Physician's Perspective

Special Section on Men’s Health

Steven R. Gambert, MD, AGSF, MACP Editor-in-Chief, Clinical Geriatrics

Although men are living longer than ever before and the life expectancy gap between men and women has declined, there remain many major factors that must be considered when evaluating the older male patient and when considering preventive healthcare for younger individuals. Geriatrics currently remains a discipline that focuses most commonly on the health issues of older women, who represent the majority of our elderly population. Whether this trend will continue or the number of older men will more closely approximate that of older women remains speculative, but men have indeed begun to make a surge on our population charts and the time appears ripe for male-focused research initiatives.

Men have their own set of issues that must be considered. They more often have occupational- and/or recreational-related risk factors, and these can result in problems many years later with the lungs, joints, brain, and other organ systems. Trauma-induced dementia, arthritis, asbestosis, and other occupational-related lung diseases are just a few of these health problems. A good history can often guide us and help us identify those persons who are most at risk or suggest a specific diagnosis. Men tend to smoke and drink more than women, and they more frequently indulge in risky and violent behaviors. Men traditionally don’t seek medical help as often as women, especially if they live alone and do not have the support or perhaps the  “nudging” from a significant other. Older men who have lost their wives have the highest rate of new alcoholism and suicide, with depression being the primary cause.

Many major health conditions affect men to a great degree, such as colon cancer and heart disease. These may be positively impacted by primary and secondary prevention. Clearly, early diagnosis and initiating treatment are key to maintaining function throughout life. There are also health conditions that only affect men, such as prostate cancer and low testosterone, each with their own consequences on physical and psychological functioning.

This issue of Clinical Geriatrics features two articles focusing on two important areas in men’s health: prostate cancer and male menopause. We are also including a helpful patient handout on tips for good health in later life for older men. Debate continues as to how best to screen for prostate cancer and when to perform prostate-specific antibody testing. While the term menopause has also been used to describe the changes in testosterone that accompany aging, normal age effects must be distinguished from true hypogonadism, and benefits of treatment must be weighed against the potential side effects of testosterone therapy. Additional research continues to be needed and guidelines established. That said, the older man is quite heterogeneous in nature and what may be appropriate for one individual may have excessive unwanted consequences for another. Do the hormonal changes that accompany older age provide some “protective” effect or are they simply by-products of end-organ failure and in need of reversal to that of youthful times? There remain many questions and future challenges as we face an ever-increasing number of healthier older men.

I hope that you enjoy the articles included in this issue and that they  stimulate you to read and to question, and, hopefully, enable you to better meet the needs of your older male patients.

Dr. Gambert is Professor of Medicine and Associate Chair for Clinical Program Development, Co-Director, Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Director, Geriatric Medicine, University of Maryland Medical Center and R Adams Cowley Shock Trauma Center, and Professor of Medicine, Division of Gerontology and Geriatric Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.

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