A friend of mine says she has to practically force her husband to accept her massages for his recurring headaches. Another friend found acupuncture quite helpful for her painful shoulder but couldn’t get her boyfriend to try it for a strained back muscle. Men admit, and their doctors concur, that they tend to deflect awareness and action when it comes to physical problems. A fear about getting bad news may be to blame, or lack of time, or plain old stubbornness, may keep them from the doctor’s office. But the societal message that he should be self-sufficient and miraculously durable is especially effective at numbing a man’s response to his own physical issues.
Dr. Sam Schikowitz, a naturopathic doctor and acupuncturist in New Paltz, says he’s noticed that the biggest insult for men is to feel defeated, whereas the biggest problem for women is feeling isolated. “So for men to go and get health care often feels like an admission of weakness—that they can’t handle it themselves—where for women, getting healthcare is a nonisolation behavior.” Another deterrent, says Schikowitz, is the tendency for a doctor to tell people what to do, with little room for discussion. “Historically, physicians have been so authoritarian that it feels to a man like a reprimand, like an authority figure imposing a power trip.”
Fortunately, a shift is afoot to empower men to view caring for their health as a powerful action. Scott Williams is vice president for professional relations and public policy at the Men’s Health Network (MHN), a national organization founded in 1992 by healthcare professionals to help men take ownership of their health. “We hear men say, ‘I don’t want to know what’s wrong,’” he says. “But we’ve seen that a motivational and empowerment message works to get men to take responsibility for their health. We encourage men to be a role model and mentor by making annual health visits, and moving past the macho man attitude that you’ve always got to suck it up. What’s macho is taking care of yourself and being there in the long haul to take care of the family. We say that we are building healthy families one man at a time.”
The Men’s Health Network
The Men’s Health Network discovered there were no widespread educational materials for men’s health, no national movements or programs, no advocacy, and no office of men’s health within the US Department of Health and Human Services as there is for women and minorities. “We found that we could not address policy and advocacy without reaching out to where men are,” Williams explains. “So we go out to employers, sports franchises, free clinics—reaching men and their families where they live, work, play, and pray.” With about 50 corporate employers and numerous other partners, MHN is making tremendous headway in improving the lives of men and those around them. The MHN website is packed with information, links, and reminders of events you might not have heard of, like Men’s Health Awareness Week in June each year, incorporating Father’s Day, and National Men’s Health Month (June).
Among the MHN’s free materials available online (www.blueprintformenshealth.com), is the Blueprint for Men’s Health, a comprehensive guide to living a healthy lifestyle, and Your Head, An Owner’s Manual, covering mental health issues. Both publications enlighten men and help them know what to ask of health providers. MHN also links men with free or low-cost health clinics (www.menshealthmonth.org) and prescription assistance programs, such as Partnership for Prescription Assistance (www.pparx.org) and Together Rx (www.togetherrxaccess.com). “There is really some fantastic help that we want to make people aware of,” says Williams.
Clearing the Acceptance Hurdle
Health information and advocacy won’t go far unless men notice they need it. Accepting that something about yourself is not the way you want it—whether physical, emotional, psychological, or other—is a hurdle that trips up many men. Dr. Kenneth Bock, an author and holistic physician at Rhinebeck Health Center, emphasizes the importance of acceptance as the vital first step toward greater health and happiness. “Men tend to judge their success compared to others, but they need to accept where they are from their own point of view. Acceptance is saying, ‘This is where I am in life, and this is what I really feel.’ It’s not easy. But on a deep level, that’s where healing starts. And it’s my job as a healer to figure out where somebody is, and to accept that without my own agenda, and then take them on a dance back to health—whether it starts at a waltz, or a tango, or a boogie. You’re not going to have someone who’s only ready for a waltz do a quick Latin dance.” (The last chapter in Bock’s first book, The Road to Immunity, describes this more fully.)
Schikowitz offers this positive spin on needing help: “The way I like to couch it is they are consulting an expert, or developing their own team of advisors who will help them maximize health and function.” To build this team, be selective so you get what’s best for who you are. “You can read about doctors’ education on their websites, and get a feel for their approach. Then ask for 15-minute interviews to find someone who you can talk to about sensitive health issues.” A good person to start with is a holistic practitioner who is willing and interested in taking the time to learn about you, and can then help you find a specialist if necessary.
Above and Below the Belt
As for the health issues a man may need to accept, those having to do with testosterone, reproductive organs, and sexuality tend to get the most publicity. “Traditionally, men’s health has been focused on what we call ‘below the belt’—erectile dysfunction, the prostate, incontinence,” says Williams. “But the Men’s Health Network is trying to bring it above the belt as well. We’ve really focused on the leading causes of death for men, and on mental health issues.”
In the US, heart disease and cancer (predominantly lung, prostate, and colorectal) are ranked as first and second causes of death among men. Together, they account for about half of male deaths annually, followed by accidents, then stroke. Smoking and being overweight put men at higher risk for heart disease and lung cancer, and for those a nutritious diet, regular exercise, and kicking the smoking habit are well established as protective. But few correlates of prostate cancer risk are established. An enlarged prostate (benign prostatic hyperplasia, or BPH), manifests in about half of men as they age, but BPH doesn’t progress to cancer predictably, though it can cause urinary blockage or incontinence.
As a precaution for prostate cancer, the American Urological Association advises men to have PSA (prostate-specific antigen) measured in a blood sample at age 40 to establish their individual baseline, and to be screened regularly after age 50, because elevations in PSA can mean prostate cancer is developing. However, the preface to an online roundtable discussion in June 2009 at the New England Journal of Medicine website (www.nejm.org/perspective-roundtable/screening-for-prostate-cancer) states: “In two large randomized trials, researchers examined the effect of annual prostate-specific antigen (PSA) screening on the rate of death from prostate cancer and found that it was small and was offset by false positive diagnoses. Since screening may have benefits in catching cancers early but may also carry risks including that of unnecessary treatment, professional societies have split on the question of whether to recommend regular PSA screening.”
