Men’s Health

In light of the recent launch of the Stanford Center for Health Research on Women and Sex Differences in Medicine (WSDM), I couldn’t help but take notice of a new paper on the topic. In an article in the journal Clinical Chemistry and Laboratory Medicine, Italian researchers have highlighted the “crucial differences between men and women” in five areas: cardiovascular disease, cancer, liver diseases, osteoporosis, and pharmacology.

Arecent journal release provides some examples of the differences:

Typically perceived as a male illness, cardiovascular disease often displays markedly different symptoms among women. While a constricted chest and pain that radiates through the left arm are standard signs of heart attack in men, in women the usual symptoms are nausea and lower abdominal pain. Although heart attacks in women are more severe and complicated, when complaining of these non-specific symptoms women often do not receive the necessary examination procedures, such as an ECG , enzyme diagnostic tests or coronary angiography.

Colon cancer is the second most common form of cancer among men and women. However, women suffer this illness at a later stage in life. Furthermore, colon tumors typically have a different location in women, and they respond better to specific chemical treatments. Gender also has an impact on the patient’s responsiveness to chemotherapy administered to treat cancer, such as colon, lung, or skin cancer. In this way, gender impacts the course of the disease and the patient’s chances for survival.

…While typically viewed as a female disease because of the much higher rate of female patients, osteoporosis also strikes men. The study contends that osteoporosis is too often overlooked in male patients, and it documents a higher mortality rate among men suffering bone fractures.

The authors conclude that “more far-reaching clinical investigations of gender differences are needed in order to eliminate fundamental inequalities between men and women in the treatment of disease.”

Previously: Exploring sex differences in the brain

An article in the San Francisco Chronicle today discusses the need to include more females in scientific research and mentions efforts being taken at Stanford to fix the problem. Erin Allday writes:

…[T]here have been tremendous advances in studying women’s health issues and including women in drug trials and clinical studies. Most of those changes followed a 1993 mandate by the National Institutes of Health that women be included in such studies.

But when it comes to basic science - studying the molecular mechanics of diseases in cells and tissues and in mice and rats - almost all of the work is on subjects with the male XY chromosome pairing.

Stanford, at least, is aiming to dig into that problem with the creation of a new center focused on sex and gender in health. The Stanford Center for Health Research on Women and Sex Differences in Medicine officially opens Wednesday with a conference on sex, gender and the brain, at which [Louann Brizendine], now a UCSF psychiatrist who has written two books on the male and female brain, is speaking.

“For just about everything in medical science, we’re still very male-focused,” said Marcia Stefanick, an obstetrics and gynecology professor at Stanford who is co-director of the new center. “Our basic understanding is missing a key ingredient, and that is the sex difference.”

Previously: Exploring sex differences in the brain and Women underrepresented in heart studies

There’s a thought-provoking feature story in the latest issue of Scientific American about the growing body of scientific evidence showing that mindfulness training lowers psychological stress and boosts both mental and physical health.

In the piece (subscription required), University of Miami psychologist Amishi Jha, PhD, systematically outlines the history of mindfulness research from the late 1970s when Jon Kabat-Zinn, PhD, began teaching the Mindfulness-Based Stress Reduction program at the University of Massachusetts Medical School to present day. In the past three decades, have shown that mindfulness-based therapies can be useful in treating anxiety disorders, preventing recurrence of depression and easing chronic pain.

Jah writes in the piece that she and colleagues recently completed a study involving U.S. Marines that suggested mindfulness training can both sharpen focus and improve mood:

Local readers, mark your calendar for a free, public event on the medical school campus on March 6. “seXX & seXY: A Dialogue on the Female Brain and the Male Brain,” will feature a variety of experts discussing sex differences in the brain and covering such topics as autism, Alzheimer’s disease and obesity. The event marks the launch of the Stanford Center for Health Research on Women and Sex Differences in Medicine, which will encourage scientists to study sex differences in cells, tissues, animal models and human health outcomes across the life span, with an emphasis on women’s health.

