11
June
2008
erectile dysfunction is more recognized probably because of Viagra and the other ED medicines – and their huge ad campaigns. In 1994 the Massachusetts Male Aging Study found male sexual dysfunction begins 40 years of age and worsens each decade of life. 40 year old men: 40% some level of dysfunction and 10% had declining libido. Sexual dysfunction includes ED, decreased libido, less satisfaction with sex or orgasm, or abnormal ejaculation. ED worsens by age 50. One study showed 47% of men 55 or older had ED.
Risk Factors: smoking, obesity, depression, neurological disorders, diabetes, high blood pressure, high cholesterol, cardiovascular disease, alcohol, drugs, and some meds. Exercise decreases the risk of ED. In obese men, ED improves with exercise and weight loss.
drjohnhong 
Men issues, Sex 
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5
December
2007
Depression in Men: for some reason it seems women are the focus of depression and not men. True 8-10% of women have major depression vs. 3-5% of men. But for men, they are less likely to discuss it or have it treated. It is thought depression affects our country so much: $83 billion a year due to functional disability and mortality. Lifetime prevalence of depression is thought to be 17.9% in white and 10.4% in blacks. Peaks in the ages 30-39. Now this is for major depression and doesn’t include minor depression or dysthymia.
Depressed older men in particular who aren’t married are more likely to commit suicide than women (probably 4x higher). Depression is a strong risk factor for all-cause mortality, and probably plays a role in illness.
Major depression: 5 of 9 symptoms for 2 weeks for the majority of each day. 2 of the symptoms must include depressed mood or anhedonia (loss of interest or pleasure). Change in sleep (sleep more or less), loss of energy, change in weight or appetite, change in psychomotor activity (usually less agile and less physically active). Poor concentration, suicidal thoughts or thinking about death, poor self esteem (feeling worthless or guilty)
Minor depression and dysthymic disorder have symptoms described in major depression but don’t fully meet criteria.
What is depressed mood? Some people say it is a feeling of sadness. Others just feel “blah”. Irritability and short-temper can be a sign of depressed mood. With anhedonia, a person doesn’t want to go out and do the things normally enjoyed. It just isn’t as fun or meaningful.
Early morning awakening can occur with depression, so about 4 hours after falling asleep, they are up for the rest of the night. If there is anxiety, falling asleep can take a long time. Some people “hibernate” and will sleep all day.
Anorexia can occur or the opposite: eating too much.
Bipolar disorder needs to be ruled out because treatment is different. Also other psychiatric and medical conditions need to be checked because they can affects a person’s mood.
Treatment: talk to your doctor. Psychotherapy and antidepressants are very effective.
drjohnhong Men issues, Psych Comments (0) » |
12
July
2007
Osteoporosis occurs in more than 2 million American men. By 2025 it is predicted the increase in bone fractures in men will be a greater rate than women. Osteoporosis is a bone disorder of decreased bone strength which increases the risk of fractures. The bone density and quality go decrease leading to demineralization, poor architecture, increased bone turnover, and damaged accumulation. On DEXA (bone mineral density test), osteoporosis is defined as more than a 2.5% standard deviation under the mean (a.k.a T score)
So you probably think osteoporosis is only a problem for women. Overall it has been true because boys probably develop stronger bones during adolescence and puberty compared to girls. Androgens (like testosterone) are known to increase periosteal bone formation (the covering of the bone) while estrogen inhibits this. Also male muscles and weight bearing exercising might contribute to stronger bones. But as we all get older, we all lose bone mass and architecture, women more than men.
The main fractures due to osteoporosis are the vertebrae (spine), hip, and wrist. Less common are upper arm, ribs, collar bone, shoulder gone, sternum, and pelvis. After the age of 50, lower BMD (bone mineral density) is associated with increased fractures. Boys being boys, fractures are more common in boys and young men, but then dips below that of women by age 50.
Fractures lag 10 years behind that of women after age of 50. It is estimated 1/7 men after 50 years age will have an osteoporotic fracture. Unlike women, men are 50% less likely to have a vertebral fracture on x-ray or a hip fracture; and 33% less likely to have a clinical vertebral fracture (that means pain). So 2/3 of men with vertebral fracture don’t know it until diagnosed by a physician.
50% of reasons for male osteoporosis are: lack of testosterone, steroids, and alcohol abuse. In Otherwise other causes include high thyroid, high parathyroid, multiple myeloma, high urine excretion of calcium, low vitamin D – such as in malabsorption syndromes, smoking, anticonvulsants, COPD, kidney stones.
Even though estrogen mentioned above inhibits the “coating” of bones, it is vital in bone resorption – meaning reforming the matrix of the bone which occurs all the time to keep the bone fresh and strong. So young men who have CYP12 aromatase gene or estrogen receptor defects, they might be more prone to osteoporosis. Kyphosis and losing height can be a sign of osteoporosis because the vertebral bodies shrink.
Elder men can develop problems with calcium and vitamin D in the GI system and kidney processing. Also elder men who experience a hip or vertebral fracture have a high mortality rate than women. Why? Not sure. But at 6mo after a hip fracture for a man, there is a 9x increased risk of death compared to someone without a fracture. The cost of male osteoporotic fractures was $2.5 billion in 1995 in the US. It is expected to be 310% more in 2025.
Sign of kyphosis: can’t stand straight and put the occiput against the wall. Also the lowest of the ribs to the upper part of the hip in the line of the armpit is less than 2 fingerbreadths in width.
Treatment includes calcium 500mg three times a day (which can also be taken in by dairy products), 1000IU of Vitamin D a day. But if someone has calcium kidney stones that might not be possible. If man has andropause, testosterone replacement can be considered. Alendronate and Risedronate are bisphosphonates to help the bone density increase. Weight bearing exercises including walking. Also life style modifications like alcohol moderation (<25g a day) and not smoking.
drjohnhong Men issues, Bones & Muscles Comments (0) » |
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