Archive for the ‘men's health’ Category

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Weighing Your Options

Sunday, January 10th, 2010
Bacchus is no longer a role model...

Bacchus is no longer a role model...

What you weigh affects how your sperm play. And your fertility. Overweight men tend to have lower semen volumes, less sperm and more oddly shaped sperm. The same is also true for men who are too thin. So, along with the many other health hazards associated with obesity, add poor semen quality to the list.

Obesity in both sexes is known to be associated with heart disease, diabetes, hypertension, and metabolic syndrome among other nasty conditions that can shorten your life. Typically, obesity is measured with BMI or body mass index, which looks at weight in relation to height. Not a perfect measure, but reasonably accurate. Using this tool, the ideal BMI for men (and women) is considered to be 20-25. A Danish study of 1600 men showed that overweight men with a BMI > 25 had a 22% lower sperm concentration compared with healthy weight men. Interestingly, a BMI of <20 was also associated with poor semen quality. For optimal sperm production, then, it helps to be not too fat and not too thin.

But what about fertility? Is it also affected by obesity? Yup. Another recent study showed that for every 20-pound increase in a man’s weight, there is a 10% increase in the chance of infertility. And this remained true when other factors that might influence the results were accounted for, including obesity status of the women, the man’s age, cigarette smoking, alcohol intake, and solvent and pesticide exposure. In addition, obesity was associated with infertility in both older and younger men.

So what is it about weight that influences men’s sperm production and fertility? One theory is that sex hormone metabolism is altered by changes in weight. Sex hormones are the “fuel” for the engine (testis) to make sperm. Obesity increases fat stores and fat converts male hormones (testosterone) into female hormones (estrogens). Too much estrogen in men is bad for sperm production. Another theory posits that normal 2-degree difference in testis temperature relative to the body is lost with obesity, as excessive fat provides too much insulation and results in overheating. On the other hand, when a man is too thin, he may take on a “catabolic” metabolic state. With a body in “starvation mode,” fertility is not the first thing on its mind and sperm production and fertility suffer.

So, is the epidemic of obesity the reason why sperm counts have been falling in Western countries over the last 50 years? Maybe. But this problem is unique in that it is utterly and entirely preventable. Eat well and in moderation, sleep well and treat your body like a temple. You used to it for your own health; now do it for the health of your future family.

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Posted in male infertility, men's health, sexual health | 2 Comments »

Keeping the Family Jewels Shining

Saturday, January 2nd, 2010
Heirlooms for the species.

Heirlooms for the species.

As a living, breathing being on this good earth, we tend to take things for granted. The ability to have offspring can be one of them. That is, until the day that a serious medical condition like cancer rears it ugly head and puts childbearing at risk. In addition to the sterilizing effect of cancer treatments, the mad rush to treat the disease often marginalizes efforts to preserve fertility. Fire all the canons and check for collateral damage later.

Fertility preservation seeks to protect men, adolescents and children from a common, serious and impactful side effect of cancer treatment: infertility. The goal of fertility restoration is to empower patients who are cured and potentially infertile to bear children. These related fields have burgeoned recently because medical care is now shifting from curing cancer to improving the quality of life among survivors. And without a doubt, for many, fertility is a key quality of life issue at some point. Thankfully, exciting new methods of restoring fertility have already been developed and even newer technologies are under study.

Classic techniques for fertility preservation in men include gonadal shielding and sperm banking. Gonadal shielding uses lead-based devices to protect the testicles from being struck directly by sterilizing radiation treatment. Sperm banking is the process of freezing healthy sperm before cancer treatment begins for later use to conceive. But there is more. For patients who are too young to bank sperm, for those who have precious little time to bank sperm, or for those who have no ejaculated sperm to bank, testis sperm retrieval by biopsy (TESE) or needle aspiration (TESA) for banking is now possible before cancer treatment. In fact, in some cases of testis cancer, it is possible to remove only the cancerous nodule instead of the whole testis, or to freeze sperm from the testicle after it is surgically removed. These are now routine ways to preserve fertility in men.

Fertility restoration for men has also seen real advances lately. Sperm “mapping” is an innovation that I developed for men who survive cancer treatment but have no sperm in the ejaculate. It non-invasively and non-surgically deciphers whether there are small numbers of mature sperm in the testis, too few to get into the ejaculate, but usable nonetheless. In men who sustain nerve injury from cancer surgery and who are unable to ejaculate, a special medical instrument can produce an ejaculate for fertility purposes in a process termed electroejaculation. Techniques such as these are valuable tools to help men deemed “sterile” after cancer treatment to become fathers.