As I wrote in a story on the new endeavor:

The center will unite the many Stanford faculty members conducting health research on women and sex differences in basic biology and the influence of gender on disease. Some researchers, for example, are examining a risk factor for Alzheimer’s disease that may be seen in women only. Others are studying how to tailor diagnostic tests and treatments for women, as well as men, with cardiovascular disease. The center hopes to promote further research in all medical disciplines, as well as identify clinical areas (such as health issues in gay, lesbian and transgender people) that need to be recognized in order to provide health equity for everyone.

…

[Directors Marcia Stefanick, PhD, and Lynn Westphal, MD,] felt strongly that the center’s emphasis should not be solely on women, but also on their Y-chromosomed (and gender variant) counterparts. Women have better outcomes than men in many disease categories, but worse outcomes in others. Investigating why, for example, men have more all-cause cancers and more heart disease, and die at higher rates than women in every age category until age 80 and older, could be of clinical benefit to both sexes, they say, as will learning why women suffer more from autoimmune diseases and other illnesses.

“Understanding the reasons would shed light on diseases and allow us to tailor treatments,” said Westphal.

The March 6 symposium (for which people can register here) will be followed by a general women’s health forum on May 15; the events are designed to interest both a lay and professional audience.

Photo by Hey Paul Studios

New research suggests that social networking sites, such as Facebook, could be effective tools in increasing awareness about HIV and potentially reducing infection rates among at-risk groups.

For the study, UCLA researchers created Facebook groups on topics such as HIV general knowledge, stigma and prevention, and they offered the opportunity for users to request at-home HIV-testing kits. Next, they recruited 112 African-American and Latino men who have sex with men through community organizations, bars, gyms and schools, and through online ads on Craigslist, Facebook and MySpace. The study involved a 12-week intervention and one-year follow-up, and, as described in a Science Daily story:

Participants were randomly assigned on Facebook to either a general health group or a secret HIV-prevention group — one that could not be accessed or searched for by non-group members.

The researchers found that participants in the HIV-prevention group freely discussed HIV-related topics such as prevention, testing, knowledge, stigma and advocacy. Those over the age of 31 were more likely to discuss prevention, testing, stigma and advocacy topics, while younger members were more interested in HIV knowledge–related discussions.

In addition, participants who posted about prevention and testing had over 11 times the odds of requesting an HIV testing kit than participants who did not discuss those topics.

The work appears in the current issue of the journal Sexually Transmitted Diseases.

Previously: Can social media improve the mental health of disaster survivors?, Facebook may grant researchers access to study data, Recognizing mental health problems through Facebook and Facebook application aims to raise awareness, prevent cervical cancer
Photo by Elvert Barnes

We’ve partnered with Inspire, a company that builds and manages online support communities for patients and caregivers, to launch a patient-focused series here on Scope. Once a month, patients affected by serious and often rare diseases share their unique stories; the latest comes from patient advocate Stan Hardin.

Society teaches us that men are the “tough” ones. Men don’t want to be considered weak, or unhealthy – which is one reason they don’t see their physicians as often as they should.

Ten years ago this past July, when I was 44, I had to overcome my own inhibitions of visiting the doctor I had seen for regular checkups over the years. Those visits were always standard - that is, except for the dreaded “turn your head and cough” moment, when things became uncomfortable for me. So this appointment, during which I was there for the doctor to examine my penis, was a difficult one.

I wound up being diagnosed with Peyronie’s disease, a condition characterized by the formation of fibrous tissue plaques within the tunica albuginea, usually causing a penile deformity and subsequent erectile dysfunction.

My general physician referred me to an experienced urologist who was trained in treating PD. His expertise went further than just treating me physically. He actually took time to sit and talk with me, and his attention on how PD would affect me psychologically and emotionally made all the difference to my being able to cope.

In 2002, with the Internet still in its infancy, there was nothing available online about PD to help me. So I created my own site and, eventually, a nonprofit advocacy organization. With exposure on the Internet came connections with other men suffering from PD, and through this communication I have made several interesting observations.

What stood out most prominently was the men feeling that male physicians themselves were uncomfortable talking to men with PD. Since this is already an awkward situation, any physician who appears this way will make his patients that much more uncomfortable. I believe that the “turn your head and cough” moment resides within the experience of men with PD much more profoundly.

