As a family doctor, I take care of a lot of men. Far too many have suffered from prostate and testicular cancer — and far too few are knowledgeable about the subjects. My hope is to change that, and to shift the focus of research to earlier detection and finding better treatments. So I have gone against the grain and
grown a special handlebar mustache this month (so fashionable!). But it’s all in the interest of men’s health awareness.
This November marks the third year that I’ve been involved in the “Movember” project. As you may know, Movember is an annual fundraising and awareness-raising campaign focused on men’s health, specifically prostate and testicular-cancer initiatives. Movember started as a tiny grassroots effort among a group of friends in Australia in 2003. By last fall, 4-million people had gotten involved, using the simple gesture of growing their facial hair to make very visible statement, prompting private and public conversation around the often-ignored issue of men’s health.
Compared with many other developed countries, the United States has a higher rate of men dying prematurely of preventable causes, such as heart disease, certain cancers and diabetes. Men’s health is a cause that I feel strongly about, and as a health-care provider, I have the opportunity to raise awareness and start conversations with people about these issues every day.
Prostate cancer is the second-most common type of cancer in the United States. One in seven American men will be diagnosed at some point in their lives, with about a third of cases in men under 65. About one in every 36 men will die from prostate cancer. Among the risk factors are aging (which we obviously can’t control) and family history, which is why it’s important to have these conversations and learn as much as you can about the health history of men in your family.
There are other risk factors we certainly can control: poor diet and lack of exercise. A 2012 Centers for Disease Control study found that only 2 percent of American men follow all the basic heart-health guidelines, such as eating a healthy diet and not smoking. These behaviors not only increase your risk of prostate cancer, but the other health ailments I mentioned earlier (heart disease and diabetes). If you’re not sure how healthy your diet actually is, talk to your primary-care provider, or ask about seeing a nutritionist who can provide one-on-one counseling and advice.
The good news for folks who are diagnosed with prostate cancer is that there are many treatment options and support resources that can help people through this difficult time and on toward a normal, healthy life. Many prostate cancers are slow-growing and may not need surgery or other radical treatment. Active surveillance (monitoring) is now a common treatment option for men with low-risk, low-grade prostate cancer.
Testicular cancer, while relatively rare, remains the most common form of cancer in men aged 18-35. It starts as an abnormal growth or tumor that develops in one or both testicles (usually just one), and commonly presents as a small, hard lump, with swelling or a change in the consistency of the testicle. Some men also experience a dull ache in the testicle or lower abdomen. Regardless of age, any man who discovers an abnormality should see a doctor immediately. Testicular cancer is highly treatable, and often curable, but like any form of cancer, the earlier it’s diagnosed, the better the outcome is likely to be.
While prostate and testicular cancers are the primary focuses of the official Movember campaign, there are other issues just as important to consider in any discussion of men’s health. For gay and bisexual men, understanding and working to reduce your risk for HIV and other sexually transmitted diseases is certainly one. Gay and bisexual men are more severely affected by HIV than any other group in the United States, and many gay and bisexual men with HIV are unaware they have it. Data collected by the National HIV Behavioral Surveillance System (NHBS) in 2011 revealed that age has a great deal to do with whether or not people are aware of their HIV status: Among HIV-positive individuals, 76 percent of those 40 and older were aware of their status, whereas only 49 percent of gay and bisexual men 18-24 were aware.
For sexually active gay and bisexual men, the most effective ways to prevent transmitting or becoming infected with HIV are to be on antiretroviral medications (to either treat or prevent infection) and to correctly use a condom every time they engage in anal sex. For HIV-negative individuals, the use of antiretrovirals is commonly referred to as PrEP (Pre-Exposure Prophylaxis), and sometimes by the pharmaceutical brand name Truvada. Your primary-care provider should be able to answer any questions about PrEP and whether it’s the right option for you (and if they can’t, be sure to find a provider who is knowledgeable about PrEP and how it works).
Sexually active gay and bisexual men should make HIV testing a regular habit, every three to six months. And since gay men are at increased risk for sexually transmitted infections such as syphilis, gonorrhea and chlamydia, we recommend that sexually active gay and bisexual men be tested at least annually for these infections as well.
In recent years, the team behind Movember has incorporated mental-health issues into their awareness campaign, recognizing the close relationship between physical and mental well-being. For a host of complex reasons, including lack of awareness, stigma and shame, mental-health problems in men often go undiagnosed. Some men may act out with risk-taking behavior (in the form of sexual activity, substance abuse or other behaviors) to numb or avoid the problems they face.
At Mazzoni Center, we are fortunate to have an in–house staff of highly experienced mental-health counselors, which makes referring patients to the resources they need, and following up on their care, that much easier. The reality for many gay and bisexual men around the country is that homophobia, stigma and discrimination can place them at risk for various physical and mental-health problems and affect whether they seek and are able to obtain competent, high-quality care. As a provider in an LGBT-focused practice, I’m working with my colleagues to change that every day.
My goal this month is not just to increase the understanding of men’s health issues, but to encourage men to act on that knowledge. So if you’re reading this, take some time to educate yourself on your family health history and personal risk factors for these conditions. Take the steps you can to improve your own health — whether that means finding a trusted primary-care provider, making an appointment you’ve been putting off, getting tested for HIV/STIs or talking with someone you trust about feelings of depression or anxiety.
While there are some things in health we can’t control, there are plenty of ways we can improve our well-being and outlook. Believing that your health matters is the first and most important step.