One of the most exciting areas of fertility restoration involves stem cell technology. Yes, the “promise” that we have all heard about stem cells curing disease will likely find its way into the fertility field as well. In pre-pubertal boys with cancer, ejaculated sperm is not present. Despite this, it may be possible to freeze the early stem cells from the testicles of boys before sterilizing treatment. After thawing, these “adult” stem cells may later be used to create sperm after further growth in a Petri dish or after transplantation back into the same individual. Also on the horizon is our ability to take skin cells from a sterile man, convert them into an embryonic-like stem cells and then “drive” these cells to become mature sperm in a dish–a true “artificial testicle.” So, with the belief that hope can cure misery, the world of science has taken fertility research from science fiction to reality. Not convinced? Stay tuned!

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Posted in male infertility, men's health, testis cancer | 4 Comments »

A Woman Among Women

Saturday, December 12th, 2009

A woman whose independence lasted longer than most countries.

A woman whose independence lasted longer than most countries.

Excuse my diversion from men’s health, but a very important woman in my life has just passed away. My last grandmother (known as Oma) lived a fiercely independent life for over 99 years, longer than most countries.


She brought our family to America from what is now Czechoslovakia in 1950, after 1000 years of farming the land and a generation of recent persecution. She brought a husband, a son (my father) and her daughter, each with a single suitcase, to Connecticut to start life anew. And we have prospered here since. A typical immigrant story.


She lived in her own home for 56 years, preparing every meal from scratch, and died there. A simple humble, life and a simple humble death. If you got to her house too late in the morning after a winter storm, you would find her clearing the snow from her driveway well into her 90’s. I only knew her as a gray-haired grandmother, but she was a constant and a compass to the entire family: our north, our south, our east, and our west. Rooted, decisive and opinionated, she was usually right, but never wrong.


She was a woman of the land, a gardener and a grower. In the words or Rilke, she knew the sound that small flowers make when they open in the morning.


The Germans play a card game call Setback, like Bridge. If you played on her team, you usually won. It was something about those million fine wrinkles that gave her the perfect poker face.


She leaves to 6 grandchildren and 8 great-grandchildren on both coasts a spirited legacy of wisdom, willfulness and fortitude that will survive for generations.

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Posted in men's health | 2 Comments »

Music to Our Ears

Sunday, November 8th, 2009

 

Miles and Microsurgery: it doesn't get any better.

Miles and Microsurgery: it doesn't get any better.

For as long we have pounded drums and plucked strings, listening to music has affected people’s sense of well-being, lifting and consoling their spirits, inducing calm and tranquility, or the trance of dance. I have listened to the sounds of classical jazz during microsurgery operations throughout my professional career as a surgeon. Coltrane, Miles, Evans, Djavan, Caetano Veloso and all the greats sweetly waft in the operating suite and overcome the din of devices within the room. Does music in the operating room lead to less wasted and more fluid surgical motion, and therefore faster procedures and better patient outcomes? Who knows. But as the background makes the painting, the music may make the maestro.

 

A recent study suggests that listening to music in surgery may also benefit patients. Maybe this is why oral surgeons and dentists offer earphones and video glasses to their patients. Anything is better than listening to the whine of the drill during a root canal. The effect of music on cortical, limbic or higher brain centers has previously been studied in patients undergoing brain surgery. These centers control feeling, thoughts and memory. In this recent research, a neurosurgeon studied the effect of different kinds of music on deeper portions of the brain, located in the thalamus. This region is responsible for sensation, motor function, consciousness, sleep and alertness. This study of music and Parkinson’s patients is quite different from what Oliver Sacks describes in his book Musicophilia, in which music therapy is used to increase the mobility and responsiveness of Parkinson’s patients.

According to this new study in awake patients undergoing surgery for Parkinson disease, music slowed the neuronal firings deep within the brain. As a consequence, patients became physically more relaxed, calm and even slept during their surgery. And pure melodic music appeared to be the most soothing to most patients.

So music in the operating room may make more sense than we think. In addition to helping the surgeon with his surgery, it may reduce patient anxiety. This in turn, could shorten operative times, reduce the need for anesthetic medication, and lead to quicker patient recovery and shorter hospital stays. In a word, more music, less pills.

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Posted in men's health, sexual health | 4 Comments »

The Bumpy Lives of Teenagers

Monday, October 26th, 2009
Teenagers: how about both high-tops and high health?

Teenagers: how about both high-tops and high health?

How seriously do you take the medical symptoms of your teenager? Aren’t the aches and pains, and the bumps and bruises the stuff of the young and the restless? Besides, kids are not supposed to get cancer and other bad things. That’s not fair play by God or Darwin. In any case, a new study reports that teens and young adults are frustrated when others don’t take their medical complaints seriously.

