Mens Health 101

What is Men’s Health?

Why all the interest, what is ‘‘men’s health,’’ and is this good for men?

It seems commonly accepted that men in general are less likely than women to seek health services. There are hard data that back up this assumption. Men are less likely to seek primary care services, often will not seek care without spousal pressure, and in general have higher death rates than women (1). The recent interest in men’s health by clinicians has been stimulated by the clear association between erectile dysfunction (ED) and cardiovascular disease. There is a 50- fold increase in cardiac events in 40–60-year-old men with ED compared with men without ED (2). In addition, there is a correlation between hypogonadism or testosterone deficiency and a multitude of medical comorbidities in men. Specifically, the higher number of cardiovascular risk factors a man has, the greater the risk of heart disease and the presence of low testosterone. While the relationship is not necessarily causal, it is uncertain which comes first: elevated blood pressure, type II DM, or low T (3).

The traditional management of men presenting to the urologist/andrologist with ED was to treat the condition with Viagra and send the patient on his way. Currently this approach is considered to be insufficient, because ED is viewed as a red flag for risk of cardiovascular disease, and as such, a more thorough evaluation of underlying cardiovascular and psychological risk factors—medical and lifestyle—should be undertaken. This recognition has greatly stimulated interested in the field of men’s health.

Just what constitutes men’s health is not well defined. Is it any medical condition that occurs in men? Is it conditions that only occur in men? Is it somewhere in between, including male-specific conditions as well as those that underlie those conditions or cause increased disease prevalence in men? Internet searches of men’s health clinics brings up a variety of offerings. Some are true multidisciplinary clinics with urologists, primary care providers, and other medical specialists, whereas others are nothing more than clinics that sell testosterone or penile injection therapy for ED. This inconsistency is not good for patients, because clinics with only one offering may fail to address un- derlying conditions. Unfortunately, these are often heavily marketed with unclear descriptions of their limited focuses. As the field of men’s health evolves, it is possible that standards and guidelines may develop that help differentiate clinics that deal with overall men’s health from those that primarily push treatments for one condition.

The clear association between sexual and reproductive dysfunction and overall male health, including cardiovascular disease, metabolic syndrome, and type II diabetes, is an opportunity to proactively address these health issues when these men present to the urologist/andrologist. Although some may view the urologist/andrologist as being the primary care physician (PCP) of the male patient, they are not by training experts in the multitude of associated medical conditions that need to be addressed. They are, however, often the first contact of the patient with the medical community and are presented an opportunity to identify patients that need further medical evaluation and treatment. Multidisciplinary men’s health clinics may certainly serve this role with ready access to multiple medical (and psychological) specialists. The American Urological Association has created a men’s health checklist to help the urologist/andrologist facilitate interdisciplinary management of men presenting with urologic conditions (4). In addition, a variety of men’s health initiatives and policies have been developed in countries such as Canada, Australia, and Ireland. Although there are primary care providers that focus on men’s health, currently there are no training programs nor an approved specialty of ‘‘men’s health’’—it overlaps many disciplines.

The practice of this evolving field is certainly not as developed as women’s health. A recent study emphasized a discrepancy in United States hospital settings, with 98% of top hospitals offering women’s health services or clinics but only 38% offering multidisciplinary men’s health services(5). Proper men’s health requires multidisciplinary expertise and an understanding by specialists and PCPs that certain conditions are associated with other medical comorbidities that may need evaluation by other specialists. Patients with ED may need primary care evaluations and cardiology evaluations, and patients seeing cardiologists or PCPs may need to be questioned about sexual function or other genitourinary conditions to allow those conditions to be addressed. This multidisciplinary interaction may be facilitated in multidisciplinary men’s health clinics or by individual providers understanding the complexity of presenting symptoms and willing to consult other specialties when indicated. As the concept of men’s health develops, we are seeing the management of the male change from management of presenting symptoms to management of risk factors and conditions leading to increased morbidity and mortality. This is the preventative model of health and well-being. This can only be good for men.

REFERENCES
Elterman DS, Kaplan SA, Pelman RS, Goldenberg SL. How ‘‘male health’’ fits into the field of urology. Nat Rev Urol 2013;10:606–12.
Inman BA, Sauver JL, Jacobson DJ, McGree ME, Nehra A, Lieber MM, et al. A population-based, longitudinal study of erectile dysfunction and future coronary artery disease. Mayo Clin Proc 2009;84:108–13.
Mulligan T, Frick MF, Zuraw QC, et. al. Prevalence of hypogonadism in males aged at least 45 years: the HIM study. Int J Clin Pract, 2006; 60 (7):762–69.
American Urological Association. Men’s health checklist. Revised. 2014. Available at:https://www.auanet.org/common/pdf/education/clinical-guidance/Mens-Health-Checklist.pdf. Last accessed January 5, 2016.
Choy J, Kashanian JA, Sharma V, Masson P, Dupree J, Le B, et al. The men’s health center: Disparities in gender specific health services among the top 50 ‘‘best hospitals’’ in America. Asian J Urol 2015;2:170–4.