Men's Health Tips: Weight Gain, Hair Loss, and Disease Prevention

• "Men often do not set their overall health condition or set prevention of health problems as a high priority in their daily life."
• "Men, in general, seem to ignore health issues until they become noticeable to others that are close to them (wife, family, or friends). Even then, in many instances, many men need prodding to have themselves examined by a physician. "
• There is evidence in the health literature that lends support to these statements. After seeing patients over many years, and after discussing health problems with my family and friends and after being prodded by my wife to take my own advice to others for checkups, I tend to think the above is true for a large number of men.
• The reasons why health is a low priority for many men is complex and may include such rationalizations as
  • "I've been doing well, so far..."
  • "I'm too busy and have to earn a living..."
  • "I've been (fill in the blank_____) for years, so why should I change now..."
  • "When I had problems before, I'd just keep on working and they would go away..."

Consequently, for many men, accepting and understanding how important good health habits and preventive medical care might be, is a struggle. Presenting it similar to the care and preventive maintenance schedule of a car might be a way of relating health care to a subject that is often familiar to them. A car requires a specific range of fuel components to run well daily. A car needs checkups to maintain its function and to detect when preventive maintenance is needed over the years. For best performance, a car needs to be occasionally driven and not simply run constantly at an idle or low speed. Although not a perfect analogy, this same general approach should be taken for men's health care.

Unfortunately, a man's health is a bit more complicated than choosing between three or four fuel mixtures and checking the tire pressure. This article will first present a general approach for men to take to maximize their chances for continued good health; the second part will discuss some of the major problems that men may encounter during their life journey that can affect their health. However, if male readers do not take that first step and realize they need to act responsibly and not take their health for granted, then it is probable this article will have no impact on them.

• Men with diabetes should use the above tips and monitor their glucose levels as directed, and try to keep the daily blood glucose levels as close to normal as possible.
• Men with unusual work schedules (night shifts, college students, military) should try to adhere to a breakfast, lunch, and dinner routine with minimal snacking.
• Men who prepare food for themselves or others should avoid using grease or frying foods in grease.
• Men trying to lose weight (body fat) should avoid all fatty and sugary foods and eat mainly vegetables, fruits, and nuts and markedly reduce his intake of meat and dairy products.
• Men should seek medical advice early if they cannot control their weight, food intake, or if they have diabetes and cannot control their blood glucose levels.
• Any weight loss regiment should not only include dietary restrictions and modifications but also an exercise regimen.

All men have to eat food for growth and maintenance of a healthy body, but men have different requirements as infants, children (kids), teenagers, young adults, adults, and seniors. For example, infants require feeding every 4 hours until they gradually age and begin to take in more solid foods. Boys develop into the more normal pattern of eating three times per day; however, as most parents know, most boys, teenagers, and young adults often snack between meals. Snacking is often not limited to these age groups because adults and seniors often do the same.

Healthy Eating

• Eat three meals a day (breakfast, lunch, and dinner). It is important to remember that dinner does not have to be the largest meal; choose lunch as the largest meal.
• The bulk of food consumption should consist of fruits, vegetables, whole grains, and fat-free or low-fat milk products.
• Choose lean meats, poultry, fish, beans, eggs, and nuts (with emphasis on beans and nuts); try to limit meats and dairy products to avoid fats and cholesterol.
• Choose foods that are low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars. Look at the labels because the first listed items on the labels usually comprise the highest concentrations of ingredients.
• Control portion sizes. Eat the smallest portion that can satisfy hunger and then stop eating.
• Snacks are OK in moderation and should consist of items like fruit, whole grains, or nuts (especially) to satisfy hunger and not cause excessive weight gain.
• Avoid sodas and sugar-enhanced drinks because of the excessive calories in the sodas and sugar drinks. Diet drinks may not be a good choice as they make some people hungrier and increase food consumption.
• Avoid eating a large meal before sleeping to decrease gastroesophageal reflux (GERD) and weight gain.
• Avoid heavy meals in the summer months, especially during hot days.
• A vegetarian lifestyle has been promoted for a healthy lifestyle and weight loss. Vegetarians should check with their physicians to be sure they are getting enough vitamins, minerals, and iron in their food. A balanced vegetarian lifestyle will not compromise a man's development as evidenced by athletes who choose such a lifestyle.
• Cooking foods (above 165 F or 73.8 C) destroys most harmful bacteria and other pathogens. If men choose to eat uncooked foods like fruits or vegetables they should be washed thoroughly before consumption. Avoid eating raw or undercooked meats of any type.

