The Men's Health Guide
The five most important topics on men's health like no one has told you before.
Welcome to The Feel Good Life, a newsletter about health, prevention, empathy, and hope. I’m Dr. Mariana and I’ll be your guide and teacher through your health and wellbeing journey. Happy to have you here!
My dear men, this is for you.
My dear women, this is for the men in your life.
So much has been said and taught about women’s health, but I can’t ignore the fact and nagging observation within me that asks how much of men’s health are we truly teaching. Are we really reaching men and showing them what they need to observe and learn? Because it goes far beyond just the gym, the muscles and the prostate. I’ve wondered how much men know about their own health for real.
In this newsletter I’m speaking about what I consider the five main key points that every man should be highly aware of regarding their own body and health.
These are:
The Prostate
Breast Health
Hormones
Sexuality
Emotions
I want to be an advocate for men’s health. I believe most of these topics are ones that somehow skim through the average health talks, and we truly need to put a giant light on them and channel it into the mainstream. Whether you identify as a man, a woman or other, this is for you and for all the men in your life. Let’s make health together, let’s taking care of each other by learning the basics.
This is why I have created this guide. A long and comprehensive health guide, so that you get all the awareness and understanding to help you take care of yourself. Please, feel free to take notes and re-visit this post as many times as you need to. It’s that important.
Ready?
Note and pen in hand? Good! Let’s go.
The Men’s Health Guide
1. The Prostate
The prostate is a small walnut-sized organ present in men and people assigned male at birth (AMAB), and it’s in charge of producing seminal fluid (also known as semen) which helps transport the spermatozoids after release.
The prostate is considered a gland. (Glands are organs that make and put out hormones that do a specific job in your body.)
It is located right under the bladder and it surrounds a portion of the tube that moves urine from the bladder to the outside - this tube is called urethra. When this gland is inflamed, it somehow chokes the urethra, making it difficult for pee to come out. When this happens, men might notice a weak urine stream or a difficulty to get started when there’s an urge to pee. Something like this:
All this matters because the reasons why a prostate can provoke these symptoms could be as mild as a Benign Prostate Hyperplasia (non-malignant growth), a prostate infection or as complex and dangerous as prostate cancer.
Which is why it’s of vital importance to get checked regularly as part of a preventative health routine, before any symptoms can appear.
Just like women need regular gynaecology checkups (ideally every year), men also need regular checkups of their unique organs to make sure everything is not only working correctly but also far from developing more severe disease.
What Does a Regular Prostate Checkup Entails?
This is the part where most men cringe at - understandably! A regular check up consists mainly of two things:
A blood test to measure the PSA (Prostate Specific Antigen). A normal PSA should be below 4 ng/ml in the lab results. Anything above that number should be checked by your doctor. The specialist doctor in charge of assessing everything prostate is called an Urologist.
The DRE (Digital Rectal Exam) - the most DREaded one (medical joke! :P). Yes, the one where doctors gently stick a finger through men’s anus to reach the prostate by hand in order to feel its size and texture. A healthy prostate must feel soft and smooth. If we notice certain rugosity or irregularity on its surface without it being painful, then most likely something important could be happening.
Why not just do the blood test alone?
Well, the reason is that both tests give us different parameters on how the prostate is working and behaving. The blood test tells us about its function, while the rectal test tells us about its structure and anatomy. There could be a problem with its anatomy while still functioning well or vice versa, and in both cases we could find a sign of malign disease.
Every country has their own protocol, so it’s important that you check with your local healthcare practitioner. Since I became a practising doctor in Spain more than a decade ago, I quickly noticed how their protocols wouldn’t include the rectal exam pretty much ever, only until a PSA blood test is altered. In my home country Costa Rica, both tests are mandatory for every men/AMAB after the age of 50.
So as you can see, it can be different in your country or region. The intention here is to give you the baseline knowledge so that you can know what to look for and what to ask your doctor.
How’s this image for a clear visual understanding?
When To Start Doing Prostate Checkups?
On overage:
50 years old is the maximum age where men should start taking this regular (yearly) check up.
In case of having direct family history with prostate issues, then 45 years old is the recommended age to get started.
And whenever higher risk is present due to personal or further family prostate disease history, then 40 years old is the recommended age.
So, if you’re over 40 and have never been guided about this or if you’ve been noticing any pee/sperm abnormalities, please ask your doctor.
