who reported walking at a less brisk pace.

“Our findings suggest a possible mechanism by which exercise may improve outcomes in men with prostate cancer,” continued Van Blarigan. “Although data from randomized, controlled trials are needed before we can conclude that exercise causes a change in vessel regularity or clinical outcomes in men with prostate cancer, our study supports the growing evidence of the benefits of exercise, such as brisk walking, for men with prostate cancer.” Continue reading

Did You Get A Recession Vasectomy?

Dear Male Readers:

Please help us figure out if this phenomenon is real:

Researchers gathered in Boston for a meeting of the International Federation of Fertility Societies and American Society for Reproductive Medicine were presented with this provocative but non-published nor peer-reviewed theory: the financial meltdown of 2008 (and the subsequent slow economic recovery) are driving more men to get vasectomies.

(kristykay22/flickr)

(kristykay22/flickr)

From WebMD:

…researchers looked at the numbers of men having vasectomies at their facility in Wisconsin from June 2005 through October 2012. They also tracked the median income in Wisconsin during those years and the median U.S. income.

“We found as the median income for Wisconsin declined, the rate of vasectomies annually went up,” Dr. Anand Shridharani, a men’s reproductive and sexual health specialist at Erlanger Health System, in Knoxville, Tenn said. In 2005, 91 men had a vasectomy and the median state income was $54,269. In 2010, 239 men had a vasectomy and the income had dropped to $50,547.

“Comparing the number of vasectomies performed per year from 2005 to 2008 versus 2009 to 2012, the difference [an increase] is statistically significant,” Shridharani said.

“The suspected reason is that having an unexpected child would increase the cost of living,” he noted. “People are having children older, and older people are more in tune with what children cost,” Shridharani suggested… Continue reading

It’s The Carbs: ADHD In Childhood Linked To Adult Obesity, Study Finds

(Tobyotter/flickr)

(Tobyotter/flickr)

Ned Hallowell is a Sudbury, Mass. psychiatrist and expert on ADHD who suffers from the condition himself. Today, he spoke with NPR about a new study in the journal Pediatrics that found boys with ADHD are more likely to become obese men compared to children without the condition. Hallowell is quoted saying the results seem reasonable:

“It makes sense, because they’re self-medicating with carbohydrates. Carbs do the same thing that stimulant medications do — promote dopamine,” says Hallowell, who wasn’t involved in the latest study. “So you get the gallon of ice cream at midnight.”

With impulse control often a problem for people suffering from the disorder, Hallowell also says that nutrition should be part of an ADHD treatment plan. Continue reading

Study: Male Baldness, Thinning Crown, Linked To Heart Disease

Here’s a good news/bad story story for men losing it up top.

First the bad: in a new analysis, male baldness is linked to an increased risk of heart disease, the online journal BMJ Open reports.

(world on jan/flickr)

(world on jan/flickr)

The silver lining: the risk is greatest for men with a “thinning crown” as opposed to a receding hairline, the study finds. Indeed, receding hairlines aren’t linked to a higher risk at all.

Researchers suggest several possible explanations: such baldness may be a sign of insulin resistance (implicated in diabetes); chronic inflammation or a heightened sensitivity to testosterone, “all of which are involved directly or indirectly in promoting cardiovascular disease.”

More from the BMJ news release:

Male pattern baldness is linked to an increased risk of coronary heart disease, but only if it’s on the top/crown of the head, rather than at the front, finds an analysis of published evidence…

A receding hairline is not linked to an increased risk, the analysis indicates.

The researchers trawled the Medline and the Cochrane Library databases for research published on male pattern baldness and coronary heart disease, and came up with 850 possible studies, published between 1950 and 2012.

But only six satisfied all the eligibility criteria and so were included in the analysis. All had been published between 1993 and 2008, and involved just under 40,000 men. Continue reading

Regret Over Shorter Penis After Prostate Cancer Treatment, Study Finds

Patients facing treatment for prostate cancer expect to be warned of certain dismal side effects: erectile dysfunction and incontinence, for instance. But a new study suggests men should be warned of another possible complication: a shorter penis.

The new report found that a small number of men enrolled in a prostate cancer study complained to their doctors that their penises seemed shorter following treatment (though no actual measurements were taken). Some of the men reported that even this perception of a shortened penis interfered with their intimate, emotional relationships and caused them to regret the type of treatment they chose.

(Wikimedia Commons)

(Wikimedia Commons)

Prostate cancer is the second most common cancer in men, with about 241,740 new cases diagnosed last year, according to the American Cancer Society. Obviously prostate cancer can be serious: it’s the second leading cause of cancer death (behind lung cancer) in American men.

But most men diagnosed with prostate cancer will live — and live with the short- and long-term implications of the type of treatment they choose to undergo. While the problems of erectile dysfunction and incontinence are widely known as possible side effects, few studies have been done on treatment-related penile shortening. But doctors say it can and does happen — though it’s rarely discussed with patients.