Life in the Viagra Era
Thanks to Viagra, erectile dysfunction (ED) has entered popular banter, for better or worse—better being that it’s getting the issue in the open, worse being that it may be scaring millions of men and their partners unnecessarily. ED, or the inability to maintain a firm erection long enough for intromission, can happen occasionally to anyone, since sexual arousal depends on multiple interdependent variables such as hormones, emotions, thoughts, and the physical health of nerves, muscles, blood vessels, and the heart. Viagra, first prescribed for men with unrelenting ED, causes blood vessels in the penis to dilate for hours, so that blood accumulates and sustains an erection of unnaturally long duration. Nowadays, men with concerns that they are staying less firm less often use ED drugs to mimic youthful vigor.
But older men, Bock says, “can still have a beautiful, intimate relationship and be sexually fulfilled without a four-hour erection from Viagra.” And while he acknowledges that some men, or their partners, will find those drugs useful, a man may be doing that instead of dealing with feelings he’s having about his life and growing older. “There is a natural change physically in life, and a 55-year-old isn’t going to be able to do what a 25-year-old can do. If you’re being realistic and optimistic, and you accept the aging process gracefully, it’s not a negative, but a positive.” By communicating well with a partner, you can continue a vibrant, sexually satisfying relationship without drugs.
The Big T
The steroid hormone testosterone drives sexual maturity and health of reproductive organs in men, including the prostate, and influences general health and behavior. Beginning in midlife, testosterone levels fall a few percent a year, though nothing like the more precipitous decline of estrogen in women during menopause. Some men may especially notice changes attributable to lowering testosterone, or have a rapid fall. “Testosterone levels are typically only checked when there are red flags related to it,” says Schikowitz, “like lowered sexual function, reduced immunity, or low energy levels.” He notes that he sees a dramatic drop in testosterone (“andropause”) mostly in those with AIDS.
Hormone augmentation is an option for men who want to relieve symptoms, but treating the underlying causes of low testosterone, such as chronic stress, can help in most cases. Testosterone shares a metabolic pathway with adrenal steroids, so stress (which activates the adrenal) can alter testosterone levels. It’s important to check for normal balance among adrenal and thyroid hormones as well, which dietary modifications and supplements can often correct. “Sometimes we do use hormones, says Bock, “but you have to be aware of the yin and yang—the balance of risks and benefits.”
Bock has created nutritional supplements that support prostate health and hormone balance, and may recommend age-appropriate nutritional or herbal supplements and detoxification, depending on an individual’s case. Schikowitz, too, recommends herbs that benefit the prostate and regulate hormone metabolism, such as zinc and saw palmetto. While ginseng is popular as an androgen-enhancing supplement, Schikowitz says he prefers other related plants.
Food and Fitness
For anybody, eating well and getting exercise are foundational to good health, including reproductive health and vigor. Without reciting all the details, excess pounds should be gradually shed with good nutrition, not a fad diet, combined with regular, enjoyable physical activities.
Schikowitz’s holistic approach includes three dietary principles. The first is good blood sugar regulation, which includes being careful of higher glycemic index and glycemic load foods, and to have protein, fat, and fiber when you are eating those foods. The second is reducing toxicity of your foods by staying away from a lot of factory-farmed animal products and heavily sprayed crops. The third principle is to increase the vitality of foods by choosing the freshest, and locally grown.
As for exercise, Chad Tyrrell, owner of Ignite Fitness in New Paltz and a longtime trainer and athlete, has some surprising counsel. “When I meet clients for the first time, what I spend a lot of time talking about is not changing their bodies, but changing their expectations. Often they have point A, where they are now, and point B, where they want to be, but they have no understanding of the cost of getting to point B—the time commitment, the intensity of effort involved—and I often have to bring them to reality. You can’t exercise twice a week for a couple hours and get six-pack abs and get big muscularly. If you exercise at a low level regularly, you’ll reap almost the maximum health benefits, but that is very different from making radical changes to your body.”
Younger men tend to go for intense body-transforming workouts, says Tyrrell, but older people have different goals. “It’s one of the reasons I love working with an older clientele. They’re not so concerned with getting in shape for the beach in three months. I get a surprising number of men who say they would just like to be fit. They want to be able to function in their daily lives well and comfortably, and we can have an amazing impact on that.”
The biggest challenge is getting people to live up to their exercise commitments. “If it was just about teaching people what exercises to do and how often, that would be easy,” he muses. “We’d be cranking out perfect bodies left and right. But the reality is that what holds people back from moving from point A to B is getting themselves here. They’ve got the kids, and houses, and jobs, and vacations—these are the speed bumps and holes in the road on the map from A to B. So the first step is to get into the gym, or find something you enjoy that places some physical demands on your body, and do it. And the second step is working hard. Consistency and intensity—those are the two things you need to fixate on.”
And by all means, find a form of exercise, or several, that you enjoy. If you like it, you’re going to do it longer, do it harder, and do it more often. Even as a trainer, Tyrrell won’t be telling you it’s easy to keep it up. “It takes rolling out of bed on days you don’t want to do it. I struggle with it myself. But the rewards are amazing and real.”
RESOURCES
Dr. Sam Schikowitz
www.wholefamilymedicine.com
Men’s Health Network
www.menshealthnetwork.org
Dr. Kenneth Bock
www.rhinebeckhealth.com
Chad Tyrrell/Ignite Fitness
www.ignite-fitness.com
This article appears in August 2009.