Awareness and early detection are everything! In case further screenings are required, your doctor will also be able to guide you. And whenever in doubt, always ask your healthcare provider. Clearing doubts is the #1 peace of mind.
2. Breast Health
This is probably one of the most unspoken topics regarding men’s health, which makes it even more vital.
Did you know breast cancer is found in men too? In the U.S.A alone, 1 case out of every 100 is breast cancer in men. Men’s breast have the same anatomical structures just like women, and even though they don't develop in the same way, they could be affected by the same medical issues. We must not disregard this fact.
In order to be one step ahead of this, breast examination should be done. Whether by yourself and/or by your doctor, this simple tool has saved so many from the crippling claws of cancer pain and its complications.
What To Look For In a Breast Examination? (Also For Women)
Common signs related to breast issues are widely known, and it’s vital to learn how to recognise them. The main ones are:
Swelling
Lumps (Whether in breasts or armpits. It’s key to always check the armpits!)
Discharge through the nipple (mainly pus, milk or blood)
Pulling or inverted nipple
Skin irregularities (orange skin sign)
Redness or irritation
The easiest way to visualise it is this well known and self-explanatory image, so please observe and notice the different possibilities. Makes it difficult to forget!
These symptoms are not a synonym of cancer but are most definitely signs that require a medical check up by your doctor regardless.
Now this image below from the American Cancer Society shows where the most common lumps come from and where they can usually show up. Pay attention to lumps in the armpits and on top of the clavicle/collarbone. Yes, anything related to breasts both in men and women could travel all the way up there!
How To Do a Breast Self-Examination?
Here’s a comprehensive and short video on what to look for and how to self-examine men’s breasts. I searched for plenty of online tutorials and this one in particular feels like the best one, the one I’d give my patients - hence why I’m sharing it here with you of course! ;)
Breast Cancer Risk Factors
Like in every situation regarding health, there are risk factors. Whether genetic or lifestyle-related, we must be aware on how it all plays a role in how our body works throughout life. So here’s a small list for you to keep track and awareness regarding your breast health.
Family History: The more cases of cancer within your family, the higher the risk. It’s important to know a bit of your family’s health history if possible so that you can attend to any situation or suspicions as soon as possible.
Genetic Mutations: Genetics are a high risk factor when there’s known presence of certain diseases and genetic issues within the family. Regarding breast cancer, the mutations called BRCA 1 and BRCA 2 are the most common ones and they don’t differentiate much between men and women. So if you don’t know about this or have never asked within your family members, it’s always a good time to do some research. Not to create panic but simply to create awareness. I’ll never stop addressing this “A” word enough!
Personal Cancer History: If you’ve been a cancer patient before, it goes without saying that controls must be there. Even after you’ve been given the green lights after several years of medical check ups without any signs, it’s only important that you keep a regular habit to check yourself and stay aware of your body.
Hormone Therapy: Since breast cancer has a high deal to do with hormones, anything related to them, whether it’s a biological condition, a pharmacological treatment or any other situation, it’s vital to keep a good checkup and always notify your doctor about any treatments used in the past or currently in the present.
Radiation Therapy: Any exposure to radiation in the chest area means a higher risk for developing breast cancer. Always notify your doctor.
Liver Diseases: Liver diseases such as cirrhosis can affect sex hormones production, causing lower levels of androgens (masculine hormone) and higher levels of estrogen (feminine hormone). And as we’ve learned, sex hormones imbalances make it higher risk for breast cancer.
Obesity: The reason why this is a risk factor is because fat cells in your body have the ability to transform male hormones to female hormones so once again, the imbalance becomes high risk. Isn’t it incredible how the body works? Yes, fat is not only there to annoy you on the outside. Fat is important and like everything else, it’s good in balanced quantities.
Other medical conditions such as Klinefelter Syndrome (genetic condition where men have an extra X chromosome) are mentioned among other risk factors for breast cancer in men. Even though is rare, it needs to be considered due to the hormonal affection it can provoke.
Ok! Long but juicy post so far. How are you holding? As I said, this is a full guide but I trust it will be helpful in the long run.
So, let’s continue.
3. Hormones
Did you know there is something called “Andropause”?
It is basically the male menopause, as many may call it. Surprise! Yes, there is such a thing.
“Andras” in Greek means human male and “pause” in Greek a cessation; so literally “andropause” is defined as a syndrome associated with a decrease in sexual satisfaction or a decline in a feeling of general well-being with low levels of testosterone in older man.”