In the current study, which was based on surveys completed by physicians treating 948 men with recurrent cancer, a total of 25 patients (2.63%) complained of a shorter penis. Complaints were most common in men who underwent surgery to have their prostate removed (19 of 510 men) and those treated with male hormone-blocking drugs combined with radiation therapy (6 of 225 men), researchers report. None of the men on radiation therapy alone complained of this particular problem.

These numbers are clearly small; but researchers say the phenomenon, due to its intimate nature, is likely underreported. The takeaway from this study, they say, is that the possibility of a slightly shorter penis after treatment should be made clear to patients as they consider their therapeutic options; a frank discussion upfront might minimize later regret. “Physicians should discuss the possibility of this rarely mentioned side effect with their patients to help them make more informed treatment choices,” the study, published in the medical journal Urology, concludes.

From the January issue of the journal Urology

From the January issue of the journal Urology

Lead author Paul L. Nguyen, M.D., a radiation oncologist at Dana-Farber Cancer Institute and Brigham and Women’s Cancer Center in Boston, said the novelty of the work is that it shows how even the perception of a shorter penis can profoundly impact a man’s quality of life and lead to regret. “Some people might think this is frivolous — who cares about a slightly shortened penis — but it really does affect people’s lives,” he said in an interview. “If guys [in the study] had this bad result they were much more likely to regret the path they chose. This is important to talk about up front when people are making their decisions.” Continue reading

Cost Study Adds To Growing Research On Benefits Of Circumcision

Preparing for a ritual circumcision

Preparing for a ritual circumcision (Cheskel Dovid/Wikimedia Commons)

“You realize, of course, this is a purely cosmetic procedure.”

That snarky-toned remark by a neonatologist is imprinted in my memory forever, tinged by the extra distress it caused me. I’d just been through a scary pre-term birth and the anxiety of more than a month of hospital care for my baby son. Now he was finally almost ready to go home, still weighing only a little over five pounds, and the last thing I wanted for him was another procedure.

But the research I’d done persuaded me that circumcision was not just a venerable tradition; it had real health benefits, both shorter-term and when he reached maturity. I knew about the growing movement among men who denounce it. I’d also heard an earful from our babysitter about the penile problems of boys in Europe, where circumcision is rare.

We chose circumcision, but apparently more and more American parents are tipping the other way — and the health results could prove expensive. NPR’s Scott Hensley has just posted an excellent “Shots” piece on the potential tab for the decline in circumcision and its background. Right now, about 55 percent of American boys are circumcised, he notes, down from a peak of 79 percent. But a growing body of research — including this Johns Hopkins study last fall — finds that circumcision has significant health benefits, preventing sexual diseases and urinary infections.

Scott writes about the latest study, on costs:

Johns Hopkins researchers analyzed how declines in circumcision would affect future health care costs, including what would happen if the rate fell to 10 percent, which is the average in Europe. The change — up or down — in HIV infections is the biggest factor. So what’s the tab? If the circumcision rate fell to 10 percent, the annual net increase in health care costs would be about a half-billion dollars a year. The findings appear in the latest issue of Archives of Pediatrics and Adolescent Medicine.

Johns Hopkins pathologist Aaron Tobian, senior author on the paper, tells Shots an increase in health costs tied to less frequent circumcision is already happening. He lays some of the blame on the American Academy of Pediatrics, whose 1999 policy statement says the “data are not sufficient to recommend routine neonatal circumcision.”

Tobian says that data gathered since then show that position is wrong. “The trials were amazingly consistent,” he says. Continue reading

Single Guy’s Lament: What Became Of The Female Condom?

female condom

(Anka Grzywacz, Wikimedia Commons)

By David C. Holzman
Guest contributor

David C. Holzman writes from Lexington, Mass., on science, medicine, energy, environment, and cars. He is Journal Highlights editor for the American Society for Microbiology and won a Plain Language Award last year from the National Institutes of Health. This essay began as a response to a CommonHealth post on why people have unsafe sex, and turned into much more.

Caution genes run in my family. My parents put seat belts in the ’57 Chevy in 1960, eight years before they became mandatory. In July, 1975, I bought Bell bicycle helmet serial number 7022. My cycling ensemble also includes one of those lime green jerseys that’s visible from the International Space Station.

And I was asking sex partners about Sexually Transmitted Diseases beginning in the early 1980s, when herpes — not HIV — was the main subject of such conversations. This despite the fact that the first time I did, the woman refused to discuss it, saying I could go to bed with her when I was ready to trust her. Condoms? Of course.

