Turek On Men's Health » BPH

Your Hair or Your Hormones

Paul Turek, MD — Mon, 30 Jan 2012 16:00:25 +0000

Be nice to have Superman's hair…but at what price? (Courtesy; MovieBlog.com)

It’s the perfect drug for 40 million men in America who are going bald. Take it once a day to keep the hair on your head and shrink the prostate, which also commonly bothers men as they age. It’s a pill that has been used by at least 2 million reproductive age men over the last decade. But is it too good to be true?

The Best Hair Pill Yet

This magic pill is finasteride (trade names; Propecia, Proscar, Avodart). It represents a class of drug called the 5-alpha reductase inhibitors. These pills act as enzyme blockers: they prevent the male hormone testosterone from converting to its metabolite dihydrotestosterone (DHT). Although testosterone is responsible for a lot of our “male” features, DHT is more potent than testosterone for scalp hair and our internal reproductive organs (prostate, seminal vesicle). These drugs work by lowering DHT production and protect the gloriously youthful hair on our heads and the enviable ability to write your name in the snow while urinating.

And these drugs work well. More effective than topical or “rub in” medications, finasteride is great for what’s called “male pattern” hair loss which is due to a receding hairline or balding on the top of the head. In essence, it slows the growth phase of hair in these areas. However, it doesn’t treat hair loss on the sides or temple area.

Finasteride, Sex and Male Fertility

Although it may keep you looking like Clark Kent, many male infertility specialists, including myself, have concerns about finasteride. First, there is a 10% chance of sexual side effects that include erectile and ejaculatory dysfunction and lowering of sex drive. These issues can be subtle while on the pill but become very obvious when men stop it; many of my patients have noted a sexual “curtain being lifted” or “coming alive” after discontinuing the pill.

Second, there is an even more profound concern about finasteride among specialists: male infertility. Before it received FDA approval, the drug trials showed that it lowered ejaculate volume but did not change sperm count or motility on semen analysis testing (actual human fertility studies are not routinely required by the FDA). Now that it has been on the market for 10 years, though, impressive declines in semen quality have been observed and published with finasteride by many of us. This effect is not subtle either, as patients with complete sterility (azoospermia) have had recovery of their sperm counts after stopping finasteride!

There are several clues that this effect on fertility was possible. The rabbit studies done for FDA approval of the drug actually showed this effect. At 3 months, there was no effect on rabbit fertility. But, when followed longer, rabbits showed significant decreases in natural fertility. In addition, while I was writing a recent reproductive physiology chapter for Campbell-Walsh Urology, our leading urology textbook, I researched at what levels the 5-alpha reductase enzyme is found in the human testis and epididymis. Lo and behold, there are gobs of this enzyme in these important organs for sperm production and maturation, implying that the blocking agent finasteride would have an effect. So now what do we do?

At this point, controlled clinical trials are needed to prove this effect on fertility. For the time being, current thinking is that finasteride may not dramatically change sperm production in healthy men, but can impair semen quality in infertile men. Typically, the effects of medications on male infertility are reversible. So, to be proactive men should consider stopping the pill at least 6 months prior to trying to conceive. And, have confidence that she loves you just as much for other reasons. As Telly Savalas once said: “We’re all born bald, baby!”

How is a Medical Visit Like A Ball Game?

Paul Turek, MD — Mon, 23 Jan 2012 16:00:30 +0000

The ultimate male bonding experience in 2012

The world came to San Francisco this weekend. The 49ers hosted the NFC Championship footba ll game at Candlestick Park and it was a day for ages. Friends clamored for tickets, taking seats at any price. Some bought tickets like they were playing the stock market: buy sooner if it rains, later if it doesn’t, or the day before, but not on game day. Not only tailgating, burgers and beer, but stories and tales all flowed freely. A perfect male-bonding experience.

The Culture of Men

As any ball game will convey, clearly the culture of men is fundamentally different from that of women. During my previous life as a decorated academic, my medical office was situated squarely in the middle of a women’s health center, complete with fake impressionist paintings on pink walls, flowers in cute vases and bathrooms with tampon dispensers. Magazines like “Shape,” “Woman’s World” and “O-The Oprah Magazine” covered the waiting room coffee tables. Simply not the best place for male DNA to visit, say nothing of being comfortable there.

