Oftentimes we referre to a journal in our house and we are referred to series of articles on women health issues including screening for various cancers, treatment for osteoporosis and hormone replacement therapy.
Though it was due to the increased awareness and tretamenr guidelines and scientific research that people with diseases like breast carcinoma and cervical carcinoma are leading long and productive lives.
Also associated is the treatment of menopausal side effects including mental rehabilitaion.
Do we have a similar male parallel : The answer is YES
Andropause (i.e depleting male hormonal levels after a climacteric) is debatable but care of many health issues and rising incidence of prostate cancer need proactive diagnosis and treatment.
Male health is a increasingly accepted paradigm which includes male sexual, urological, uro oncological, mental and other geriatric health issues.
Screening
Screening is subjecting normal healthy population to tests of proven significance that diagnose a potentially serious disease mostly a cancer.
The parallel in males is prostate cancer.
The test needed is Blood level of Prostate Specific Antigen or PSA.
The recommended population is any healthy male more than 50 years without any family history pf prostate cancer or more than 45 years with first degree male relative suffering from cancer prostate.
Though the conventional value has been less than 4 ng/ml, the values are now calibrated to the increasing age and in that regards the increasing volumes of benign prosttaic tissue through the years.
What if PSA > 4 ng/ml
Repeat value confirms the increase along with Urine analysis and Clinical examination including digital rectal examination to rule out overt prostatic cancer disease.
The recommendation today is to subject the patient to an image guided biopsy mostly done by Ultrasoung guidance to span the prostate completely.
In event of dodgy rise, non conformatory clinical findings Magnetic Resonance Imaging od prostate which measure and evaluates many technical factors( Multiparametric or mp) is done. MRI characterises and suspected prostatic growth or lesion in 5 categories ( PIRAD score) of which 4 and 5 are highly suspicious of cancer.
In such a case MRI TRUS ( Magnetic Resonance Imaging _ Trans Rectal Ultrasound) fusion biopsy id recommended which accurately targets the suspected lesion
Biopsy
Biopsy is any tissue that is taken for microscopic evaluation for diagnosis.
This can decide benign or apparently normal tissue from cancerous tissue.
The prostatic biopsy divides the tissue into grade or Gleason score ranging from Gleason score 6 to Gleason 10 with increasing aggresiveness of disease.
Treatment
The treatment of disease is based upon the stage i.e the spread of the disease and rest of factors such as Gleason score. Twentyfirst century health care provides established robotic surgery programmes, Image guided Radiation therapy.
Hypogonadism
Or reduced male sex hormone levels in human body.
The natural Testosterone levels in male humans reduce by 1% annually after a certain age.
The main symptoms are reduced sexual desire and other sexual functional parameters, reduced capacity to exercise, reduced functional muscle mass, osteoporosis and weight gain or fat gain.
The symptoms are also a manifestation of life style disorders and are strongly related to cardiac risk
The levels need to be measured when all other causes are ruled out. The normal value of Serum Testosterone vary widely and generally considered normal above a level of 220 pg/ml
The reduction can also be owing to certain diseases such as liver disease, hypothyroidism, steroid therapy , intake of anti seizure medications and obesity
The treatment can vary from daily intake of Testosterone in form of Testosterone capsules, Injectible forms of Testosterone and gel application.
The oral or capsule form is occasionally associated with liver peliosis hepatis opr blood filled cavities in liver but the latest undecanoate form escapes liver metabolism and this complication is rare.
Injectible prepration can come in various depot forms of different durations ranging from 3 months to 6 months to annual.
These provide sustained replacement but may have an ON OFF effect during the immediate period before and after replacement.
There is also gel based therapy which is easy to apply gives near natural levels of Testosterone replacement but is not suitable to hyperhydrotic or sweaty people or humid climates
Erectile dysfunction
Natural erection is a sequential process that onvolves neurological stimulus , arousal at the brain level and a very complex interaction of human nerves and blood vessels that become turgid to cause penile erection.
So a problem at any level can cause deficient erection.
Natural potency may face decline in ageing males, this is guided as much by psychology and natural role of senesence. This also involves partners drive, social and domestic reasons. The apparent lack of libido or partners involvement or stress may precipitate less than satisfactory performance and hence undue anxiety.
It is important to reason the cause. It is also very necessary to have a monogamous healthy relationship with regular coital attempts. It is very common for a couple to drift apart in relationship and longing and then blame the result to impotence or senesence
Another important factor is health. Sexual activity is effort involved activity and any distress in this area is now known to be a harbinger of other vascular diseases such as heart diseases. This is espacially so for Diabetic men.
An overall good exercise tolerance and good overall health avoids issues and makes options for potency enhance ment wider and mostly non invasive.
Another potential factor may be neurological or due to involvemnet of nerves in an ageing males. This may be due to Diabetes, Spinal problems, other demyeleinating diseases, neurovascular problems as recovering stroke.
The treatment is mostly disease and problem guided.
An overall healthy relationship, minimal stress and good health which takes into account osteoporosis, Vit D supplementation and Vit B12 levels will help assess the cause and treatment much faster and efficient.
The treatment is multipronged depending upon the cause.
Weight reduction and better diabetes control may be the first advice one may give that is precipitating erectile dysfunction.
On treatment side, one must distinguish low libido and Testosterone levels from difficulty in coitus due to pure erectile failure or maintainance
As discussed before hypogonadism or poor Testosterone can be easily treated with injectiblee Testosterone and oral therapy
The optons involving treatment of erectile failure include Phosphodiesterase inhibitors or PDE 5 inhibitors that potentiate the neurovascular release of chemicals necessary for erection
These drugs are the mainstay of treatment of impotence in any males
Now these drugs can be given in graduated doses also.
Next in line is self admnistered vacuum therapy or injections or a combination of these both.
A vacuum pump comes with a one time puchase assembly of pump, soft rubber rings and training on usage.
A vacuum device may also be combioned with PDE 5 inhibitor therapy.
Self admnistered injection therapy involves a single, or a combination of two or three drugs which can be used on as needed basis