Healthy living involves more than physical health, it also includes emotional or mental health. The following are some ways men can support their mental health and well-being.

• Get enough sleep daily; the CDC recommends the following by age group (naps inclusive):
  • 12-18 hours from birth to 2 months,
  • 14-15 hours from 3-11 months of age,
  • 12-18 hours for 1-3 years of age,
  • 11-13 hours for 3-5 years of age,
  • 10-11 hours for 5-10 years of age,
  • 8 1/2-9 1/2 hours for 10-17 years of age, and
  • Those 18 and above need 7 to 9 hours of sleep.
  • Elderly men (commonly defined as 65 years of age or above in developed countries) need about 7 to 9 hours but do not sleep as deeply and may awaken at night or wake early, so naps (like kids need) allow them to accumulate the total of 7 to 9 hours of sleep.
• Take a walk and reflect on what you see and hear at least several times per week to sharpen powers of observation.
• Try something new (eat a new food, try a different route to work, go to a new museum display) to avoid living by habit and keep or sharpen adaptive skills.
• Do some mind exercises (read, do a puzzle occasionally during the week) to practice problem-solving skills.
• Try to focus on a process intensely and complete a segment of it over one to several hours, then take a break and do something relaxing (walk, exercise, short nap).
• Plan to spend some time talking with other people about different subjects; this helps socialization skills.
• Try to make some leisure time to do some things that interest you every week (hobby, sport); in short, have some fun. Learn ways to say "no" when something occurs that you do not want to do or be involved with; occasionally compromise (on things that are not vitally important) because it will allow for better or more workable relationships with many people (significant other, family, coworkers).
• Have fun with someone else (go on a trip with someone you love, go shopping, go fishing; do not let vacation time slip away).
• Let yourself be pleased with your achievements, both big and small (develop contentment). Have a network of friends; those men with strong social support systems lead healthier lives.
• Seek help and advice early if you feel depressed, have suicidal thoughts, or consider harming yourself or others. Men are more effective in completing suicide attempts than women.
• Men taking medicine for mental-health problems should not stop taking these medications, no matter how "well" they feel, until they have discussed their situation with their prescribing doctor(s).

The above are ways to form a good foundation for men's physical and mental health. They do not cover every aspect of men's health; the following section offers some "fine tuning" of men's health.

The top ten basic problems and diseases that cause death and disability in men are as follows:

1. Heart disease
2. Cancers
3. Injuries and accidents (trauma)
4. Strokes
5. Chronic obstructive pulmonary disease (COPD)
6. Diabetes
7. Influenza (flu) and pneumonia
8. Suicide
9. Kidney disease
10. Alzheimer's disease

Health screening tests are important to help a man determine if health problems are developing, to attack problems or diseases before they become more serious, to keep vaccinations up to date and to establish an ongoing relationship with a physician so if a man becomes ill, he will have someone he knows to go to.

Screening tests suggested by the National Institutes of Health (NIH) for men ages 18-39:

• Blood pressure check every 2 years or every year if it 120-139/80-89; if its higher, see a physician

Blood Pressure Screening

• Have your blood pressure checked every 2 years unless it is 120-139/80-89 Hg or higher, in which case you need to have it checked every year.
• Watch for blood pressure screenings in your area. Ask your health care practitioner if you can stop in to have your blood pressure checked. Check your blood pressure using the automated machines at local grocery stores and pharmacies.
• If the top number (systolic number) is greater than 130 or the bottom number (diastolic number) is greater than 85, call your doctor.
• If you have diabetes, heart disease, kidney problems, or certain other conditions, you may need to be monitored more closely.

