Men’s Health

Howard LeWine, M.D.

FDA warns about blood clot risk with testosterone products

“Replacing” a hormone the body normally makes when it is running low isn’t necessarily the safest thing to do. Women and their doctors learned this with estrogen after menopause. Now the FDA is sounding a warning that testosterone therapy can cause potentially dangerous blood clots in men. Such blood clots, called deep-vein thrombosis (DVT) and pulmonary embolism kill as many as 180,000 Americans each year, more than the number of people who die from breast, prostate, colon, and skin cancers combined. The new warning is not related to the FDA’s evaluation of possible links between testosterone therapy and stroke, heart attack, and death. Experts recommend testosterone therapy for men with a low testosterone level and one or more of the “classic” symptoms. For the rest? They get a talk-with-your-doctor recommendation. The warnings highlight that taking testosterone isn’t risk free. Combined with the lack of evidence about who really benefits, it means that the decision to start testosterone therapy is an individual one. A man must weigh the potential benefits against the potential increased risks of heart attack, stroke, and blood clots. If the balance tips in favor of moving forward, then trying testosterone is reasonable thing to do.

Daniel Pendick

Erectile dysfunction drugs and skin cancer — should you worry?

A study published in JAMA Internal Medicine this week found that men who used the erection-enhancing drug sildenafil (Viagra) were 84% more likely to develop melanoma, the most dangerous form of skin cancer, over a period of 10 years. That finding makes for an attention-grabbing headline. But it doesn’t tell the real story—that the study found an association (not cause and effect), that this hasn’t been seen in other studies of men, and that, even if it holds true, the absolute increase is small, from 4.3 cases of melanoma for every 1,000 men who didn’t take Viagra to 8.6 of every 1,000 men who took it. The take-home message is that it’s important to worry about melanoma—which is largely caused by getting too much sun—but not yet about Viagra and melanoma.

Patrick J. Skerrett

Selenium, vitamin E supplements increase prostate cancer risk

Taking supplements of selenium or vitamin E, once thought to prevent prostate cancer, seems to do just the opposite. A new report shows that men who take vitamin E or selenium are at higher risk for developing prostate cancer. Bottom line: men shouldn’t take selenium or vitamin E as a way to prevent prostate cancer, or anything else for that matter.

Patrick J. Skerrett

New study adds caution to testosterone therapy for “low T”

Mass marketing of testosterone therapy may have men eager to try this seemingly simple fix. But the latest science should have them scratching their heads and putting away the credit card—at least for now. A new study published in the online journal PLOS One shows an increase in the risk of having a heart attack in the months after starting testosterone therapy. The potential for danger was highest in older men. A report in the November 6, 2013, issue of JAMA showed that men who used testosterone therapy didn’t fare as well after artery-opening angioplasty as men who didn’t take testosterone. Neither was the type of study that can prove cause and effect. They can only show associations, or links. That means there’s no smoking gun here that testosterone therapy is harmful. But the studies do suggest caution. Given the uncertainly over the benefits and risks of testosterone therapy, what’s a man to do? Take a cautious approach, advises the Harvard Men’s Health Watch.

Daniel Pendick

Prostate cancer lives as it is born: slow-growing and benign or fast-growing and dangerous

In many men diagnosed with prostate cancer, the cancer cells grow so slowly that they never break free of the gland, spread to distant sites, and pose a serious risk to health and longevity. Instead of embarking on immediate treatment, a growing number of men choose active surveillance, in which doctors monitor low-risk cancers closely and consider treatment only when the disease appears to make threatening moves toward growing and spreading. A new Harvard study shows that the aggressiveness of prostate cancer at diagnosis remains stable over time for most men. If confirmed, then prompt treatment can be reserved for the cancers most likely to pose a threat, while men with slow-growing, benign prostate cancer—which is unlikely to cause problems in a man’s lifetime—can reasonably choose active surveillance.

Howard LeWine, M.D.

Fish oil: friend or foe?

News out of Seattle is sure to fuel confusion about fish oil supplements. A study by scientists at the Fred Hutchinson Cancer Research Center in Seattle linked eating a lot of oily fish or taking potent fish oil supplements to a 43% increased risk for prostate cancer overall, and a 71% increased risk for aggressive prostate cancer. Fish oil loaded with omega-3 fatty acids, which play important roles in health. Deficiencies in them have been linked to a variety of health problems, including cardiovascular disease, some cancers, mood disorders, arthritis, and more. But that doesn’t mean taking high doses translates to better health and disease prevention. Despite this one study, you should still consider eating fish and other seafood as a healthy strategy. Twice a week is a good goal.

Daniel Pendick

Healthy fats may fight early-stage prostate cancer

Each year, nearly a quarter of a million American men learn they have prostate cancer. Most are diagnosed with early-stage cancer that has not spread beyond the prostate gland. Traditional treatments include surgery, radiation therapy, and a “watch and wait” strategy called active surveillance. A new study published online this week in JAMA Internal Medicine indicates that diet may be an important add-on. The study, part of the ongoing Harvard-based Health Professionals Follow-up Study, suggests that eating more foods that deliver healthy vegetable oils can help fight the second leading cause of cancer death in men. Earlier studies have implicated the traditional Western diet, which is relatively high in red meat and other sources of animal fats, with a higher risk for developing prostate cancer in the first place, while eating more vegetable oils and vegetable protein may help prevent it.

Stephanie Watson

Recognizing the “unusual” signs of depression

People tend to think that the telltale sign of depression is sadness—a pervasive down, dragging feeling that won’t let up, day after day. But depression often manifests itself as something else entirely—like aches and pains or memory lapses. These “unusual” symptoms are actually quite common. They can mask depression—and delay an important diagnosis—especially in older people, who often display their depression in ways other than sadness. These include trouble sleeping, lack of energy, fatigue, trouble concentrating or remembering, loss of appetite, and aches and pains that don’t go away. If you have one or more of these symptoms that can’t be traced to an illness or ailment, a frank talk with a trusted doctor about the possibility of depression might be a good step forward.

Patrick J. Skerrett

High-dose vitamin C linked to kidney stones in men

File this under “if a little bit is good, a lot isn’t necessarily better:” taking high-dose vitamin C appears to double a man’s risk of developing painful kidney stones. In an article published yesterday in JAMA Internal Medicine, Swedish researchers detail a connection between kidney stone formation and vitamin C supplements among more than 23,000 Swedish men. Over an 11-year period, about 2% of the men developed kidney stones. Men who reported taking vitamin C supplements were twice as likely to have experienced the misery of kidney stones. Use of a standard multivitamin didn’t seem to up the risk. Many people believe that extra vitamin C can prevent colds, supercharge the immune system, detoxify the body, protect the heart, fight cancer, and more. To date, though, the evidence doesn’t support claims that extra vitamin C is helpful. If high-dose vitamin C doesn’t improve health, then any hazard from it, even a small one, is too much.

Harvey B. Simon, M.D.

Biking and sex—avoid the vicious cycle

Bicycling is a terrific way to get from one place to another. It’s also an excellent form of exercise. Some men and women avoid bicycling, though, because they worry that it may damage their reproductive organs and harm their sexual function. This mainly happens to people who cycle a lot. And it isn’t inevitable. One problem is the design of many bicycle seats, which put pressure on the perineum, a region of the body that runs from the anus to the sex organs. It contains the nerves and arteries that supply the penis in men and the clitoris and labia in women. You don’t have to give up biking to preserve your sexual function. Take a few simple precautions, like picking a wider seat, and shifting your position and taking breaks during long rides. These precautions will ensure that your passion for exercise doesn’t interfere with your passion in the bedroom.