Journalist David C. Holzman

Now, in 2012, I still wouldn’t dream of leaving my seatbelt unbuckled, or biking without my helmet and jersey. I’ve never stopped asking new sex partners about STDs. But recent news reports have suggested that among the middle aged, rates of sexually transmitted diseases are rising while condom use is falling, and I have to confess:

At 59, I’ve worn condoms probably fewer than five times since the millennium, despite having been single for six of those years, during which time I’ve averaged one or two new partners a year, and despite the admonitions of my wonderful primary care doctor. The reason is simple: in my 20s and 30s, sex with a condom felt like getting massaged over a shirt. Now it feels like a massage through a winter overcoat.

I did don a condom last fall, when a new partner made a big deal of it. As a precaution, I took half a Viagra beforehand. (I don’t normally need the pharmaceutical pump; it was left over from earlier, when an antidepressant that I have long since discontinued had turned a Corvette into a Yugo.)

Despite my precaution, our effort to couple resulted in a deflationary event. I couldn’t feel a thing. Actually, I take that back. I did feel the condom squeezing me like a latex boa constrictor, then a softening like a leak in a bicycle tire. And then I felt lost. With that thing on, I would have needed a GPS to find my way in.

I’d like to note here that I take good care of my body. My diet is Michael Pollan-approved, my body mass index is 20, and I run more than 1,000 miles a year. But studies have shown that penile sensitivity declines steadily after the teens and 20s, so that by the 40s and 50s, men require more intense stimulation, says Culley C. Carson, III, Rhodes Distinguished Professor of Urology at the University of North Carolina. “And condoms add to the disability, if you will.”

female condom

Female condom (Wikimedia Commons)

I knew that there was an alternative — at least, there had been once. In 1993, I dated a woman who worked on reproductive issues at the National Institutes of Health. We initially used male condoms, but she soon introduced me to something called a female condom, which we used from then on. Then made of polyurethane, it fit inside the vagina, clinging snugly to the walls, held there by an inner and an outer ring. The sensation wasn’t quite as wonderful as using nothing, but for me, the sense of touch was like 20-20 vision rather than the somatosensory blurring that condoms induce. I marveled at the wonder of this device.

Nonetheless, for nearly the next two decades, I never even heard the phrase, “female condom,” nor did I read it, in the mainstream media or any health news outlet. It made few headlines at the major international AIDS conference this week.

Just prior to the date of the deflationary event, knowing that my hydraulics were not what they’d once been, I called a few drug stores to ask if they had female condoms. No one had heard of them.

New HIV diagnoses in people over 50 had doubled from 2000 to 2009.

Soon after, I began seeing news reports with titles like “Seniors’ sex lives are up — and so are STD cases,” and “Condom Use Lowest…Among Adults Over 40?”

In case you missed all that, there were two major sources. One was an editorial last winter in the Student British Medical Journal, written by Rachel von Simson, a medical student at King’s College London, and Ranjababu Kulasegaram, a consultant genitourinary physician at St. Thomas’ Hospital London. The two investigators found that in the UK, new HIV diagnoses in people over 50 had doubled from 2000 to 2009.

How much of that jump comes from unprotected sex? Not clear. They did not break it down by method of transmission, and von Simson says there are no data on condom use in older adults in the UK: “No one was interested in measuring rates until we already had a problem, making past comparison impossible, and still no one has got around to a large study.” Continue reading

Prostate Round-Up: The Ever-Growing Appeal Of Watchful Waiting

Invasive prostate cancer cells

I stand accused (by a man) of paying little heed to recent important prostate news because I lack that particular bit of anatomy myself.

Guilty. But please let me make up for my neglect. Here’s a round-up of the latest wisdom on prostate cancer, and here’s its bottom line: In the prostate cancer field, “watchful waiting” — officially known as “active surveillance” — has never looked better.

Dr. Philip Kantoff, director of the Lank Center for Genitourinary Oncology at Dana Farber Cancer Institute: “This study strongly supports the option of active surveillance in men with good-risk prostate cancer.”

The study he was referring to is just out in The New England Journal of Medicine here, and it’s a high-quality study that randomly assigned 731 men with localized prostate cancer either to surgery or to observation.

Dr. Philip Kantoff” (Courtesy of DFCI)

A decade later, the outcomes of the two groups were strikingly similar: In the prostate surgery group, 171 of 364 men, or 47 percent, died. In the observation group, 183 out of 367, or 49.9 percent, died. “Among men assigned to radical prostatectomy, 21 (5.8%) died from prostate cancer or treatment, as compared with 31 men (8.4%) assigned to observation,” the study reports. How can this be? Prostate cancer is often “indolent;” it can grow very slowly and pose little threat for a long time.

A bit more from Dr. Kantoff: “This is a very important study. It supports what we have known for some time, that there is a great deal of over-treatment of prostate cancer, particularly for men with low risk prostate cancer. More and more physicians and patients are adopting active surveillance as a viable option for men with low risk prostate cancer.” Continue reading