Presented at a European cancer society meeting, the study interviewed a cadre of 16 to 24 year olds who were diagnosed with cancer 2 to 4 months prior. Remarkably, the time between the onset of symptoms and the formal diagnosis of cancer ranged from 8 weeks to 11 years! In addition, the young patients claimed that they were told that it “was normal to feel tired,” or that their symptoms were “due to menstrual problems, fluid on the knee, irritable bowel syndrome, excess weight or lack of exercise” when in fact they had cancer.

Why is it difficult to know whether there are really important medical issues regarding their health when teenagers make that claim? First of all, in many cases, it may not be possible to figure things out any sooner than we do. Medicine is a tremendously complex field. We must deal with diseases like tuberculosis, nicknamed the “great imitator,” as it causes symptoms that can mimic hundreds of other diseases, cancer among them. Next, because it occurs infrequently, cancers are usually low on the list of possible diagnoses for youngsters. Zebras just aren’t that common outside of Africa. Furthermore, kids don’t have that many “risk factors” that alert the medical system to the possibility of cancer. They haven’t smoked cigarettes for 40 years, enough to have every doctor constantly sniffing around them for the 3 or 4 cancers that smoking can cause. In short, kids are different beasts than adults and this makes finding serious diagnoses a little more difficult.

Finally, kids and young adults (especially young men) might not be used to being sick and may not know when their symptoms are medically important. Take for example my study of men with benign cysts of the scrotum, a diagnosis that needs to be evaluated to exclude testis cancer. I found that although most affected men know that there is a mass growing in the scrotum, they do not seek medical attention until it becomes, on average, the size of a normal testicle and causes discomfort. Regardless of why, this is a terrible problem in and of itself.

As medical providers, we really need to better educate teenagers and men in health care prevention and help them to develop a medical “instinct” about their bodies that brings them to care sooner rather than later. It shouldn’t have to hurt or to be life threatening for a man to seek medical attention. And they shouldn’t have to worry that they won’t be taken seriously when they do seek care. Facing issues similar to those of teens seeking care, the Men’s Health movement is equally plagued with the problem of  trying to best serve men’s needs within a relatively unresponsive system. My tasks are clear…

Posted in men's health | 1 Comment »

Autumn in California

Monday, August 31st, 2009
Ending a sunset surf session in Santa Cruz

Ending a sunset surf session in Santa Cruz

Autumn is approaching, and San Francisco is sweltering in an Indian summer.  In the city where I live and practice my profession, September is our most California-like month. The air goes still and briny as the breeze wanes, and drapes itself heavily on the roofs and hills. The clouds dance with delight in a painterly way. Our Junes and Julys are gloomy, to many a tourist’s surprise, as if the fog has gathered from afar, and migrated here for the summer. As the tourists begin to leave, the city glows with a diffuse, cottony, almost silky light. Swimsuits replace wetsuits as the sea is warm before the winter chill, and the beaches are dotted with surfers. That’s fall in my City by the Bay.

Autumn in San Francisco is when balmy nights lead to blissful, restful sleep, and to a focus regained. As school starts, the sweaters and scarves emerge. Productivity surges, along with traffic, as minds return from all corners of the earth to think everyday thoughts, and perform everyday rituals. Budgets tighten as memories of Bora Bora fade gracefully like an ancient memory. Gone are the lazy afternoons, the nectarines and peaches left uneaten, and late afternoon naps that fuel the evening flurry. The change in countenance of the city’s many faces replaces the colorful foliage of the New England autumn.

Why not remember to play when the wind sweeps all the warmth away? Why not take a moment to breath, to just stand and watch the golden light as the days fail sooner, as the birds steer gracefully south? Perhaps playing is exactly what is needed as autumn sets in. Instead of filling the mind’s nooks with obligations, meetings, health care, politics, PTA, financials and homework, take a brief moment to play and delight, like a child with a bright new toy. A perfect time to take play a little more seriously.

Autumn, with its tremendous force of change, its leaves going up in flame by slow degrees, its rush of wind and its earth fertile with pumpkins, is ripe for a little lightness of being. We should taste the last of the blackberries, play a little football, tell stories by campfire, toast to friendship and find other ways to keep summer alive. The waves will soon rise powerfully in the sea near my home, replacing the dead surf of summer. I’ll be swimming into them, negotiating a ride when I can, and letting them carry me back to shore.

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Posted in men's health | 5 Comments »

The Ailing Male Pill

Thursday, August 6th, 2009
What shape will the male pill take?

What shape will the male pill take?

A male birth control pill certainly sounds like a good idea. But after 25 years and millions of dollars of research, there’s still no pill. We put a man on the moon faster than we’ve invented a male pill.