There is also a general feeling of helplessness about this disorder, as evident by two patient comments on our site:

I’m 31, married and too young for PD, I’ve had it for 2 ½ years. The urologist told me to take Vitamin E and that there is no treatment; he scheduled me for a follow up appointment. I never went, what’s the point?

And:

I have had PD for two years… My doctor sent me to a specialist, who told me that if I had been looking at PD on the internet, that I knew more about the disease than he did… I am 57 years old and very surprised at the dismal options for real help out there!

It’s clear to me that any physician who examines a man with PD - and with any “below the waist” disorder – needs to be aware of, and sensitive to, the patient’s uneasiness about being examined and being diagnosed with this type of disease. The importance of communication cannot be overstated.

I now know how fortunate I was to have a urologist who understood the complexity that surrounds a diagnosis of PD, and who came to my level and made me feel comfortable with the disease and talking about it. Even after a diagnosis of PD, I can proudly proclaim that I am still a man – and also an active participant in my health care.

Stan Hardin, of Colorado Springs, Colorado is founder and president of Association of Peyronie’s Disease Advocates, a nonprofit organization dedicated to the education and awareness about PD, The clinical information from the APDA is overseen by some of the most renowned urologists who research Peyronie’s disease and treat men with PD.

Depression is largely seen as a women’s heath issue and statistics back up this notion, showing that we are 70 percent more likely than men to get the blues. But new research shows this gender gap may cause signs of depression among men to be overlooked and result in them not getting the help they need.

For the study, British researchers asked more than 1,200 adults to read a short narrative about a person exhibiting symptoms of depression. Half the stories referred to a female character, while the other half involved a male character. Afterwards volunteers were asked if they thought the vignettes described someone who might have a mental health condition and how likely they were to suggest the person seek help for it. The Atlantic reports:

Participants were significantly more likely to assert that Jack wasn’t suffering from a mental disorder. Men, in particular, were more likely than women to come to this conclusion. On the other hand, men and women were equally likely to conclude that Kate had a mental disorder.

Respondents, particularly men, rated Kate’s case as significantly more distressing, difficult to treat, and deserving of sympathy than they did Jack’s case. And women were more likely than men to think that Jack’s story was distressing.

The findings reminded me of a Scope Q&A last year where my colleague spoke with patient advocate Mark Meier about how the belief that depression is a women’s issue gets in the way of men getting help and the need to raise awareness to overcome this mental health roadblock.

Previously: Breaking the silence about depression among men, Gender differences and mental health and Why are women more likely to need mental-health help?
Photo by Lloyd Morgan

I’ve been in the medical writing business for about 25 years, and there are few issues that have been as contentious as one I tackled recently for my article in Stanford Medicine magazine – the PSA test for prostate cancer. It is understandably an emotional issue for men, as it deals with an insidious disease that is responsible for 28,000 deaths a year. No man wants to hear that he has prostate cancer. But the question is, is the PSA a truly useful way for men to learn their status?

The perspectives on both sides could not be more divergent. Some argue the PSA, which is not a very precise test, represents a classic case of overscreening – an overused test that adds millions in unnecessary health care costs. Many men whose PSA numbers are high may not have cancer at all or a cancer so benign that it does not demand treatment, critics say. And yet those men, fearing the worst, may opt for treatments that can cause them permanent harm, such as impotency or incontinence. For that reason, the U.S. Preventive Services Task Force (USPSTF) has strongly recommended against the test, saying it causes more harm than good.

On the other side are those who believe the PSA is still a worthwhile tool, a good predictor of who is likely to develop the disease, particularly aggressive disease. In the two decades since it’s become widespread, they note, more men with advanced disease have been spared from death. One reader also criticized the USPSTF’s methodology, saying the group used faulty statistics to overstate the harms of screening.

James Brooks, MD, a professor of urology at Stanford and expert on prostate cancer, takes a middle ground. He believes the test is an indicator of risk, just as a blood pressure test is an indicator of risk for heart disease. But he doesn’t press his patients to pursue treatment just because their PSA numbers seem questionable at first, especially if a biopsy suggests they have low-grade disease; rather, he encourages those to consider active surveillance, in which the cancer can be regularly monitored.