Cholesterol Screening and Heart Disease Prevention

• Men over age 34 should be checked every 5 years.
• If you have risk factors for heart disease, such as diabetes, start getting screened earlier, at age 20.

Men that have diabetes, heart disease, kidney problems, or certain other conditions may need to be monitored more closely.

Dental Exam

• Go to the dentist every year for an exam and cleaning.

Eye Exam

• If you have vision problems, have an eye exam every 2 years.

Immunizations

• After age 19, men should have a tetanus-diphtheria and acellular pertussis (Tdap) vaccine once as part of a man's tetanus-diphtheria vaccines. Men should have a tetanus-diphtheria booster every 10 years.
• Get a flu shot each year.
• Your doctor may recommend other immunizations if you have certain medical conditions, such as diabetes.

Infectious Disease Screening

• Depending on a man's lifestyle and medical history, they may need to be screened for infections such as syphilis, chlamydia, and HIV, as well as other infections.

Preventive Health Visits

Preventive health visits should be every 2 years, and may include:

• Checking height and weight
• Screening for alcohol and tobacco use
• Screening for depression

For men aged 40–64, the NIH recommends those tests listed for men aged 18–39 listed above with the following changes or additions:

Colon Cancer Screening

Colon cancer screening: People between ages 50 and 75 should be screened for colorectal cancer. African-Americans should consider starting screening at age 45. This may involve:

• A stool test done every year.
• Flexible sigmoidoscopy every 5 years along with a stool occult blood test.
• Colonoscopy every 10 years. People with risk factors for colon cancer, such as ulcerative colitis, a personal or family history of colorectal cancer, or a history of large colorectal adenomas may need a colonoscopy more often.

Immunizations

• Men should receive a flu vaccine every year.
• Doctor may recommend other vaccinations for men that have certain medical conditions, such as diabetes.
• Men should have a tetanus-diphtheria booster vaccination every 10 years. If you have not received a tetanus-diphtheria and acellular pertussis (Tdap) vaccine as one of your tetanus-diphtheria vaccines, you should have it once.
• Men may get a shingles or herpes zoster vaccination once after age 60. (Some doctors recommend a pneumococcal vaccine at age 60)

Osteoporosis Screening

• All men ages 50 to 70 with risk factors for osteoporosis should discuss screening with their doctor.

Preventive health visit every 2 years until age 50, and then once a year, should include:

• Checking height and weight
• Screening for alcohol and tobacco use
• Screening for depression
• Routine diagnostic tests are not currently recommended.
• Some men should consider taking a low-dose aspirin every day to reduce the chance of heart attacks.

Prostate Cancer Screening

• Most men age 50 or older should discuss screening for prostate cancer with their health care practitioner. African-American men and those with a family history of prostate cancer should start screening at age 45.
• During screening, a PSA blood test is often done (however, in 2011, recommendations from a consensus study suggested PSA tests should not be done as part of the screening because they concluded that too often, test results led to unwarranted treatments and other tests); this test should be discussed with your doctor.

Men over the age of 65 should add the following tests to the list for ages 40–64;

Abdominal Aortic Aneurysm Screening

• Men between ages 65-75 who have smoked should have an ultrasound done once to screen for abdominal aortic aneurysms.
• Other men should discuss such screening with their health care practitioner.

Colon Cancer Screening

One of the following screening tests should be done:

• A stool test every year
• Flexible sigmoidoscopy every 5 years along with a stool occult blood test
• Colonoscopy every 10 years
• After age 75, men should discuss colon cancer screening with their doctor

Eye Exam

• Have an eye exam every 2 years, especially if you have vision problems or risk factors for glaucoma.

Immunizations

• Men over 65 should get a pneumococcal vaccine if they have never had before, or if they received one more than 5 years before they turned 65.
• Get a flu shot every year
• Get a tetanus-diphtheria booster every 10 years
• Men may get a shingles or herpes zoster vaccination after age 60. Men can get it at any age if they never had the vaccination. Currently, the recommendation is for only one dose, but this may change.

