December 26, 2023
Men are expected to live 5 years less than women on average in the United States.
“Men and women think very differently about healthcare. Whether it's anthropology or socialization, men think they're indestructible,” says Ajay Nangia, MD. “They ignore things, but prevention is the cure many times, and we want to be sure to encourage men to do their preventative care before ‘the big one,’ as I call it.”
Dr. Nangia is a urologist at The University of Kansas Health System who specializes in men's health issues as they relate to sexual and reproductive health. The urology team at the health system is nationally recognized and highly specialized, with specialists in every area of urology. This includes Richard “Jake” Fantus, MD, who has a special interest in vasectomies, vasectomy reversals, inflatable penile prosthetic implantation surgery and minimally invasive BPH procedures, and William Parker, MD, who specializes in the treatment of all urologic malignancies, including bladder, kidney, testis, penile and prostate cancers.
Our subspecialty-trained urologic experts work together with other medical and surgical specialty areas to ensure you receive the best treatment and newest, leading-edge options. The doctors compared a man seeing a urologist to a woman seeing a gynecologist. While the focus may be primarily on reproductive or sexual organs, that is not the entirety of the care they provide.
“Men's health is not just urological, it's not sexual, it’s not the kidney, bladder or prostate area. It's all of it. It's the cholesterol, it's the thyroid, it's the colon cancer,” says Dr. Nangia.
Every doctor who looks after a male patient is involved in preventing and treating male disease. This includes primary care, internists, endocrinologists, psychiatrists, physical therapists and more. Our team recommends referring to this great guide from the American Urological Association that shows what is covered in common urology screenings by age, as well as related healthcare issues that can be coordinated with another provider, like primary care.
Ultimately, the health system doctors stressed that men must take ownership of their health.
One way to get started as your own advocate is to do research and prepare questions for your doctor’s appointments. Some of the most common men’s health issues our urologists encounter are explored below.
1. Birth control
Dr. Nangia says they have seen a massive increase in consultations for vasectomies over the last year. There may be many reasons for that, but the doctors say it has been correlated with increased restrictions on abortion. While many men are looking for a vasectomy to be birth control for now – and reversed later – the doctors say vasectomies should be viewed as permanent birth control.
“We do have this ability to reverse it, but just because we can doesn't mean we should. That's where the real challenge and the shared decision-making has to come in,” says Dr. Parker.
Dr. Fantus cited research on vasectomy regret among men who were talked into getting one. So, if you are investigating a vasectomy procedure, expect to have an in-depth discussion with your urologist about your reasons for wanting one and your future reproductive plans.
Aside from vasectomy, men tend to rely on condoms for birth control. But we continue to investigate additional options. For example, the health system has been participating in National Institutes of Health trials for men’s hormonal birth control. In the future, there may be a true reversible form of contraception for men, much like what exists for women.
2. Enlarged prostate, or BPH
BPH stands for benign prostatic hyperplasia. It simply means an enlarged prostate. It affects up to 50% of men by the age of 50 and almost all men over the age of 70. A common BPH symptom is frequent urination or trouble with urination. BPH can be treated with lifestyle changes, medications to shrink or relax the prostate and even surgical procedures to trim the prostate. This includes the latest minimally invasive robotic procedure called Aquablation therapy. It uses a heat-free water jet to remove prostate tissue with minimal irreversible side effects.
3. Low testosterone
“It’s really important that we have a conversation about your symptoms, things like problems with erections or sex drive, loss of muscle mass or osteoporosis," says Dr. Fantus.
If you are reporting those symptoms, you may get screened for testosterone deficiency. That looks for a low testosterone level on 2 morning tests.
However, even if you have low testosterone, you may not be treated with hormone supplements. That’s because testosterone can do things like shut down the body’s ability to make sperm. So, if you are still interested in having children, testosterone medications may not be the solution.
“People focus so heavily on testosterone being the be-all and end-all of their problem. It isn't. It's their overall health, weight, diet, sleep, exercise and stress,” says Dr. Nangia.
4. Erectile dysfunction
Many people like to blame erectile dysfunction on low testosterone. But Dr. Fantus says the causes are multifactorial, or caused by several different things. For example, aging, hardening of the arteries, high blood pressure, high cholesterol, diabetes and obesity can all contribute to erectile dysfunction. Additionally, there is also psychogenic erectile dysfunction or performance anxiety.
Because of all this, it’s not common to go straight to medications. Dr. Fantus says the No. 1 treatment is lifestyle modifications, which include weight loss, diet and exercise as appropriate. He says that men who lose up to 10% of their body weight will generally have some reversal of their erectile dysfunction symptoms.
If that is not successful, there are medications – like Cialis, Viagra and others – or injections, vacuum devices and surgeries to correct erectile dysfunction. One example is that Dr. Fantus performs a minimally invasive procedure to insert inflatable penile prosthetic devices, which offers a permanent treatment for ED.
5. PSA testing
The American Cancer Society estimates that 1 in 8 men in the U.S. will get prostate cancer. A prostate-specific antigen (PSA) test is a blood test that is used to screen for prostate cancer. Dr. Parker says he recommends men start getting their PSA levels tested in their 40s. However, not all providers will offer it, so you may need to request it specifically.
“There's this myth out there that you die with prostate cancer, not from it,” says Dr. Parker. “Prostate cancer kills a lot of men every year. That's a potentially avoidable outcome with early detection screening.”
In addition to a PSA test, your doctor will also likely complete a digital rectal exam.
6. Prostate cancer treatment
Unfortunately, getting treatment for prostate cancer can lead to many of the common men’s health issues explored here. During treatment, you’re given medication to block testosterone. That can mimic symptoms of menopause, like hot flashes, fatigue and brain fog, in addition to urinary incontinence and erectile dysfunction. Learn more about prostate cancer treatment options.
7. Self-checks and testicular cancer
Testicular cancer is the most common cancer for young men aged about 15 to 40. Like breast cancer, teaching self-exams has been somewhat controversial, says Dr. Nangia. The United States Preventative Services Task Force doesn’t recommend self-checks because there’s concern about causing undue anxiety. However, Dr. Nangia says that proper education around self-exams is a useful, free way to catch testicular cancer early.
“Testicular self-exam is easy. You should be feeling your testicles in the shower. See what things feel like,” says Dr. Parker. “But the most important thing is to not be afraid of what you feel and seek the advice or evaluation of a doctor if you’re concerned.”
There’s a common misconception that the “turn-your-head-and-cough” test in a doctor’s office is part of a testicular exam. Dr. Fantus says it’s actually to look for a hernia, especially if you are having urinary pain or pain in the scrotum.