Men's health

The field of men's health is concerned with health issues and aging changes peculiar to post-pubescent males. Growth in adolescent boys (puberty to 19) occurs in spurts, usually over 4-5 years, with the first growth spurt occurringbetween ages 10 and 14. Puberty is accompanied by an increase in height; theappearance of body hair; an enlargement of the testicles, penis, and scrotum; growth of the larynx, or voice box; and development of sweat glands.

The visible changes of puberty may occur at very different ages in differentadolescent males. Boys who mature much earlier or much later than their peersmay encounter serious social problems. These boys may be reassured if a doctor assures them that they are normal adolescents, and will become normal adult men.

Health problems potentially affecting adolescent males include the abuse of (tobacco, (alcohol and illicit drugs; overexposure to the sun; unhealthy eating habits; and sexually transmitted diseases.

Adolescents typically believe that they are indestructible, so educators andparents struggle against pressures from advertisers, popular culture, and peers to convince them to minimize their health risks. For instance, tobacco companies admitted in court that they attempted to entice young people to smoke.Advertisements for alcohol show people young enough for adolescents to relate to.

Yet evidence show that an adolescent male who develops and practices good health habits greatly reduces his risk for most serious illnesses, both during his adolescent years and throughout his life. As will become evident, most illnesses that are issues in men's health are related in some way to simple lifestyle choices and preventive measures. Many men can remain strong and vigorous throughout their lives.

Issues of sexuality are paramount in the lives of many adolescents, both maleand female. Definitions of responsible sexuality vary widely. Some people believe that young people simply should abstain from sexual intercourse, or even sexual contact with the opposite sex. Others believe that adolescent malesneed to know what to do if and when they become sexually active. Certainly, they should understand that they can become fathers as the result of their sexual activities, and they also should understand that they can contract sexually transmitted diseases even from young women with no apparent signs of illness.

Some adolescent boys may struggle to decide whether they are heterosexual orhomosexual. Although the Kinsey Reports of the 1940's and 1950's seemed to indicate that about 10% of the population is homosexual, some later studies claim that the proportion is as low as 3%. However, whether one boy in 10 or oneboy in 30 is homosexual, many adolescents either will face a decision themselves or will know someone who faces it. For many adolescents and young men, homosexuality is the ultimate sexual difference. Many homosexuals experience hostility or even violence at the hands of other males because of this.

Most men between the ages of 20 and 39 enjoy relatively good health. Their bodies do not change much physiologically, and their health concerns are oftenfocused on sexuality, reproduction, and preventing accidents. Additional health concerns may include weight gain due to excessive calorie consumption, alcohol or drug abuse, skin cancer, and testicular cancer.

In this age group, prevention of illness rather than treating of illness usually is the major priority. For instance, testicular cancer occurs more frequently in this age group than in any other. Men in this age group should learnhow to perform testicular self-examination and should report any unusual findings to a doctor. Most cases of testicular cancer can be cured, and generallya young man will return to normal sexual performance and normal fertibility.

Changes in the skin--particularly a mole that changes shape or color--need tobe examined by a professional. It is wise to have bood pressure checked every couple of years, as well as the pressure within the eye, even if a man feels perfectly well and has no apparent vision problems.

As with adolescents, social pressures from peers and from the general culture(movies, videos, advertisements, and the like) encourage young men to drinkheavily, smoke, drive dangerously, and solve conflicts by using violence, among other problematic behaviors. All of these behaviors can reduce a young man's health at the time and can lead to even more serious problems as he ages.

In modern American society, a young man generally needs to make specific plans to get enough exercise. The U.S. surgeon general advocates doing 30 minutesof moderate aerobic exercise almost every day, and activities to develop strength approximately twice a week. Young men are often active in high school and college with team sports, or they simply choose to use some of their leisure time to be active. Only elite athletes can move on beyond college team sports, and most men find that careers and families limit the time for activities and the types of sports they can play.

One outlet adopted by many young men is body building or competitive sports such as distance running or bicycling. Generally these activites provide healthy exercise and psychological satisfaction. However, some young men go overboard. They may take dangerous drugs such as steroids or questionable nutritional supplements, hoping to build muscles more quickly. Androgenic steroids frequently cause sexual problems and psychological imbalances, while other supplements are unregulated and may have unknown ingredients and unpredictable side effects.

The best nutritional approach for would-be athletes of all sorts continues tobe a well balanced diets, with plenty of grains, fruits, and vegetables. Athletes need enough calories to fuel their activities and any desired gain in weight, for certain body builders. The typical American diet provides more than enough protein for muscle growth, so protein supplementation is rarely a useful idea.

