A preventative maintenance schedule for men's health

By Liz Szabo, USA TODAY

Updated 8/27/2012 12:31 AM

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Few men would drive a beloved sports car into the ground, ruining its engine for lack of routine oil changes, tune-ups or new belts.

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  The American Heart Association advises men to check their blood pressure at least every two years.

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The American Heart Association advises men to check their blood pressure at least every two years.

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Yet many men don't think twice about neglecting their health, letting a decade or more slip by without scheduling a checkup, says Jeff Cain, president-elect of the American Academy of Family Physicians. One-third of men have no regular doctor, and the same number say they visit a doc only when really sick.

"Men are used to maintaining their cars, but they aren't used to maintaining themselves," says Cain, a professor at the University of Colorado-Denver. "But it's just like taking your car to a regular mechanic: The same doctor who takes care of you when you're sick can take care of you when you're well, and hopefully prevent problems down the road."

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• STORY: Heart disease in men can be fought head-on

Unlike women, however, men aren't handed a preventive maintenance schedule. Women learn from an early age to schedule a "well woman exam" every year. While young women often seek out these exams to obtain birth control, the visits give doctors a chance to screen for cancer and sexually transmitted infections, as well as provide essential health education, such as about nutrition, exercise and mental health, says Michael LeFevre, co-chair of the U.S. Preventive Services Task Force, a volunteer panel that advises the government. Women stay in the medical system as they age, bear children and go through menopause, frequently connecting not only with their own doctors but with their children's pediatricians.

Men, on the other hand, may disappear from the patient rolls at age 18, avoiding checkups until age 40 or 50, when they show up for a cancer screening — often at the suggestion of their wives, Cain says.

Yet doctors say there are lots of things that men can do to take care of themselves — both inside and outside of the exam room — at every stage of life.

Eating well, exercising, avoiding tobacco and practicing safer sex are some of the keys to good health, LeFevre says. Annual flu shots are important at any age, as well.

"Those behavioral things are probably more important than getting tests," LeFevre says.

But unlike a car, men aren't all the same. A man's family history can play a far more important role in his risk of disease — and in setting the best time to test for certain conditions — than his age. While conditions such as diabetes may not develop until middle age, even young men can be at risk of sudden cardiac death during sports, says Michael Soleimani, a family physician at Kaiser Permanente Southern California.

While doctors may not have an owner's manual, experts say the average guy can help protect his health by paying attention to some of these issues as he ages.

By Suzy Parker, USA TODAY

Age 18

Family history discussion with parents

Vaccinations

•A meningitis shot, required at many colleges.

•HPV shot, to prevent infection with the human papillomavirus, which causes a variety of cancers and genital warts, if men haven't been vaccinated already. This vaccine is most effective if given before men become sexually active.

•Tetanus-diphtheria-pertussis (Tdap) booster. Everyone needs a tetanus booster every 10 years. And recent outbreaks of pertussis, or whooping cough, have led the Centers for Disease Control and Prevention to recommend this vaccine for everyone.

Weight check

•Men don't need to go to the doctor to track their weight, but they should monitor it to make sure they don't put on too many extra pounds after they graduate high school, LeFevre says. Online sites and apps can help guys calculate their BMI, or body mass index.

Blood pressure

•Guys should get their blood pressure checked at age 18, too, although this can also be done by a nurse or even the trainer at the gym, LeFevre says. The American Heart Association recommends men check their blood pressure at least every two years. A blood pressure of 120/80 or less is considered healthy.

Your 20s and 30s

Cholesterol

•Men should take a fasting cholesterol test every five years, beginning at age 20, according to the Heart Association. Men with unhealthy cholesterol may need more frequent tests.

Your 40s

Hepatitis C

•The Centers for Disease Control and Prevention recommends that Baby Boomers, or those born between 1945 and 1965, get a one-time test for hepatitis C, which can destroy the liver. Many people with the disease don't know they have it.

Diabetes

By age 45, the American Heart Association recommends that men have a fasting blood sugar test, which can tell if men are diabetic or pre-diabetic. Men should repeat the test at least every three years. Many men don't realize they have diabetes or are on their way to developing it. Making early lifestyle changes can prevent the disease from developing, or keep it under control to avoid long-term complications, says Raul Seballos, vice chair of preventive medicine at the Cleveland Clinic.

Your 50s

Colon cancer

•The task force recommends men at average risk get screened for colorectal cancer beginning at age 50. Men at higher risk should get screened earlier, LeFevre says. Men who choose screening colonoscopies should be checked every 10 years, while those screened with fecal occult blood tests — a non-invasive test — need to be tested annually.

Prostate cancer

•Experts disagree about the benefits of routine screening for prostate cancer. The preventive services task force has concluded that PSA testing typically does more harm than good. Other groups, such as the American Cancer Society, say men should discuss the risks and benefits with their doctors and make an informed decision.