Osteoporosis Screening

• All men over age 65 should discuss osteoporosis screening with their health care practitioner.

Prostate Cancer Screening

• All men should discuss prostate cancer screening with their health care practitioner.
• (See above 40 – 64 age section on prostate testing for controversy about PSA testing.)

Preventive Health Visits Annually

Preventive health visits each year should include:

• Checking height and weight
• Screening for alcohol and tobacco use
• Screening for depression
• Screening for the risk of falls or medication interactions
• Screening for hearing loss

As previously stated, men's health is a bit more complicated than car care, but with all of the above considered, the recommendations and tests form a reasonable basic health guide for men to follow. The following is a list of potential health problems that affect some men. It is not meant to be all-inclusive, but is designed to give basic information to men about the condition. Because each condition may be complicated and have more in-depth information (books are available on some of these topics) than can be covered in this article, each topic will have at least one or more reference listed in the reference section.

Men's sexual health begins at birth. In the U.S. and other countries, one of the first decisions made by the parents of a male infant is to consider circumcision (surgical removal of the foreskin that covers the penis). Although there is no absolute medical reason for this operation according to major medical groups (American Academy of Pediatrics and the American College of Obstetricians and Gynecologists), it is a common procedure done in the U.S. (about 75% of all U.S. males are circumcised).

Why is circumcision ever done? Besides being done for religious reasons, it is widely believed that circumcision promotes better hygiene in males and reduces the incidence or chance for several types of infection and penile problems to develop in males, both young and older(adults) that retain their foreskin. Although the inability to retract the foreskin fully at birth is not a medical reason for a circumcision, circumcision can prevent:

• phimosis (the inability to retract the foreskin at an age when it should normally be retractable),
• paraphimosis (the painful inability to return the foreskin to its original location), and
• balanoposthitis (inflammation of the glans and foreskin).

Studies indicate young circumcised males may have a 10 fold decrease in the number of urinary tract infections as compared to uncircumcised males. In addition, other studies indicate that circumcised males have a lower risk for:

• cancer of the penis,
• cancer of the cervix with their female sexual partners,
• lower incidence of sexually transmitted diseases and if infected with HIV, a lower chance of transmitting HIV to a sex partner.

Although circumcision may increase the chance of meatitis (inflammation of the opening of the penis), the risks of the procedure are small if done on healthy newborns before the age of two months. Ultimately circumcision remains a personal, family decision.

• Puberty (sexual development to become fertile or sperm-producing) in males usually begins between the ages of 11 or 12 through 16, and is commenced by multiple factors including genetic triggers, hormonal surges (testosterone), and other factors that are not clearly understood.
• Usually, over a period of 6 months or so, the testicles and penis begin to enlarge, then pubic and armpit hair begin to develop.
• Next, the voice becomes deeper and the musculature becomes thicker.
• Although facial hair is the last obvious change, most males also begin a growth spurt during puberty that comprises about 18% of their final adult height.
• Parents or caregivers of males that fail to develop these signs of puberty should initially seek advice from the pediatric doctor or pediatric endocrinologist.

For the majority of men, sexual health is never considered until problems develop. The first problems may begin with puberty; many males that are becoming sexually mature may not understand that they are going through bodily and hormonal changes that occur in almost every male, and may suffer anxiety, confusion, misinformation from peers, and if slower developing, social stresses.

Parents and caregivers should look for the signs of puberty in boys and, if possible, anticipate the changes and take the time to help them understand what is happening to their bodies. This information should include topics such as human sexuality, sexual development and issues arising from sexual development. If a parent or other caregiver, for whatever reason, feels they cannot do this, they should choose another competent individual to help them inform their developing male about sexual development (for example, doctor or health counselor).

Any number of readers may think the above is bad advice and such things should only be discussed by (married) adults, while many other readers may think the discussion of such subjects comprise only part of many subjects that should be addressed. Most doctors recommend individuals be informed about their biology.