Competitive wrestlers, on the other hand, often try to lose weight so they can compete in a lower weight class. A typical shortcut to weight loss is to abuse drugs known as diuretics, which cause the body to release water. In extreme cases, overuse of diuretics can lead to severe kidney damage, convulsions,or other problems; they are not a good way for wrestlers to lose weight.

Other athletes overtrain or compete beyond their physical limitations. If this happens in hot weather, a young man may develop anything from heat exhaustion to heat stroke; the latter can be fatal. Overtraining, week after week, can lead to overall fatigue, depression, and a rash of minor injuries.

Most other preventive measures are not medical at all, but rather common sense. Wearing seat belts in cars and helmets on motorcycles and bicycles saves the lives of many men each year and preserves the independence and functioningof many others. Healthy diets and moderate exercise reduce obesity at this age group, as well as problems such as heart disease and diabetes when a man is older. Men who use firearms should use them wisely, and men in this age group should learn the dangers of drinking and driving. A disturbing proportionof male college students engage in "binge drinking," a form of alcohol abusethat can occasionally be fatal.

Sexuality issues in young men continue to be challenging. Married men may find it difficult to confine their sexual activities only to their wives. Singlemen, despite impressions in popular culture, often find themselves without asexual partner much of the time, and this is a cause of real distress. Homosexual men may be stigmatized by "straight" society.

The onset and increased rate of hair loss in men between the ages of 40 and 65 is often the first sign of aging. It is almost entirely genetically determined and nearly impossible to prevent. Prescription medications may promote hair growth in some men, particularly if they seek medical attention when hairloss is first apparent. Even if effective in a particular man, these drugs probably need to be taken for his entire lifetime if he wishes not to become bald. In the same way, a man in this age group has little ability to control changes in his eyesight. Almost all men will develop presbyopia (a reduced ability to focus on nearby images) during this age period and will need some sortof corrective lens--spectacles or contact lenses--for reading and similar activities. On the other hand, although a slight decline in hearing acuity is common as men age, hearing loss caused by loud noises is preventable to some degree. Men who work in noisy environments should wear ear protection on the job. Musicians or people who spend a lot of time listening to live music should wear ear protection; frequently listening to very loud music on headphonescan cause lasting hearing loss, as well. hearing.

Other aspects of aging respond to lifestyle, with the consequences of diet and other health-related habits becoming increasingly evident as a man enters his 50s. Examples of aging changes that respond to lifestyle include loss of skin elasticity and muscle strength, increase in body fat, narrowing and hardening of the arteries, rise in blood pressure, increase in cholesterol levelsand bone loss. With efforts to maintain general fitness and to eat a balanced, prudent diet, these aging changes are significantly less noticeable. Although most men are aware that they should reduce the amount of fat in their diets (particularly saturated fat) and that they should eat more fruits and vegetables, the need for calcium is less well known. Even though women suffer farmore frequently than men from osteoporosis, the disorder does exist in oldermen. The best way to forestall osteoporosis is to consume ample calcium fromsource such as low-fat dairy products or dark green vegetables.

Men in this age group should receive frequent screening examinations from their doctors. The notion of "the annual physical" is probably excessive in mostmen who feel well and live prudently, but authorities advise an examinationevery two to five years to check for a variety of potential problems. These include prostate problems (see below), as well as high blood pressure, gastrointestial bleeding (which may be a sign of cancer), early signs of cardiac disease, skin cancers, kidney problems, and liver problems. Men with chronic problems should see their doctors more frequently, based on the medical advice they receive.

Many men experience a gradual lessening of sexual desire at this time, a result of the body secreting less testosterone and decreased nerve conduction. While a gradual lessening in sexual desire may be normal, more drastic reductions are not. Drastic reductions in sexual desire often have medical causes, and sometimes psychological ones. Changes in blood vessels and nerves that result from smoking or excessive alcohol consumption can cause severe dysfunction, so again lifestyle choices can influence a man's well-being. Other cases ofsexual dysfunction resolve when general illnesses such as diabetes and highblood pressure are brought under control. Another potentially controllable factor in sexual dysfunction is medications. Drugs used for everything from hypertension to glaucoma can reduce a man's sexual functioning, so men need to check carefully with their doctors to see if sexual problems may be related tomedications. Men who are depressed or anxious because of career worries or other reasons often have reduced sexual desire, and counseling or medication can reduce the problem. Similarly, a simple lack of sleep in someone with a high-pressure job can diminish sexual functioning.