Lung cancer

•For the first time, major medical groups such as the American Society of Clinical Oncology this year began recommending lung cancer screening for certain older smokers and former smokers: those ages 55 to 74 who smoked the equivalent of a pack of cigarettes a day for 30 years. The society recommends the screenings only be performed at academic medical centers, such as universities, with specialized surgeons and radiologists on staff. Lung cancer screening is not recommended for other people, because the risks of invasive follow-up tests outweigh the potential benefits.

Aspirin therapy

•While doctors don't recommend that everyone take aspirin, a daily low-dose pill can help reduce the risk of heart attack in men with certain risk factors, LeFevre says. By age 50, it's worth talking to the doctor about whether a daily baby aspirin could be beneficial. LeFevre cautions that no one begin taking aspirin on their own, without medical advice, because the pills can cause severe bleeding and ulcers in some people.

Your 60s and 70s

Peripheral artery disease

•The American Heart Association suggests having an ankle-brachial index test every year or two, starting in your 60s. The test measures the pulses in your feet to detect plaque build-up in the arteries of the legs, which can lead to blood clots.

Abdominal aortic aneurysm

•Men who have ever smoked should get a one-time ultrasound test for this type of aneurysm, in which the blood vessel balloons out and threatens to burst, between ages 65 and 75. Non-smokers don't need it, the preventive task force says.

www.vydox.com

Health Law Has Gaps in Services for Men

By Kaiser Health News

Published: September 02, 2012

The federal healthcare overhaul greatly expanded women's access to free preventive services, particularly for sexual and reproductive health. Men didn't fare nearly as well.

The Affordable Care Act guidelines' promise of free contraception may have generated the most controversy, but the law also provides many other services for women, including free screening for HIV, chlamydia and gonorrhea, and pregnancy-related benefits such as screening for gestational diabetes, and breastfeeding support, supplies, and counseling.

"Groups that were really focused on the health of women were identifying specific gaps that they wanted to make sure were covered," says Adam Sonfield, a senior public policy associate at the Guttmacher Institute, a research and advocacy organization.

Gaps in men's preventive health didn't receive the same focused attention by men's health groups, he says.

Under the law, new health plans or those whose benefits have changed substantially are required to provide four types of preventive care without any copayments or other forms of cost-sharing: services recommended by the U.S. Preventive Services Task Force (USPSTF), immunizations recommended by the CDC's Advisory Committee on Immunization Practices, and preventive services and screenings for women and for children that are recommended by the Health Resources and Services Administration (HRSA).

Sen. Barbara Mikulski (D-Md.) championed adding women's preventive services recommended by HRSA following an outcry over a USPSTF recommendation that regular mammography screening for most women begin at age 50 rather than age 40. In a separate amendment, she successfully pushed to reinstate the earlier recommendations that called for mammography screening starting at age 40. The new requirements substantially broadened the free preventive services available to women.

The new law requires most health plans to begin providing free contraceptives to women when their new plan year begins this fall or next year. It covers all FDA-approved methods, including permanent ones such as tubal ligation. But since its scope is limited to women's services, it does not offer free coverage for vasectomies.

Men's health specialists say both men and women could have benefited from such a requirement. Even though they're generally simpler and less expensive than female sterilization, cost can be a factor that deters men from getting vasectomies.

"Particularly for older men who are interested in playing a role in pregnancy prevention through sterilization, there are not many low-cost services available, even in a large city," says David Bell, MD, MPH, medical director of the Young Men's Clinic at New York-Presbyterian Hospital's Family Planning Clinic.

The health law also requires free coverage for screening for a number of sexually transmitted diseases in women but not men. For example, HIV screening is covered annually for all sexually active women. In men, free screening is recommended for those who are at higher risk, such as men who have sex with men or with multiple partners.

Similarly, the USPSTF, a federal panel of experts, recommends screening all sexually active women younger than 25 for chlamydia and screening at-risk women for gonorrhea. But the task force says there's not enough evidence to make such recommendations for men.

Some of the new preventive coverage requirements do address men's sexual health. For example, under CDC recommendations that become effective in December, new health plans must cover the three-shot human papillomavirus (HPV) vaccine for young men at no charge. Previously recommended for young women primarily to prevent cervical cancer, the vaccine is also associated with some cancers that affect men. It is recommended routinely for young men ages 11 or 12, and for those ages 13 to 21 who haven't been vaccinated.

It's no accident that most of the new preventive benefits are aimed at women, say experts. "Women bear a disproportionate burden when it comes to sexually transmitted diseases and preventing pregnancy," says Deborah Arrindell, vice president for health policy at the American Social Health Association, an advocacy group.

As women enter their reproductive years, they typically begin to see a primary-care practitioner, often a gynecologist, for regular checkups and to receive contraceptives. In 2009, 66% of women ages 18 to 44 visited a primary-care provider, compared with 52% of men in that age group, according to the CDC's National Center for Health Statistics.

Although men may visit the doctor to get a physical for work, sports, or school, it's not routine, say experts. "Many of the men who visit the family planning clinic are sent by their partners," says Bell. "Fifty percent came because of a female in their life."

Part of the problem in improving coverage of sexual and reproductive health for men is that research is scarce and comprehensive clinical guidelines have never been established, say experts. The USPSTF, in declining to recommend screening for chlamydia in men, for example, said there was a "critical gap" in research on the benefits of screening men for the disease.

