Men's health refers to any aspect of overall male health that may affect well-being, energy level, sexual function or fertility.
Erectile Dysfunction
Erectile dysfunction (ED) is defined as the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. Erectile dysfunction is strongly age related and affects as many as 30 million American men. While there is an estimated prevalence across all ages of about 10% (making erectile dysfunction common), the prevalence rises to over 50% in men between 50 and 70 years of age, though it is not an inevitable consequence of normal ageing. While ED is common, only about 5% of men ever discuss this problem with a physician. It is also associated with a number of organic disorders and diseases. In diabetes, for instance, ED occurs in up to 40% of men. But ED may also occur with cardiovascular disorders (especially in men with angina or after myocardial infarction), neurological disorders, after pelvic surgery or trauma, and as a consequence of pharmacological treatments of a number of diseases. Currently, there are a number of lifestyle changes and treatment options available for men with erectile dysfunction. In some cases, the first course of treatment satisfies the patient and his partner. For other patients a number of steps may be taken before one is found satisfactory. Among the treatment options are:
- Changing habits
and medications
Quitting smoking can be an important step in reducing the impact of impotence or eliminating it altogether. Small changes in prescription medications may also help improve erectile quality.
- Hormone Medications
While only 5% of ED cases are caused by irregular levels of sex hormones (such as low levels of testosterone, excess prolactin and excess estrogen), these conditions are usually treatable with excellent results.
- Professional
Counseling
Because ED can result from a combination of psychological and physical factors, counseling can lessen anxiety, which in turn may reduce the impact and duration of the condition. This therapy is often used in combination with other treatments directed by a physician.
- Vacuum Devices
This treatment involves the use of an external vacuum device and one or more tension rings (basically rubber bands). The device works by inserting the penis into a plastic cylinder, which is then pumped to create a controlled vacuum. Once an adequate erection is produced, a tension band is slipped around the base of the penis to maintain the erection; the vacuum device is then removed. The erection-like state generally lasts long enough for a couple to have intercourse.
- Injection Therapy
One of the newest forms of treatment involves the self-injection of medication into the side of the penis. The relatively painless injection produces erections of good quality for about 70-80 percent of patients. There are several injectable medications that, when used alone, help increase blood flow to the penis which promotes an erection. Originally, these medications had been registered and marketed to treat other conditions. Researchers, however, also found them to be effective in treating erectile dysfunction, so doctors began prescribing these medications for their patients.
- Penile Prostheses
This treatment involves the surgical placement of a stationary or movable device into the two sides of the penis, allowing erections as often as desired. These implants come in two forms: an inflatable device and semi-rigid rods. This treatment is not recommended until other methods have been considered or tried first.
- Oral Therapy
Yohimbine occurs naturally in the bark of evergreen trees and has been used as an aphrodisiac for centuries by Indians and Africans. It is believed the drug works by enhancing nerve sensitivity in the penis. While there have been no large-scale studies to prove the drug's effectiveness, a small percentage of men report it to be helpful for impotence.
- Surgical Treatment
This treatment is usually reserved for those patients whose blood flow has been blocked by an injury to the penis or pelvic area. Surgery is also used to correct ED caused by vascular blockages. The goal of this treatment is to correct a blockage of blood flow to the penis so that erections will occur naturally.
Hormonal Changes With Aging
We now know that many men have a decline in important hormone levels as they age. This can occur in some men in their 30's and 40's, but is more common in their 50's, 60's and 70's. Many physicians have called this condition "andropause," which may be analogous to the female menopause. However, unlike in the female, male hormone problems do not occur in every man and occur at variable ages. The condition includes changes in many hormones including testosterone, DHEA, growth factor/insulin-like growth factor, and melatonin.
Decreased testosterone levels (hypogonadism) are estimated to occur in 4 to 5 million men. Unfortunately, male hypogonadism appears to be underdiagnosed and undertreated. Only about 5% of hypogonadal men ever receive testosterone replacement. Clinically, the symptoms of hypogonadism are
- Often attributed to other medical problems
- Not reported by patients, and
- Not recognized or understood by many physicians.
In men, testosterone and its metabolites are responsible for virilization, normal pubertal development. In adult males, testosterone is not only responsible for maintenance of secondary sex characteristics (facial hair, deep voice, erectile function), but also for cognition, muscle strength, libido and bone strength.
Hypogonadism is associated
with a number of signs and symptoms. These include:
- Loss of libido
- Erectile dysfunction
- Mood and behavioral symptoms (depression, irritability)
- Loss of motivation
- Lethargy or loss of energy
A deficiency of endogenous testosterone also has a deleterious effect on bone mass and is a risk factor for osteoporosis. Furthermore, reduced muscle mass is also associated with low testosterone levels. Because hypogonadism is characterized by testicular dysfunction, production of sperm and semen volume is often impaired.
The diagnosis of
these hormone problems is not difficult if the physician is looking for
the signs and symptoms and understands what blood tests to obtain. Treatment
is easy and well-tolerated. Treatment depends on whether the man is attempting
pregnancy. If no pregnancy is being attempted, treatment with one of several
easy to use forms of testosterone is safe and effective. Testosterone
replacement can be accomplished through injections, patches or absorbable
gels. If pregnancy is desired, testosterone itself cannot be used as this
causes a sharp decline in sperm production. In this case, either Clomid
or another pituitary hormone called hCG must be used. In men with a low
testosterone level and low sperm counts, this type of treatment is highly
effective in improving sperm quality.
