Men's health

A three-article symposium

Symposium coordinator

John H. MacIndoe, MD
Director, Department of Endocrinology
HealthPartners Medical Group and Clinics
Adjunct Professor of Medicine
University of Minnesota Medical School
Minneapolis

VOL 114 / NO 4 / OCTOBER 2003 / POSTGRADUATE MEDICINE

INTRODUCTION TO THE SYMPOSIUM. By John H. MacIndoe, MD
ERECTILE DYSFUNCTION AND VASCULAR DISEASE: What is the connection? By Luciano Kolodny, MD
PROSTATE CANCER INTERVENTION: Involving the patient in early detection and treatment. By Timothy J. Wilt, MD, MPH, Melissa R. Partin, PhD
THE CHALLENGES OF TESTOSTERONE DEFICIENCY: Uncovering the problem, evaluating the role of therapy. By John H. MacIndoe, MD

In general, men die earlier than women in the United States. Although the life expectancy of both sexes increased significantly during the 20th century, seemingly greater advances in women's health have widened the gender gap in survival from about 1 year in the 1920s to 5 years today (1).

I find it useful to consider men's health issues in two separate contexts. The first includes anatomic or physiologic issues that are unique to men (ie, related to male urogenital structure and function). The second encompasses issues that relate to and largely result from the characteristic attitudes and behaviors of men about their own health. For example, men take more health risks than women and make far fewer visits to healthcare professionals throughout most of their lives. Thus, the major challenges to primary care physicians are getting men into the office and dealing with their healthcare needs effectively once they are there.

This symposium focuses on three men's health issues commonly encountered in the primary care office: erectile dysfunction, prostate cancer screening, and testosterone deficiency.

Any upturn in men's visits to their primary care physician in recent years is largely due to increasing concerns about erectile dysfunction and patient expectations for drugs to treat it. This phenomenon often provides physicians with an unexpected opportunity to establish rapport with new patients and evaluate them for healthcare risks in addition to their presenting complaints.

In the first article, Dr Luciano Kolodny reviews the erectile process and the epidemiologic factors of erectile dysfunction. He discusses the growing evidence linking many cases of this disorder to the presence of underlying vascular disease--the single leading cause of death in men. This article is a reminder to look carefully for treatable coronary artery disease risks in these patients.

Next, Drs Timothy J. Wilt and Melissa R. Partin offer a thought-provoking discussion that challenges widely held concepts about office-based prostate cancer screening procedures. Clearly, a routine prostate-specific antigen test and a digital rectal exam may not always be in the best interests of our patients.

Lastly, I tackle an increasingly controversial and divisive topic in men's health: testosterone deficiency. Androgen deficiency in adult men is both common and underrecognized. I discuss guidelines developed by an expert panel of the Endocrine Society for the diagnosis and treatment of this disorder. The article also summarizes the debate about the benefits and risks of testosterone replacement therapy.

We hope that you find these presentations both enlightening and useful in your clinical practice.

Reference

Cowley G. The biggest prize of all. Newsweek Jun 16, 2003:47

RETURN TO OCTOBER 2003 TABLE OF CONTENTS

[an error occurred while processing this directive]

Please send technical questions related to the Web site to Ann Harste