The prostate gland is a chestnut-shaped gland that is located at the base of the bladder and surrounds the urethra that allows urine to pass out of the bladder. The prostate is actually made up of multiple small glands that produce a milky-white fluid secreted into the urethra when a man ejaculates sperm through the urethra; the fluid and sperm mixture is known as semen or ejaculate. A normal prostate gland is small and soft when digitally palpated during a rectal examination.

Benign prostatic hyperplasia (BPH) is the abnormal proliferation of prostate cells (non-cancerous) and usually cause progressive enlargement of the prostate gland. The most common clinical manifestation of BPH is a set of voiding dysfunctions due to the squeezing pressure on the urethra. Untreated, obstruction resulting from BPH can lead to slow, intermittent urinary flow or acute urinary retention, which can require surgical interventions such as transurethral resection of the prostate (TURP) or prostatectomy. BPH is not a source of prostatic cancer. Usually, BPH can be managed medically with medications such as alpha-blockers and 5-alpha reductase inhibitors. In BPH, the gland is often enlarged and soft or "boggy" when digitally palpated during a rectal exam.

Prostatic cancer is a disease in which cells of the prostate gland become abnormal and start to grow uncontrollably, forming tumors in the prostate and in some men, prostate cell tumors in other organs, especially the bones. Prostatic cancer can have the same symptoms as BPH, but if the tumors proliferate, can cause death. In prostate cancer, the gland may be enlarged and have firm or hard areas when digitally palpated during a rectal exam

Men, please note the last sentence in the above three paragraphs. Yes, you should get a digital rectal examination done as part of any man's yearly physical exam especially after age 50; for some men at higher risk (African American men and men that have a family history of prostate cancer) they should get routine digital exams starting at age 40 or even earlier. Not getting the digital exam is like driving any type of used or "vintage" car in California through the mountains, deserts, and seashore for years and never stopping to check the oil level (another imperfect analogy).

Treatment for BPH ranges from watchful waiting (no treatment, observation ) to medication to reduce symptoms or surgery. Treatment for prostatic cancer ranges from watchful waiting (no treatment, observation), to surgery, radiation therapy, hormone therapy, chemotherapy and biologic therapy while new treatments are being developed (cryotherapy, high intensity ultrasound, and proton beam therapy).

Erectile dysfunction (ED) is a man's inability to achieve and maintain an erection of the penis. While not a disease in itself, is may be a symptom of other diseases. Erectile dysfunction and impotence are frequently used interchangeably in the lay and medical literature, but impotence can also mean incapable of sexual intercourse and sterile (infertile). However, erectile dysfunction often can be intermittent; because some men occasionally have erectile dysfunction and other times are capable of intercourse with normal semen production, they do not fit into all of the implied meanings of impotence. For example, men that have "premature ejaculation" (defined as ejecting semen from the penis, usually with orgasm sooner than the man or his partner wishes during sexual activity) are considered to have a form of erectile dysfunction. Consequently, not all men with erectile dysfunction symptoms are "impotent" although they may be "impotent" intermittently when attempting any form of intercourse.

As many as 50% of all men (ages 40–70 and older) experience a form of erectile dysfunction at some time during their lifetime, with the incidence increasing as the man ages. These statistics on erectile dysfunction vary in the literature, but it is clear that erectile dysfunction is common. Many clinicians prefer to simply classify erectile dysfunction in general terms of mild, moderate, or severe. Until recently, the large majority of men with erectile dysfunction have never discussed this with their doctors. However, men consider this as an important aspect of their lives and their sexual partner's life, and even a single incidence of erectile dysfunction may cause excessive concerns with the man and his partner. Although many men still are reluctant to discuss erectile dysfunction with anyone, current medical and lay press articles, constant TV and internet saturation of commercials, and programs about erectile dysfunction and its treatment(s) have decreased some men's inhibitions about discussing erectile dysfunction.