The question isn’t really whether it can be done, because it can. The production of sperm is linked to testosterone levels in the body. When testosterone levels are too high, the body stops producing sperm. Witness the testis shrinking (atrophy) that occurs with anabolic steroid use. Such pills have been tested, and are successful. One problem, though, is that the ability of hormone-based male pills to work perfectly (which they really need to do) varies with a man’s ethnicity. Works for some, but not all. This issue alone may prove fatal for the male hormone pill.

Besides this, there is a litany of concerns regarding the physical side effects of a hormone-based male pill. Immediate concerns have been a big issue in past trials- adult acne, weight gain, moodiness and the like. But what about possible long term effects? The female contraceptive pill has been linked with higher rates of heart disease and breast and liver cancer in women. Although not completely comforting, at least we know these issues in women. But little to no research has addressed similar issues with long term “pill” use in men.

Despite all of this, there is still a healthy interest in a male birth control pill. Studies have shown that men in committed relationships are more interested than single men in a pill– no surprise here. Single men are interested in using condoms for the added bonus of protection against STDs. A male birth control pill might also be a better contraceptive alternative for men who want more control over family planning than that offered by vasectomy. That said, there is still the eternal question of whether or not a pill would sell successfully– would women, in the end, trust their partners to be consistent and compliant in taking the pill? The answer to this question varies from couple to couple, but to get a sense of things, ask yourself how often you fail to take something as simple and uneventful as a daily multivitamin to get an idea of the magnitude of this problem.

There simply aren’t enough options for male contraception on the market today. The main ones are abstinence, rhythm method, withdrawal, condoms, and vasectomy. Given this lineup, there is certainly room for more, and more reliable, contraceptives for men. One thing seems reasonable clear: given the safety and effectiveness of vasectomy, and fact that daily compliance is not needed to keep it effective, anything new has to be this good or better. How about a truly reversible vasectomy? Or a long term, implantable hormonal device? In the end, these are likely to become tasty alternatives to a male pill.

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Posted in men's health | 1 Comment »

Breakfast: The Best Fuel For the Engine

Monday, June 29th, 2009

Run clean, run hard, run fast...with breakfast

Run clean, run hard, run fast...with breakfast

Most Americans wake up, rub the sleep out of their eyes, clean up and rush out the door. Breakfast is an afterthought. But soon after that, stomachs start to growl for some food energy. But by now it’s gotten a bit too late, and no oatmeal or egg will suffice. It’s time for doughnuts, or candy at the receptionist’s desk, or the potato chips in the vending machine.

There’s a good reason for this behavior. It’s called blood sugar. And blood sugar is at its lowest upon waking. Hypoglycemia is associated with slowness, dullness, sleepiness, crankiness, and it sparks feelings of hunger. For sugar. And once we have it, we feel sated and comfortable again, not to mention more awake, because sugar gives us a burst of adrenaline. Tasks are done with a flourish. Until about 10 o’clock in the morning. Then there’s another crash.

The high levels of sugar in our blood cause the pancreas to secrete insulin. With the help of insulin, sugar moves from the blood stream into the body’s cells to do work. This lowers blood sugar levels again, and the body goes back to feeling irritable and hungry. And so we make a midmorning beeline for the Jelly Bellies to receive another jolt, another spike in our blood sugar, and the vicious cycle continues. In the end, this cycle causes weight gain and fatigue, and affects overall and sexual health.

One thing can help with this, and that’s something called “breakfast.” Statistic after statistic tells us how important breakfast is, especially one that contains whole grains and protein. The Imperial College of London found that people who ate breakfast were far less likely to give in to fatty foods later in the day. Another study showed that drinking fat-free milk at breakfast helped people to feel fuller, more satisfied and to eat fewer calories at lunch. Yet another study reported that people who ate two eggs for breakfast lost 65% more weight and felt more energetic than people who ate bagels for breakfast. And the list goes on. Suffice it to say, starting the day with a good breakfast should help you to actually lose weight and improve your overall health and sex life. It is by far the most important meal of the day.

Eating a proper breakfast, before you get too hungry, makes it easier to resist sugar cravings and helps you make healthier choices at lunch and dinner. Stick to whole foods and grains as much as possible, and include protein in your breakfast. A well designed breakfast takes longer to digest and will cause less of a spike in your blood sugar. Apples or bananas paired with almond or peanut butter, for instance, could pass for breakfast. Whole grain toast with nut butter; yogurt and fruit with a handful of nuts; even a protein shake can make the grade. Opt out of the French toast and go for the scrambled eggs. Another trick is to make breakfast more convenient than a trip to Starbucks. Get it into your system before a croissant does. Trust me, the rest of the day will be a cakewalk.

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Posted in men's health | 1 Comment »

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