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A User’s Guide to Men’s Health

By Joe Sugarman
Let’s call it tough-guy syndrome.

Men are less likely than women to visit a doctor, and even when they do, they are less likely to be honest about their symptoms, especially “masculine” guys with male doctors, according to a recent Rutgers University study. The danger of ignoring a warning sign like a sexual slump is that it could indicate a more serious condition, such as diabetes or hypertension. We asked experts at Johns Hopkins to offer advice on how to identify, address, and prevent common men’s health issues, and they gave us evidence-based answers on everything from ED to heart disease, and from hair loss to supplements. The good news is that when addressed early, many issues can be managed, even reversed. (Here’s a hint: A few extra pounds around your midsection is often where problems start.) In the following pages, learn how subtle lifestyle changes—maintaining healthy weight, consuming alcohol in moderation, practicing proper skincare, reducing stress, getting more sleep—can help stave off chronic disease and keep you healthier, longer.

Johns Hopkins Experts

Prostate Health: Ballentine Carter, urologist
Hair Loss: Lisa Ishii, otolaryngologist/facial plastic surgeon, and specialist in hair restoration
Healthy Skin: Anna Chien, dermatologist
Supplements: Lawrence Cheskin, gastroenterologist; Gerry Mullin, integrative gastroenterologist
ED: Arthur “Bud” Burnett, urologist
Heart Health: Kerry Stewart, exercise physiologist

Keep Your Prostate Healthy


Approximately one in seven men will be diagnosed with prostate cancer, making it the most common cancer in men, other than skin cancer. It’s also the second deadliest cancer, behind lung cancer. So, is there anything you can do to decrease your odds of getting it?

“The 30,000-foot view is that a heart-healthy diet is a prostate-healthy diet,” says urologist Ballentine Carter. “Diet improves prostate health. Exercise improves prostate health. That’s been proved. Even after diagnosis people who maintain a healthy diet have a smaller chance of recurrence.” 

Illustration of running shoes surrounded by fruits and vegetables

According to Carter, eating fresh fruits and vegetables and maintaining a healthy weight go a lot further in potentially preventing the disease than supplements that claim to be good for prostate health, like saw palmetto, DHEA, and selenium. “Throw them all out,” says Carter, who stresses they are ineffective at best and potentially harmful at worst. “If you were dealt a certain set of genetic cards and you metabolize supplements in a negative way, they could be harmful.”

Carter recommends that men in the high-risk category—African-American men and those with a family history of the disease—get a prostate exam and PSA screening by age 40 to establish a baseline. Those who aren’t at high risk can wait until 50.

Getting a checkup is important in catching the disease at its early stages because it often presents no symptoms or symptoms similar to those of an enlarged prostate, also known as benign prostatic hyperplasia (BPH), the most common prostate problem in men over 50. (Symptoms of BPH include frequent or urgent urination, trouble urinating, or urinary incontinence.) But Carter says that having an enlarged prostate doesn’t mean your risk of cancer increases.

“What I tell patients is that prostates come in all sizes, like breasts,” he says. “There are plenty of people who have large prostates and have no symptoms. And there are plenty of people who have small prostates, and they have really bad symptoms. There may be some environmental factors involved, but like many things, it depends on the cards you were dealt.”

Heart disease is the No. 1 killer of men in America. Inactivity is the No. 1 risk factor for heart disease in men. Guidelines have shown that doing 30 minutes of exercise a day or 150 minutes a week produces almost the same health benefits as running a six-minute mile.

The Bald Truth

with otolaryngologist Lisa Ishii


You inherit the hair of your mother’s father.

FALSE. There’s a genetic predisposition for balding, but the gene may come from either side.

Men who go bald have more testosterone.

FALSE. It’s not the testosterone itself that is harmful to the hair root. It’s a breakdown of testosterone into something called DHT (dihydrotestosterone). We don’t know exactly how it happens, but it causes the hair root to shrivel up and die.

Saw palmetto stems hair loss.

UNCLEAR. The reason it may be true is because saw palmetto decreases the conversion of testosterone to DHT, but there is not enough data as yet.

Top-view illustration of three balding men sitting on a couch

Hats cause hair loss.

FALSE. It’s a common misconception, but there’s no relation.

Overshampooing or using the wrong shampoo is a cause.

FALSE. The chemicals in shampoos cannot penetrate the skin to get to the hair root, and hair loss happens at the root.

Stress or sudden tragedy can contribute to hair loss.

TRUE. If you have severe physical or less commonly psychological stress, like a death in the family, it can cause the hair root to shift into the telogen (shedding) phase and you suddenly shed a whole bunch of hair at once. It’s not true that common, everyday stress causes it.

Hair loss treatments work.

TRUE. Propecia blocks the enzyme that converts testosterone to DHT. Rogaine (minoxidil) was initially designed for hypertension. People took it in pill form and noted they had better hair. Both slow down the rate at which you lose your hair but don’t necessarily help with regrowth.

Iron deficiency = hair loss.

FALSE. At one point it was accepted as true but has since been proved wrong.

If you have hair past age 40, you likely won’t go bald.

FALSE. Your likelihood of experiencing pattern hair loss increases with each decade, but the later you start experiencing it, the better off you will be. You’ll likely end up with more hair if you start losing your hair at 40 than at 20.