As read in this article by the Indian Journal of Endocrinology and Metabolism.
However, we will not use the term male menopause because in reality it can be misleading, since hormonal processes happen differently in each gender due to a vast number of reasons.
The simple reality is that men have hormones too, and as natural and biological as it is, these hormones can fluctuate through life. Every single person will have a different experience of such fluctuations.
The organs in charge of producing hormones in the body are called endocrine glands, and there are many of them. For example: the pancreas, the thyroid, the parathyroids, the hypothalamus, the pituitary, ovaries and testicles, just to mention a few. And they all have quite different and varied functions within the body, from growth, to metabolism, to reproduction, to sleep control and even mood balance. I’d confidently say that the body is basically ran by hormones! If hormones are in good balance, everything else will just work and flow.
Hormonal alterations in men could mean many different things, alerting about health problems such as thyroiditis, prostate issues, diabetes, obesity and ageing, just to mention a few common ones.
So for men just like for women, hormones will also run the show. It’s only natural then for men to feel symptoms if something hormonal goes out of whack, regardless of what’s producing it.
In the case of andropause, which I’ll focus on for men’s sake and since it’s not widely spoken about, men can definitely show some symptoms - sometimes in their late 40s or early 50s. Symptoms like: mood swings, irritability, depression, lack of enthusiasm, lowered libido (sex drive), insomnia, difficulty focusing, heat waves, unusual fat distribution and a possible loss of muscle mass. All these are symptoms men could show during hormonal changes related to age.
This isn’ a given for all men but having this awareness is important because they could struggle with this too and most people wouldn’t know. And they definitely deserve the same help and coverage like women have.
So, regardless of what can be causing a hormonal imbalance in men, it is vital to know how it shows up, what it could look like in terms of symptoms so that you can always check in case you feel any of these as mentioned in this section.
Awareness. Always awareness.
4. Sexuality
Now, sexuality is indeed a giant taboo in our society. And I believe in men’s case there has been a long, deep and unhealthy connection between sexuality and power, making many men feel like their sense of masculinity goes 100% tied with how sexually strong they are. And in reality, there is so much more to men’s sexual health than just sex.
The main topics regarding men’s sexual health are usually these:
Erectile Dysfunction & Premature Ejaculation
Infertility
Vasectomy
STDs (Sexually Transmitted Diseases)
Emotional State
(Feel free to comment or message me to add more according to your experience. I’d love your feedback.)
In my consultation day in and day out, I see how men are so prone and keen to take pills to make them go erect in 20 minutes or less. Most of them have never read or even considered the side effects of such pills when used longterm. Considering that different forms of erectile dysfunction can be as common as 40% on men over 40 years of age, and up to 70% in later decades of life, it’s still one of the most feared and most uncomfortable topics to bring up during consultation. And this needs to be addressed.
So can be infertility. Approximately between 20-30% of infertility cases around the world are due to men, which is not a small amount. This detailed study explains a unique view on male infertility around the globe. No one should ever feel the unsurmountable guilt that infertility carries and yet, it’s forever heavy and present.
It’s important to know how all these issues can be highly influenced by external factors, ranging from lifestyle habits such as alcohol, tobacco or drug intake, to medical conditions, therapeutic and pharmacological treatments, genetics and more. So many things can affect the way in which the male sexual/reproductive system works, affecting not just one area of their life but many.
On birth control, vasectomy (the surgical procedure for male sterilisation or permanent contraception) is among the best and safest options, considering it could be reversed. Yet it also still remains a taboo in most societies and parts of the world.
Same goes for STD or STI (sexually transmitted diseases/infections). It is known, according to recent WHO data, that ‘more than 30 different bacteria, viruses and parasites are known to be transmitted through sexual contact’, and in many cases even through pregnancy and birth.
Among the most common and dangerous STDs are Human Papillomavirus, HIV and Syphilis, causing severe issues like cervical cancer, infertility or even fatal neonatal complications.
It is indeed of high responsibility from both men and women to prevent STDs by practicing safe sex. Which brings the biggest issue with safe sex, and this is: SEX EDUCATION.
As biological as sexuality can be, the desire to feel good and be seen as virile, strong and manly goes deep into a men’s psyche.
I can only imagine the inner pressure men might feel when not being able to talk or ask freely about something while worrying in silence. Maybe it’s my female nature feeling all this, or maybe I’m wrong and men just process it differently…but it’s definitely not what I see in medical consultation.