The risk of heart disease starts to increase significantly in men older than45, and the incidence of colon cancer, skin cancer, and cataracts and glaucoma increases in this age group. Lifestyle choices figure strongly here, as well. Good dietary habits, preferably from early adulthood, and regular exercisetend to reduce the risk of both heart disease and colon cancer. However, heart disease and colon cancer occur even in men with excellent health habits, which is why periodical physical examinations are valuable. If caught early, many forms of heart disease and colon cancer can be cured or managed so that aman's overall health can remain good.

The incidence of both skin cancer and cataracts is increased in men who spenda lot of time in the sun. Sun screen for the screen and UV-protective sunglasses for the eyes are extremely valuable. Men who have frequent sun tans or sunburns should see a dermatologist regularly. Some forms of skin cancer, including basal cell and squamous cell carcinoma, are almost always curable if treated early. Malignant melanoma, on the other hand, can be deadly. These cancers typically look something like skin moles, and any mole that looks unusualor changes its appearance (shape, color, size) need to be evaluated promptlyby a physician. Although men with light skin are most likely to develop skincancer, no group is immune.

In addition to cataracts, another potential eye problem in this group is glaucoma. Men in this age group should ask their eye care professionals to screenfor it. Caught early, this disorder is almost always manageable with medicines, laser treatments, or surgery. However, glaucoma is "the silent thief" andcan cause significant visual loss or even blindness with no major symptoms if it is undetected.

Enlargement of the prostate is also common in men over 40. For men over 50, cancer of the prostrate is the most common type of cancer and the second leading cause of cancer death, following lung cancer. All men should undergo prostate screening on a regular basis from about age 40 on. At a minimum, this includes a digital rectal examination performed by a doctor. Starting around age50, many doctors advise regular blood tests for PSA (prostate specific antigen.) A high and rising level of PSA often indicates the presence of prostatecancer. However, use of the test for screening is controversial. Some authorities point out that many prostate cancers grow so slowly that they cause no health problems in many men with the disease. Unfortunately, the screening tests can not tell the difference between a slow-growing prostate cancer and a more aggressive, more dangerous form. Therefore, use of the PSA test may drivemen to have tests or treatments they do not really need for good health. This is a difficult issue, and each man needs to discuss it with his own doctor.

The other cause of prostate enlargement, benign prostatic hypertrophy (BPH),can lead to urinary problems, including infections or difficulties with urination. BPH can sometimes be managed with drugs; in some men, a form of surgeryis the best way to provide relief. Other men may choose to live with some inconvenience and some discomfort, at least for a while, because both drugs andsurgery can have side effects.

Prostate surgery used to condemn many men to incontinence or impotence. Withthe development of "nerve sparing" removal of the prostate, plus other less drastic techniques, these post-surgical problems are much less frequent. Men who have successful prostate surgery will have completely normal sexual performance and live completely normal lives. Nonetheless, even in the hands of themost experienced surgeon problems can occur, so men must weigh the medical problems against the potential side effects.

The changes seen in middle age continue gradually for most men into old age.

Other problems emerge as well. It is not uncommon for men over 65 to experience a gradual decline in height, continued decline in eyesight and hearing, loss of flexibility due to osteoarthritis, loss of aerobic capacity, increase in cholesterol levels, changes in sleeping patterns, further decline in the intensity of sexual interest, and memory loss. Some of these problems may havepsychological components, as well. Many men who retire are not prepared for the loss of status, structure, and social contact that their jobs provided. Asa result, they may become depressed or anxious, to the point where counseling or even medication is necessary. With emotions in better balance, older menmay see improvements in their sleep patterns, sexual interest, and memory loss.

In addition, men over 65 are especially prone to chronic diseases such as heart disease, certain cancers, and diabetes; falls; flu and pneumonia; gastrointestinal ailments; physiological intolerance of heat and cold; and incontinence. Many of these ailments can be prevented or reduced in severity with preventive measures, as well. Many cases of diabetes will respond to modest weightloss (sometimes just 10 pounds or so) plus regular, moderate exercise. Excellent vaccines exist for the most deadly form of pneumonia (one dose sufficesfor a lifetime), and for the flu (one dose per year, keyed to that year's flustrain.) Men who are intolerant of cold or heat need to be sure that they keep the temperature in their homes at an appropriate level. With the financialpressures that may come with retirement, men may turn down the heat in the winter or decline to use an air conditioner in the summer. This can be deadly,leading to hypothermia in cold weather or heat stroke in hot weather.

Loss of aerobic capacity, falls, and other signs of physical weakness can often be reduced by even very modest exercise. Researchers have shown that evenpeople in their 90's can benefit from simple exercises; they are better ableto get out of a chair or a bed, their balance is better, and they can walk far enough to handle more daily affairs.

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