To better understand erectile dysfunction, it is important to understand how an erection develops. An erection occurs when sexual stimulation occurs due to mental or physical stimulation (or both) that cause, via nerve impulses, spongy tissue in the penis (corpora cavernosa) to expand when smooth muscle (about one-half of the corpora cavernosa tissue) in the penis relaxes (via nitric oxide - cyclic GMP production) and allows the spongy tissue to become saturated with blood under pressure (about 200mm Hg pressure). An erection is sustained when the veins in the tunica albuginea that drain the corpora cavernosa are compressed by this spongy tissue. The erection ceases when the smooth muscle contracts (due to falling cyclic GMP production), and allows the blood to drain through the veins in the tunica albuginea. An erection is the result of a complicated biological response to sexual stimulus that involves mental perception, physical (or tactile) sensation, and chemical responses to these nerve-generated impulses in a man over time that usually peak and begin to cease or reverse after ejaculation. Erectile dysfunction can result when one or more of these complicated steps are not completed. Unfortunately, individual men often have many different causes for erectile dysfunction, but diagnosis of an man's erectile dysfunction almost always centers on one or more of these problems:

• Mental health
• Nerve system function (both central and peripheral)
• Physical health (especially the vascular system)
• Chemical changes in the body (especially hormonal and nerve-generated chemical changes)

There are multiple ways to begin to determine the underlying problems that result in erectile dysfunction; all of them begin with a detailed sexual history. Again, the car analogy; if your car is not performing well, would you not answer the mechanic's pointed questions about its function? In addition, if you answered the questions and the mechanic said you better go to see the specialist at the dealer's to get the best answers, and any needed "parts and fine tuning," what would you do? The same is similar for men with erectile dysfunction; while their primary doctor may help diagnose and treat some men with erectile dysfunction, men often may benefit from a specialist (such as an urologist, endocrinologist, or psychologist) that diagnoses and treats specific aspects of erectile dysfunction. Some doctors will ask the patient to complete a standardized test before they interview the them in depth. An example of a short test is below.

The International Index of Erectile Function (IIEF) has developed a short format of five questions that are graded from 0-5 by the man with a potential erectile dysfunction problem. A score of 5 is the best rating. The five questions are as follows:

1. How do you rate your confidence that you could achieve and maintain an erection?
2. When you had erections with sexual stimulation, how often were your erections hard enough for penetration?
3. During sexual intercourse, how often were you able to maintain your erection after you had penetrated your partner?
4. During sexual intercourse, how difficult was it to maintain your erection to the completion of intercourse?
5. When you attempted sexual intercourse, how often was it satisfactory for you?

The score for no erectile dysfunction problems is 25, while a score of 11 usually indicates moderate to severe erectile dysfunction. However, this set of questions only begins to explore the erectile dysfunction problem and does not reveal underlying causes of erectile dysfunction.

Treatment of erectile dysfunction varies with the underlying causes. Some of the treatments for ED are outlined below.

• Oral medications that enhance the nitric oxide – cyclic AMP, and relaxes smooth muscle in the penis such as sildenafil (Viagra), Tadalafil (Cialis) and Vardenafil (Levitra) and others. These medications can be dangerous to use in some men taking nitrates, high blood pressure medications, anticoagulants, and some prostate medications or have diseases such as diabetes, heart disease, stroke, and blood pressure problems.
• Other medications such as alprostadil self-injection (into the penis base), alprostadil penis suppository, and hormone (testosterone) therapy may be needed.
• Vacuum constriction device (penis pump) is a tube placed over the penis and then a vacuum is made by removing the air in the tube which then pulls blood into the penis, producing an erect penis. A tension ring (constricting ring) is then slipped around the penis base. The ring holds the blood in the penis and maintains the erection after the tube is removed. The ring is removed after intercourse.
• Penile implants are surgically inserted devices into the penis that are either mechanically inflatable or are semi-rigid rods. This surgery is done only by urologic specialists, and is usually the last treatment tried on men with severe erectile dysfunction.
• Blood vessel surgery is sometimes attempted on men with damaged penile blood vessels
• Psychological counseling and co-counseling with the sex partner of men with erectile dysfunction may be successful without medical or surgical treatment with some men; counseling may help in conjunction with the other treatments for erectile dysfunction.