There’s indeed so much to dig and learn about this, but most of all to share for men to become more aware of their own nature. I have found good links while researching for this guide, so I want to leave the most resourceful ones in my opinion for you to search further. Men’s sexuality is vast too and we must be able to go through the entirety of it as best as we can.
Men and Sexuality
Men’s Sexual Health: 5 Things You Need to Know
Keeping Men’s Hormones in Balance
Male Sexuality and Emotional Needs
Understanding Men’s Sexuality
5. Emotions
Now let me go a bit deeper, it’s time. And it’s safe to do so. Shall we?
For as long as I’ve known in my career (and in personal life), there has been a deep and impending need to address more of men’s health. Endless times I’ve felt this need to be an advocate for such silent screaming void in society where a giant blackhole swallows it all inadvertently.
The shadow of a male-ruled society has been living with us all for as long as we know, becoming a war against genders and between genders. We’ve all been touched or affected by this, one way or another and for generations, which has caused a wound as deep as those silent screams. And to come out of this situation is no easy task, yet not impossible either.
As deep as I am, I have felt that the need to try and understand what has happened in this worldly wounded situation is becoming urgent. It makes me want to go further, into trying to understand the male wound. Not the physical but the emotional.
Might be utopian, but I truly believe that as humans and as a society we need to shift our thinking. And in this case it would mean to shift the way we think of men and their whole “macho” behaviour into trying to understand why they became that in the first place. It’s difficult to even bring this up for many, I know, but I am choosing to take this safe leap here for the sake of a greater good.
Of course this comes without making a general statement on every single men on Planet Earth. Instead, it’s more of an observation on the humanity of this all and how we can evolve into our society’s best version.
The resistance I have observed in male patients when addressing the prostate topic is quite an eye-opening reaction. Why do men fear this talk so much? Is it only the fact that a physical trespassing could happen? Or is it a trespassing beyond the ego? And why?
Men have been taught for generations to be the providers, the strong asset of the family unit, the one in charge, the one in control. I can only wonder what kind of deep unconscious pressure they had to embrace, making them believe that shedding tears or showing emotions is a sign of weakness - when we are all only human and naturally full of emotions.
So yes, it is no wonder to me that men are a most wounded part of our society, hence why we’ve all somehow seen or suffered what we have as a whole. Which is to me a far more important reason to look into this…into them; to let them know they are allowed to feel, to express, to show, to fail, to enjoy, to smile too.
All these aspects have made me consider deeply on how we need to be advocates for men’s health too. As women we are protecting each other and it’s both wonderful and amazing to see. But protecting ourselves from what? From patriarchal thinking? So then let’s go even deeper and let’s not only protect ourselves as a group by fighting and avoiding men, but let’s also turn towards them and see how we can help them heal themselves through the deepest wound of all. Might take generations to accomplish this that I’m sensing, but we must start somewhere, just like it happened when it all first began.
This is all my personal views and opinions, and I only hope I can get to open a door, a window or even a small slit through which we can all start a process of change towards the one thing the world and humans need the most: BALANCE.
And based on this all, is why I decided to create this men’s health guide. Because health is not only about the body but also the mind and the emotions. And emotions are not a matter of gender but a matter of being human.
May this open up not only your awareness but also your minds and hearts. Whatever your life experiences have been, I truly pray and trust that some of these words (and this guide) will help you reach a next level of health and healing.
We certainly all deserve to feel more, better and greater.
Final Notes on Men’s Health
As you can gather by now, there is so much to men’s health that needs to be addressed. The male body is as complex and fascinating.
These topics need to become a more open conversation so that men can address their own issues, whether with doctors, partners, friends or therapists of any kind. And we must start by creating a safe place for men to talk whenever what they feel or notice something unusual within the realm of their own bodies. To me, this safe space begins with the awareness of what’s normal and what isn’t. From this point onwards and with the awareness in hand, people can take action.
Thank you for reading, it’s important. If you find this useful or if you know of someone who could benefit from this information, please pass it along and help spread the word. Remember: prevention is better than cure!
And if you have any doubts after reading this post, please just reach me out at thefeelgoodlife@substack.com and I’d be more than happy to help you clear those doubts and guide you as best as I can.
Hugs,
Dr. Mariana
Image Credits: Google Images, Pixabay, Walnut Prostate Cancer Campaign, Prostate Health Education Network, The Conversation