The Turek Clinic as Man Cave

Having close to an allergic reaction to this, when I ventured out to create a men’s health clinic, I tried to replicate the ball game experience in a medical office. Here are the essential elements that I considered:

Street parking. For some reason, men prefer it; don’t ask me why.
Convenience. Ball games start on time and (generally) finish on time. Medical visits should also be on time. No long lines, no waiting.
One chance. There are no second chances in playoffs games. When helping men, do as much done as possible in a single office visit. Use follow-up phone appointments after that.
Personality. Sports teams have players and, as everyone knows, players have personality. Men want to know their doctor’s personality. It helps them to develop trust. Sure, a “power wall” of diplomas is nice, but how about hanging a balsa wood surf board in the lobby along with a stylized picture of a late 60s Maserati Ghibli. Men need to trust that their doctor is human and understands them.
Space. Ball games are often outdoors, often in chest-beating, cold weather. Bringing that outdoor feeling inside is important. Floor to ceiling windows facing the San Francisco Bay is perfect, with plenty of room to lounge around on Wi-Fi. And cover the coffee table with men’s magazines, a whole slew of them. Oh, also make sure that there’s ESPN or surfing movies on a large flat screen TV.
The Staff. Here’s where a medical office can beat a ticket taker at a ball game. Imagine being greeted first thing in the morning by a smiling face and an offer of coffee or tea. The essence of The Turek Clinic approach.
Long visits. Ball games take time. Medical office visits should too. Most men are nervous for the first several minutes of any doctor’s visit. Honestly, what can you expect to learn from a patient during that time? The book is just opening. This is precisely why I never understood the average, 12-minute doctor’s visit. Men need time to open up and relax. Not only that, I am convinced that listening to men is the secret to curing their ills.

So is a visit to The Turek Clinic the same as attending a NFC playoff game? Probably not. But it is about as comfortable as men will ever be in a doctor’s office. And they will remember this comfort and trust in the doctor. And if they remember, instead of quietly suffering through another problem in the future, they will reach out and call again. And that is the key to great care for men.

The Prostate: All You Ever Wanted to Know

Paul Turek, MD — Mon, 01 Jun 2009 18:20:39 +0000

One famous fountain: the mannequin pis in Belgium

As a man ages, he is more likely to look at travel experiences as a series of restroom stops. He might begin navigating his way to the grocery store, the gas station or to a friend’s house for poker based on whether or not there’s a restroom conveniently located nearby. This may sound like the end of the world, but it’s not. It may be the end of long road trips. It is also the start of the realization that, similar to needing reading glasses, he is not immortal but actually a simple human being.

The prostate is a gland the size of a walnut at the base of the penis. It wraps around the urethra (the tube that urine comes from). A prostate is essential for normal male fertility, as it is responsible for making fluid that protects and nourishes sperm. Everything is shipshape until a man gets older, when two problems can arise. One is benign prostatic hypertrophy (BPH), which is a fancy way of saying enlargement of the prostate. This occurs in about half of all men in their sixties. For reasons still unclear, the prostate continues to grow as a man gets older. It is usually symptomatic – men have urinary urgency, dribbling, weak stream and may have to get up at night to urinate. The other problem is prostate cancer. Most commonly, cancer has no symptoms.

BPH is not preventable, but prostate cancer may be. Following a heart-healthy, low-fat, low carbohydrate diet is key to the prevention strategy, as are exercise, weight management and stress reduction. Concentrate on fruits and vegetables, which are high in antioxidants that protect the cells of your body from becoming cancerous. Soy and green tea may also protect the prostate. Sugar intake should also be limited, as it often ends up stored in your body as fat, and obesity is linked to prostate cancer.

That said it may surprise you to know that prostate cancer doesn’t always kill. Cancer is no one’s friend, but prostate cancer is not as deadly as lung cancer, colon cancer or breast cancer. It is much more slow-growing than these other cancers, doubling in size every 2-3 years instead of every 4-6 months. As such, a man is eight to ten times more likely to die of heart disease than prostate cancer. Even more interesting, some believe that prostate cancer is really a disease of age in men, as the likelihood of having small amounts of cancer in the prostate goes up with age. That means that about 80% of 90 year old men will have prostate cancer, and may never know it. They will likely die of unrelated causes. It also means that there are many prostate cancers occurring in men that are “clinically insignificant,” a rare term in cancer medicine. So, many prostate “cancers” actually don’t act as such.

Although diseases of the prostate are rarely lethal, they can affect your quality of life…and your road trips. Men over forty should start to have the prostate checked regularly, although most men would rather spend quality time with the dentist’s drill than go in for that exam. Blood tests for a substance called PSA, can also help detect cancer. The symptoms of prostatic enlargement can treated with pills; if these don’t work, various, safe but indescribable procedures can remove the symptom-causing prostatic tissue. Some of the FDA approved pills to treat BPH also prevent prostate cancer. Now that’s a pill that men might want to swallow. So, for all kinds of reasons, don’t ignore the prostate. Try to attend to it before it disrupts the flow of your daily life.

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