Testosterone is a steroid hormone produced in the testicles of men and the ovaries of women, and in small amounts in the adrenal glands. The hormone has many functions in men; development of sexual maturity characteristics such as voice, pubic hair, muscle growth, bone growth, and affects sexual function and sexual desire. The hormone is produced as part of a complicated feedback endocrine system involving the brain via the hypothalamus and pituitary gland secretions (hormones such as gonadotrophin). In adult males, this results in a variable normal range of testosterone in the blood of about 270–1070 ng/dl (normal ranges depend on the type of test used to detect testosterone), and vary in this range daily. Low testosterone is considered to be detectable testosterone levels in males that are below the low levels considered normal in men. For example, if the normal testosterone levels for a test are between a normal low of 270 and an upper normal level of 1070 ng/dl, then values below 270 ng/dl would indicate low testosterone levels in the man. Low testosterone may result in decreased libido, weak or no erections, low or lower sperm counts, and increased breast size (gynecomastia).

Low testosterone levels (also termed hypogonadism) may result from one or more causes as follows:

• Testicular problems (undescended testicles, testicular injuries)
• Hypothalamus problems (brain tumors, interference of endocrine system by medications)
• Pituitary problems (brain tumors, interference of endocrine system by medications)
• Infection (mumps, orchitis, HIV)
• Stress (mental, physical)
• Genetic problems
• Chemotherapy
• Medications
• Aging (normal aging results in decreasing testosterone levels in men)

Medication is available to men to restore testosterone levels. It is available in pills, gels, patches, injections, and gum tablets. Any testosterone medication should be prescribed by a doctor and usually only after testing to determine that low testosterone is present. In general, low testosterone can be a symptom of an underlying problem that if diagnosed and treated, may resolve the low testosterone levels. Testosterone medications are not risk-free; interference with the normal feedback endocrine system that may even further lower testosterone and sperm levels, stimulate prostate cell growth (prostatic hyperplasia), exacerbate sleep apnea, enlarge breasts in men, cause acne and may even stimulate prostatic cancer cells to grow.

Illustration of the endocrine system

Many men like to see themselves as independent problem solvers. Although this is usually a desirable trait, sometimes it can get men into trouble. To use the car analogy again, if you think your car has a leaking head gasket, are you really the best person diagnose and fix it? The same is true for many aspects of men's health. Men should not go to websites, friends, or "online pharmacies" to get medications to treat themselves. Because treatments for some of men's health problems have the potential to cause additional problems (see above), men are urged to discuss any problems and medications, including alternative or holistic treatments with a doctor before starting any type of treatment or medication. Moreover, some of the symptoms that the individual might be treating could be a sign of a significant medical condition.

Finally, this article serves mainly as an introduction to men's health. More in depth articles on the topics mentioned here are available in the references listed.

Most men can begin moderate exercise, such as walking, without a medical examination. The following people, however, should consult a doctor before beginning more vigorous exercise:

• Men over age 40
• Individuals with heart or lung disease, asthma, arthritis, or osteoporosis
• Individuals who experience chest pressure or pain with exertion, or who develop fatigue or shortness of breath easily Individuals with conditions that increase their risks of developing coronary heart disease, such as high blood pressure, diabetes, cigarette smoking, high blood cholesterol, or having family members who had early onset heart attacks and coronary heart disease
• Individuals who are morbidly obese
• Regular exercise can prevent and reverse age-related decreases in muscle mass and strength, balance, flexibility, endurance, and decrease the risk of falls in the elderly. Regular exercise can help prevent coronary heart disease, stroke, diabetes, obesity, and high blood pressure. Regular, weight-bearing exercise can also help prevent osteoporosis by building bone strength. Most clinicians suggest that the use of weights, even in elderly men, improves balance, mental health, mood and self-confidence. Thirty minutes of modest exercise (walking is OK) at least three to five days a week is recommended, but the greatest health benefits come from exercising most days of the week.
• Stop smoking tobacco; start to stop today (it takes about 15 years of nonsmoking behavior to achieve a "normal" risk level for heart disease for those that smoke). Stop using chewing tobacco to avoid oral cancers.
• Chronic, excess alcohol consumption is the major cause of liver cirrhosis in the U.S. Liver cirrhosis can cause internal hemorrhage, fluid accumulation in the abdomen, easy bleeding and bruising, muscle wasting, mental confusion, infections, and in advanced cases, coma, and kidney failure. Liver cirrhosis can lead to liver cancer.
• Alcohol accounts for 40%-50% of deaths from automobile accidents in the U.S.
• Alcohol use is a significant cause of injury and death from home accidents, drowning, and burns.
• Make good choices; do not ever use illegal intravenous drugs, cocaine, or other non-prescribed stimulant or depressive compounds.
• Venereal disease (sexually transmitted diseases or STDs)can be avoided many ways, including using condoms.
• Taking some risks is often a part of men's life that men enjoy (athletics, race car driving, wilderness hiking, mountain climbing, scuba diving, and many others) but there are foolish risks that should be avoided:
  • driving under the influence of alcohol or drugs,
  • driving while sleep-deprived,
  • reckless driving and speeding plus "road rage,"
  • driving while using cell phones, texting, or performing other tasks,
  • motorcycle (and bicycle) riding without helmets,
  • possession of firearms and guns without proper training and storage, and
  • smoking in bed are some examples.

Basic Problems That Cause Death and Disability in Men References

CDC.gov. Leading Causes of Death in Males United States, 2006.
<http://www.cdc.gov/men/lcod/index.htm>

CDC.gov. Pneumococcal Disease In-Short.
<http://www.cdc.gov/vaccines/vpd-vac/pneumo/in-short-both.htm>

CDC.gov. Life expectancy at birth, at 65 years of age, and at 75 years of age, by race and sex: United States, selected years 1900-2007.
<http://www.cdc.gov/nchs/data/hus/hus2009tables/Table024.pdf>

CDC.gov. Lung Cancer Risk Factors.
<http://www.cdc.gov/cancer/lung/basic_info/risk_factors.htm>

National Kidney Foundation.org. Chronic Kidney Disease (CKD).
<http://www.kidney.org/kidneydisease/ckd/index.cfm>

Prostate References

MedTerms.com. Prostate gland.
<http://www.medterms.com/script/main/art.asp?articlekey=5073>

MedscapeReference.com. Prostate Cancer.
<http://emedicine.medscape.com/article/1967731-overview>

MedicineNet.com. Benign Prostate Hyperplasia.
<https://www.medicinenet.com/benign_prostatic_hyperplasia/article.htm>

Cancer.gov. General Information About Prostate Cancer.
<http://www.cancer.gov/cancertopics/pdq/treatment/prostate/Patient/page1>

Circumcision References

MedicineNet.com. Circumcision the Surgical Procedure.
<https://www.medicinenet.com/circumcision_the_surgical_procedure/article.htm>

MedicineNet.com. Circumcision The Medical Pros and Cons.
<https://www.medicinenet.com/circumcision_the_medical_pros_and_cons/page5.htm>

Male Sexual Development References

MedicineNet.com. Puberty.
<https://www.medicinenet.com/puberty/article.htm>

Erectile Dysfunction References

MedscapeReference.com. Erectile Dysfunction.
<http://emedicine.medscape.com/article/444220-overview#a0101>

MedscapeReference.com. Physiology of Erectile Dysfunction.
<http://emedicine.medscape.com/article/1980364-overview>

MedscapeReference.com. History Taking in the Erectile Dysfunction Patient.
<http://emedicine.medscape.com/article/1980342-overview>

Low Testosterone References

MedicineNet.com. Low Testosterone (Low T)
<https://www.medicinenet.com/low_testosterone/article.htm>

WebMD.com. How Low Testosterone Can Affect Your Sex Drive.
<http://men.webmd.com/how-low-testosterone-can-affect-your-sex-drive>

National Institutes of Health. X-Plain Low Testosterone Reference Summary.
<http://www.nlm.nih.gov/medlineplus/tutorials/lowtestosterone/ur189102.pdf>