En español l Everyone knows men aren't always keen on peppering their doctors with questions. Or, as Joshua Kosowsky, M.D., coauthor of When Doctors Don't Listen, bluntly put it, "Men don't want to talk about feeling something in their testicles or having rectal bleeding."
Figures from the Agency for Healthcare Research and Quality (AHRQ) in Rockville, Md., back that up: Men are 24 percent less likely than women to have visited a doctor within the past year.
But men need to change, says Kosowsky, an assistant professor at Harvard Medical School and clinical director of the Brigham & Women's Hospital Emergency Medicine Department. "You have to get over the reluctance to open up to your doctors. You have to advocate for yourself."
To help ease the conversation, below are 10 key topics every man should discuss with his doctor to stay on top of his health.
1. There seems to be a lot of debate about whether men should be regularly screened for prostate cancer. To be frank, I'm confused. Do you think I need to be tested?
"The American Urological Association recommends yearly screening with a prostate-specific antigen (PSA) blood test and a digital rectal exam for men ages 50 to 75," says James Ulchaker, a urologist at the Cleveland Clinic. Men who have a family history of prostate cancer and African American men should begin annual screenings at age 40. PSA is a protein produced by the prostate; a blood test can show whether protein levels are at a normal or an elevated range.
However, you should talk to your doctor about what the options are if the test indicates a problem, says Kosowsky. "Prostate cancer is a very slow-growing cancer. Even if you have it, it's not likely to kill you. And an elevated PSA may just be a sign of normal aging."
If you do have an elevated PSA, one option is to have a needle biopsy. But even if the biopsy reveals cancer, your doctor may recommend watchful waiting with a repeated PSA test every six months. "We are doing more and more watchful waiting because we know that many men are overtreated for prostate cancer," says Ulchaker. Plus, treatment options such as the removal of the prostate or radiation therapy can have unwelcome side effects, such as erectile dysfunction — the inability to sustain an erection — and loss of bladder control.
2. With an annual physical now covered by insurance, what screenings do I need?
Men over 50 should have annual physicals that include blood pressure and cholesterol screenings. Their fasting glucose, or blood sugar, levels should be tested every three years, according to the Cleveland Clinic.
"Of these, the most important is screening for high blood pressure," says Carolyn Clancy, M.D., director of AHRQ. According to the Centers for Disease Control and Prevention (CDC), 68 million adults have high blood pressure, and more than half do not have it under control. Normal blood pressure is around 120 over 80. "What's important is to know and write down your numbers each time," says Clancy. "If most of the time, your blood pressure is 90 over 60 and then suddenly it's 130 over 80, that's more concerning than for someone who is usually 120 over 80." If your blood pressure is high, your doctor will want to check it more often and may suggest you monitor it with a home blood pressure machine.
3. I'm not feeling as sexually vital as I'd like. Could something be wrong with my health?
"If you have a decreased libido [sex drive], a morning test of your testosterone level is an appropriate screening," says Ulchaker. "If the test is normal, most urologists do not recommend additional testosterone."
If the problem is erectile dysfunction, you have multiple options, including oral medications, such as sildenafil, or vacuum erection devices, says Ulchaker. But you may not need such measures. Obesity, smoking and diabetes can all interfere with sexual function. Taking off a few pounds, giving up cigarettes or managing your diabetes could make all the difference.
And don't forget the side effects of the medications you take. Some types of drugs, such as antidepressants, statins and blood pressure drugs, also can cause erectile dysfunction. Make sure to talk to your doctor about the medicines — both prescription and over-the-counter — you take regularly.
4. I'm urinating more than usual. Should I be concerned?
"As men get older, more develop voiding dysfunction," says Ulchaker. "The number one reason behind urinary urgency is caffeine. Alcohol also stops the kidneys from reabsorbing water." The result: you pee more frequently. Cut back on both, and your peeing problem may cease.
5. I haven't been sleeping well. Is that a cause for concern?
The CDC reports that 50 million to 70 million adults have a sleep problem, and nearly 37 percent of people ages 55 to 65 fall asleep unintentionally during the day at least once a month. One common sleep problem affecting more than 18 million Americans, especially men, is sleep apnea — a pause in breathing — which can disrupt sleep and increase the chance of developing cardiovascular problems. You're at higher risk for sleep apnea if you're overweight and over age 40.
Don't forget to take some common-sense steps to improving your sleeping habits. These include:
- Limiting caffeine, alcohol, nicotine and large meals close to bedtime;
- Keeping regular sleep hours;
- Avoiding exercise in the hours right before bed.
6. I'm worried because several relatives in my family have had heart attacks. How can I tell if I'm at risk for heart disease?
Family history is a major risk factor for heart disease, so telling your doctor about a family pattern is important.
"But truthfully, everyone is at risk," says Kosowsky. "And if you are a smoker, you are at much higher risk" — about two to four times higher, according to the CDC. Speak frankly with your doctor about your lifestyle, including how much exercise you get and what you eat. That is key to getting an accurate answer about your chances of heart problems, Kosowsky says.
7. I'd like to take better care of my health and start exercising more. Do I need a stress test before starting to work out?
A stress test involves walking on a treadmill while your heart is monitored to see how it responds to exertion. "If you have a high risk for heart disease, then talk to your doctor before you start exercising," says Kosowsky. "He may recommend that you first exercise in a monitored setting to make sure your heart is strong enough."
But if your doctor recommends a stress test, find out why he or she thinks it's necessary. What does the doctor hope to learn from the test? "A stress test can lead to false positives that may lead to unnecessary treatments," Kosowsky says. "Ask about alternatives."
8. I don't think my weight is a problem, but how can I tell for sure?
"The answer is linked to exercise," says Kosowsky. "Fat or thin, you're not at a healthy weight if you're not exercising." The American Heart Association recommends that you exercise 30 minutes at least three times a week.
Also keep in mind that after age 50, your metabolism slows down and weight gain is common, especially if you don't make changes in your diet or increase your physical activity. One way to check how you're doing is to calculate your body mass index (BMI), a measure of body fat.
9. I've been having this strange pain or discomfort. I feel a bit silly asking, but is this anything I should be worried about?
If you have questions, ask, especially about a change from your usual health status. "There are no stupid questions," says Kosowsky. "Men should ask about things that bother them or bring up any change in their normal condition. This is particularly true for men who may be squeamish about discussing issues like rectal pain and testicular swelling. And don't let your doctor simply dismiss your complaints." Sometimes small issues are minor, other times they can signal bigger issues.
10. My tests indicate I have a health problem. Can you tell me specifically what my diagnosis is?
Once you've gone over your tests and concerns with your doctor, ask for a diagnosis. "If your doctor can't give you a specific diagnosis, then ask what is most likely causing your problems," says Kosowsky. "And if you're worried that you have something like cancer, let your doctor know. Don't assume that he or she knows what you are thinking." Ask: What do we do next? Do I have choices I need to make? If further tests or treatment are needed, you should always ask why you need this and what the alternatives are, Kosowsky says. It's also important to have your doctor discuss the benefits and side effects of each option, so that you understand what you can expect, Clancy says. Ask, too, how you can get more information about your condition.