The Insider’s Guide to the Five Popular Supplements for Men


Men’s Multivitamins

The claim: Often spiked with lycopene and saw palmetto for prostate health, they provide vitamins and nutrients men’s bodies need. The verdict: “Studies show they’re not worth spending money on,” says integrative gastroenterologist Gerry Mullin. “I like to recommend to people to just eat well.” Gastroenterologist Lawrence Cheskin adds that if you’re going to take a multi­vitamin, make sure it’s specifically for men as multi­vitamins for women often have iron, which, in excess, is a heart disease risk for men.

Vitamin D

The claim: Good for heart health, cancer prevention, and the immune system, vitamin D is often seen in lower levels in men than women. The verdict: Jury’s still out. There’s no consensus as to whether we should be screening people for vitamin D levels or not, says Cheskin, who personally does recommend screening to his patients.

Illustration of a fish oil supplement

Fish Oil

The claim: Helps prevent heart disease. The verdict: “There’s a large body of evidence that omega-3 fatty acids as opposed to omega-6 fatty acids are good for heart disease risk and other things including brain function,” Cheskin says.

Lycopene

The claim: An antioxidant found in red fruits and vegetables, such as tomatoes, which is effective for prostate health. The verdict: “There have been studies about the benefits of lycopene for prostate health,” Mullin says, “but it’s not a magic bullet. If I had an enlarged prostate and I was having problems, I’d consider it, but I wouldn’t take it just because I’m a male and happen to have an enlarged prostate.”

Magnesium

The claim: Effective in combating everything from heart disease and hypertension to muscle aches and insomnia. The verdict: Like any supplement, if there is a specific medical condition that would make your magnesium levels low, you could take it, Cheskin says. Otherwise, you don’t need to take it on its own.

Body by Decade


Silhouette of the male body

Heart

The problem: As men age, blood pressure and cholesterol levels often increase. The fix: Eat a heart-healthy diet, exercise, and have your blood pressure and cholesterol levels checked annually. Consider a coronary calcium scan above age 50, if heart disease runs in the family.

Skin

The problem: Men ignore their skin more often than women. The fix: Get an annual head-to-toe skin screen by a dermatologist to evaluate suspicious moles and other skin conditions.

Muscle

The problem: Men begin losing muscle mass by age 30. The fix: Incorporate muscle training into your fitness routine to help increase bone density, metabolism, and muscle-fat ratio, while maintaining flexibility and balance.

Colon

The problem: Colon cancer is the third most common cancer in men. The fix: Eat a diet high in vegetables, fruits, and whole grains, and low in red meat and alcohol. Consider a colon­oscopy at age 50, particularly if colon cancer runs in the family.

Prostate

The problem: Benign prostatic hyperplasia (an enlarged prostate) affects about 50 percent of men between the ages of 51 and 60 and up to 90 percent of men older than 80. The fix: Eat a low-fat diet, exercise, and undergo a prostate exam by age 50 or sooner if at high risk for prostate cancer.

Testosterone

The problem: Levels typically decrease with age, with about 20 percent of men having low T by their 60s. The fix: See an endo­crinologist to get your testosterone levels checked, if experiencing a drop in libido, energy level, unexplained weight gain, or ongoing depression.

Beware the Spare Tire
“I always say to patients, ‘Don’t look at the weight on the scale so much, look at your belt size,’” says exercise physiologist Kerry Stewart. “People who have more fat around their waist are at a higher risk for heart disease and diabetes than if more of the fat was below the waist. Men are more susceptible to belly fat than women; this could explain why men have more heart disease than women. Men with the highest risk have a waist circumference of 40 inches or higher. Luckily, exercise, no matter what it is, takes off belly fat before it does so anywhere else on the body.”

ED Q&A

with urologist Arthur Burnett


First off, what is the definition of erectile dysfunction?

The clinical definition is a persistent inability to obtain and maintain an erection that is sufficient for satisfactory sexual intercourse.

How do you distinguish between a “sexual slump” and clinical ED?

There are so many factors that play into a man’s achieving an erection. Some are transient, some are more constant. Transient things could be just how rested you are, how much stress you’ve been under that day, whether you had something to drink. Something personal or emotional can influence a response. More constant things are those that are changing a person’s physiology—diabetes or cardiovascular disease or being a longtime smoker or being out of shape. ED is a symptom and not a disease itself.

Illustration of a condom with a speedometer printed on the wrapper

So, it can be a symptom of a bigger health problem?

Some do say the penis can be a barometer of your overall health. As your penile vascular health goes, so goes your overall vascular systemic health. Since the blood vessels in the penis are smaller than those in the chest, arterial damage can show up there first.

Can it be a symptom of low testosterone levels?

The two are not so tied together. Some men have very low testosterone and can get erections. Other men have a normal range of testosterone and have ED because of other issues, so there isn’t necessarily a connection.

What’s the difference between the “big three” ED medications?

They all work in a similar way, targeting the mechanism of how tissue responds in the penile area. Cialis has a longer half-life of roughly 17½ hours in the body. That’s why it’s called the “weekend drug.” By contrast Viagra and Levitra have half-lives of four hours. Side effects are generally the same and are typically minor. The real risk is that if taken in combination with nitrate drugs, they can have serious blood pressure–lowering effects.

What about taking natural supplements like red ginseng, DHEA, or zinc?

Those things are unproved, so I don’t recommend them.

A Canary in the Coal Mine?
Men in their 40s who have erectile dysfunction and no other risk factors for cardiovascular disease run an 80 percent risk of developing heart problems within 10 years.
 

Infographic: top five tips for great skin

Illustration of a stethoscope with the Mars (male) symbol
Illustrations by Charlie Gentle

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