There is one point on which both sides agree: It’s important for men to make informed decisions. Men should talk to their doctors before they get tested and if they do, spend some quality time afterwards discussing the results before they pursue treatment. And the other point of agreement: We need better tests.

Previously: The money crunch: Stanford Medicine magazine’s new special report, Ask Stanford Med: Answers to your questions on prostate cancer and the latest research and To screen or not to screen? When it comes to prostate and breast cancers, that’s still the question

On Saturday, a panel of Stanford Hospital & Clinics physicians will participate in a free panel discussion about the latest information on diagnosing and treating prostate cancer.

The public event will be held at the Sheraton Palo Alto from 9:30 to 11 am. Seating is limited; pre-registration is encouraged at stanfordhospital.org/prostatehealth. A hospital release offers more details on the scheduled speakers and topics:

Moderating the 90-minute panel discussion will be Eila Skinner, MD, chair of Stanford’s Department of Urology. She will be joined by other Stanford prostate cancer experts who will cover the following topics:

• Prostate Cancer Screening and Watchful Waiting - Benjamin Chung, MD, director of minimally invasive urologic surgery
• Update on Surgical Prostate Cancer Treatments - Mark Gonzalgo, MD, PhD, director of robotic-assisted urologic cancer surgery and physician leader of the Urologic Cancer Care Program
• New Treatments for Metastatic Prostate Cancer - Sandhya Srinivas, MD, a medical oncologist and member of the National Comprehensive Cancer Network’s Prostate Panel

In addition to moderating the panel, Skinner is also taking questions this week on prostate health via the @SUMedicine Twitter feed and Scope as part of our Ask Stanford Med series.

Previously: Ask Stanford Med: Urology chair taking questions on prostate cancer and the latest research, Study calls for increased awareness for minorities and gay men following prostate cancer treatment and Making difficult choices about prostate cancer

There has been much discussion over the years about the pros and cons of the prostate-specific antigen (PSA) test. And this past May, a U.S. government task force sparked controversy with its recommendation that doctors not routinely screen healthy men for prostate cancer using the test.

To continue the conversation on prostate cancer and screening, and in recognition of Prostate Cancer Awareness Month, we’ve asked Eila Skinner, MD, chair of the urology department at Stanford, to respond to your questions on the disease and the latest research advancements in diagnosis and treatment.

The second leading cause of cancer death among men in the United States, prostate cancer occurs mainly in older men. Nearly two thirds are diagnosed in men aged 65 or older and one in six men in America will be diagnosed with the disease during his lifetime, according to statistics from the American Cancer Society.

One of the most highly respected urologic surgeons in the nation, Skinner served as the vice chair of the urology department at the University of Southern California prior to being named chair here in February. Her primary research interests are in the area of cancer prevention, bladder cancer and urinary tract reconstruction. As medical director of the “Real Men Cook” Foundation since 2003, she has coordinated education and screening for prostate cancer for more than 1,000 Los Angeles-area African-American and Latino men annually.

Questions can be submitted to Skinner by either sending a tweet that includes the hashtag #AskSUMed or posting your question in the comments section below. We’ll collect questions until Tuesday (Sept. 11) at 5 pm.

When submitting questions, please abide by the following ground rules:

• Stay on topic
• Be respectful to the person answering your questions
• Be respectful to one another in submitting questions
• Do not monopolize the conversation or post the same question repeatedly
• Kindly ignore disrespectful or off topic comments
• Know that Twitter handles and/or names may be used in the responses

Skinner will respond to a selection of the questions submitted, but not all of them, in a future entry on Scope.

Finally - and you may have already guessed this - an answer to any question submitted as part of this feature is meant to offer medical information, not medical advice. These answers are not a basis for any action or inaction, and they’re also not meant to replace the evaluation and determination of your doctor, who will address your specific medical needs and can make a diagnosis and give you the appropriate care.

Previously: Study calls for increased awareness for minorities and gay men following prostate cancer treatment, Making difficult choices about prostate cancer and To screen or not to screen? When it comes to prostate and breast cancers, that’s still the question
Photo by Alatryste