Some women's health advocates note wryly that although there may be a relative dearth of data related to men's sexual and reproductive health, much of the broad medical research conducted to date has focused on men. Clinical trials for many drugs, for example, for many years excluded women.

Regardless, advocates agree that leveling the playing field for the sexes for sexual and reproductive health services only makes sense.

"It seems foolish to do it differently for women than for men," says Sonfield.

www.vydox.com

Farmers hear men's health message

JILL GALLOWAY

Last updated 12:00 04/09/2012

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MURRAY WILSON/FAIRFAX NZ

STRONG MESSAGE: Bulls flying doctor Dave Baldwin has just finished making his film Healthy Bastards and had help from Freyberg High School art students.

Doctor Dave Baldwin says he has spent $100,000 of his own money getting his message of being "a healthy bastard" out to men.

He spoke to about 50 farmers at Feilding at the final Manawatu Finishing Farm seminar. Baldwin talked about staying healthy and said he was pleased to communicate with the group because it was the target audience for his message.

He said he had been a GP in Bulls for 20 years, and ran his business with his son, Marc, flying around two-thirds of the country doing aviation checkups on pilots.

"As a GP I see that 20 per cent of men don't give a shit about their health - people such as those overweight, smokers, drug-takers. Nothing has changed with that group in 20 years."

Nothing the Government or any health group had done had made any difference to that number, he said.

Farmers were the same, in that one in five didn't care about their own health, Baldwin said.

"Even though a lot of them are highly educated and hard workers, they are not listening to the good health messages. So I don't see the farmers as anything different from the general population."

Baldwin said farmers who didn't care about their health should know better.

"They're dealing with animal health and they are involved with the beautiful New Zealand outdoors. They are more in tune with their environment.

"The reason I love dealing with rural people is that I am a free spirit. We are blessed to be in a country where it is possible to fly, fish, shoot a deer. The reason I love rural people is I feel at ease - as one with them."

He said men lived four years less than women, on average.

"They have higher rates of suicide, heart disease, cancer - the lot. They are not meant to die earlier than women, but they do."

A song written by Bullfrog Rata for Baldwin's "Healthy Bastards" campaign said: "You never know how long you're here for, so live your life to the max."

That's something Baldwin feels strongly about.

He said when he grew up, men's "bits and pieces" weren't talked about and many men were still shy about it.

"But prostate cancer is the biggest killer in this country, and 3300 a year die in Australia and New Zealand. Picking up cancer early is the best way to deal with it. Ignorance is fear."

Baldwin suggested men go for checks each year once they reach 50, or from 40 years of age if there is prostate cancer in the family.

Hair pill may harm sex life indefinitely

Joe and Teresa Graedon: Hair pill may harm sex life indefinitely

By Joe Graedon, M.S. and Teresa Graedon, Ph.D.
Posted: 07/25/2012 07:27:35 PM PDT
Updated: 07/25/2012 07:30:46 PM PDT

How many men would willingly trade in their sex drive for a full head of hair? For some, that might seem like a deal with the devil.

Evidence is accumulating, though, that at least a few men make such a Faustian exchange when they accept a prescription for finasteride. This medication is used to reverse male pattern baldness (as Propecia) or control the symptoms of prostate enlargement (as Proscar). A related drug, dutasteride (Avodart), is also used to treat an enlarged prostate.

These drugs work by blocking the conversion of the male hormone testosterone to its byproduct dihydrotestosterone, or DHT. Research has shown that DHT contributes to both male pattern baldness and prostate gland growth. Blocking DHT production can help men hang on to their hair longer as well as keep their prostates from expanding.

The problem is that there are side effects. The most notable are decreased libido, trouble with ejaculation and erectile dysfunction. These are thought to be uncommon, however, and physicians have assumed that they would disappear once the drug was discontinued.

The official prescribing information for Propecia is confusing on this matter. On the one hand, doctors are told that sexual side effects resolve when the drug is stopped. On the other hand, though, there is a suggestion that sexual dysfunction may persist "after discontinuation of treatment."

A study published in the Journal of Sexual Medicine (online, July 12, 2012)

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suggests that some men may suffer long-lasting complications after quitting finasteride. Michael Irwig, M.D., recruited young, healthy subjects who had taken Propecia for hair loss. Their average age was 31, and they had not experienced sexual problems before taking this medication. All of the volunteers in this study had complained of erectile dysfunction or other sexual difficulties while taking the drug and for a time after stopping.
The surprising finding from this research is that 96 percent of these otherwise healthy young men were still having significant sexual problems roughly a year after Irwig enrolled them in the study. He is concerned that in some cases such sexual side effects could be permanent.

Men reported lowered sex drive, reduced arousal, erectile dysfunction, impaired sensation and less satisfaction with orgasm. They also complained of semen quality, penis curvature and decreased testicular size.

Joe Graedon is a pharmacologist. Teresa Graedon holds a doctorate in medical anthropology and is a nutrition expert. Write to them in care of their website: http://www.vydoxtrial.com/trial/