Men’s health professionals perform health screenings at regular intervals and ensure that all these mechanisms are regulated.
What Should We Understand About Men's Health?
We can call the system that helps to lead a quality life by detecting diseases such as possible prostate diseases, late onset hypogonadism (andropause), erectile dysfunction as men’s health.
Especially after a certain age, some negative changes are observed in organs such as prostate, urinary bladder, penis, testis, depending on age, just as wearing glasses, hair whitening, diabetes, hypertension develop due to visual impairment.
Most of these negative changes occur as a result of the decrease in the hormonal values that provide the formation and maintenance of male characters such as testosterone hormone.
Serious problems may occur due to impairment of this hormonal mechanism, testicular shrinkage, lower urinary tract problems due to disruptions in the bladder prostate complex, depression, obesity, bone mineral density disorders.
What Situations Does Men's Health Cover?
Basically men’s health;
- Late-onset hypogonadism (IH-Andropause) diagnosis and treatment
- Prostate disease diagnosis and treatment
- Male infertility
- Sexual dysfunctions (erectile dysfunction, premature ejaculation, late ejaculation)
1.What is Late Onset Hypogonadism (Andropause)?
Hypogonadism means the failure or under-functioning of the testicles (eggs). Normally, after the follicle stimulating (FSH) and luteinizing (LH) hormones are secreted from the pituitary gland, they pass into the blood and come to the eggs, namely the testicles, through the blood.
In the testicles, FSH stimulates the Sertoli cells that make sperm, and LH stimulates the Leydig cells that produce testosterone, enabling the production of testosterone hormone when needed.
When testosterone in the blood decreases sperm in the testicle, FSH, LH hormone is secreted from the anterior part of the pituitary gland and sperm and testosterone are produced in response.
This situation is in a cycle. When there is a problem in any step of this cycle, testosterone and sperm cannot be produced sufficiently and the situation we call hypogonadism occurs.
This disorder can be caused by eggs or the pituitary gland. This condition is called primary hypogonadism when it is congenital and secondary hypogonadism when it occurs later.
Especially after the age of 40, the testosterone hormone begins to decrease, but in some people, this situation reaches serious dimensions and can lead to very serious problems such as decrease in sexual desire, weight gain, shrinkage in testicles, depression, irritability, restlessness, inadequate erection.
We call this situation late onset hypogonadism, or andropause. In the presence of these symptoms, a urology physician who is interested in this issue should be consulted and treated by performing the necessary analyzes.
How is GBH-Andropause Diagnosed and Treated?
In cases such as decreased sexual desire, irritability, flushing, restlessness, decrease in erection, increased blood sugar, obesity, heart problems, person should definitely go to a urologist and necessary examinations and tests should be done. With a detailed physical examination, weight status, size of testicles, type of hair growth, penis length, consistency of the prostate should be determined and noted.
FSH, LH, testosterone, sex hormone binding globulin (SHBG), albumin and prostate specific antigen (PSA) values should be checked between 9 and 11 am. If the patient has complaints and the blood testosterone level is low, andropause is diagnosed and if there is no harm in using testosterone, testosterone treatment should be performed.
If the patient has complaints, but the testosterone level is at or near the lower limit, the bioavalible testosterone level is checked and if necessary, testosterone treatment is applied. If the testosterone level is normal and the patient has complaints, other reasons should be considered and the treatment principle should be determined accordingly. Testosterone treatment can be performed orally (by mouth), intramuscular (by intramuscular needle) gel or subcutaneous implant. Intramuscular treatment once every three months seems to be the most practical.
Can Testosterone Treatment Be Given To Those With Prostate Cancer Or Suspected?
Testosterone cannot be given to a patient with prostate cancer, but if there is no suspicion of recurrence in the follow-up of cancer treatment, if the patient has severe ICD complaints and testosterone is low, there is no harm in treating it. It should be ensured that patients with high PSA levels do not have prostate cancer first.
2.Diagnosis and Treatment of Prostate Diseases
Prostate basically has 3 types of diseases: prostatitis, benign prostate enlargement (BPH) and prostate cancer.
Prostatitis: In the acute one, there is inflammation in the prostate, there are serious complaints such as fever, chills, difficulty urinating, burning in urine. There is severe inflammation in the urinalysis or prostate fluid analysis, and it heals when treated.
Chronic prostatitis, on the other hand, has symptoms of general infection such as occasional fever, difficulty urinating, and shivering, there is inflammation in urinalysis and when treated, complaints disappear but recur occasionally.
Chronic non-inflammatory prostatitis, on the other hand, causes complaints such as groin pain, discomfort in the pelvic area, burning in the urine. All the tests performed are normal. The patients do not respond much to the treatment, and therefore the patients go from doctor to doctor.
In chronic inflammatory prostatitis, there is no complaint in the patient, but there is inflammation in the tests. Treatment is the same as for other types.
Benign prostatic enlargement or benign prostatic hyperplasia (BPH): normal weight of the prostate is around 20 grams. Age-related benign growth of the prostate is called BPH.
As a result of the enlargement of the prostate, the part of the urinary tract passing through the prostate becomes blocked. The patient cannot urinate comfortably. If the urinary bladder is damaged and progresses further, kidney failure may develop.
The diagnosis is made by examining the urinary flow rate, prostate specific antigen (PSA), urinalysis, and urea creatinine levels. In addition, the international symptom score (IPSS) is filled and also digital rectal examination is very important.
Depending on the severity of BPH, medical treatment or surgery can be performed when necessary.
If there are mild complaints and symptoms and if BPH does not completely obstruct the urinary tract, drug treatment is performed first, and if there is no response, surgical treatment is performed.
In surgical treatment, methods such as TURP, TUR-Laser, TUR-plasma kinetics are preferred with a closed system. If the prostate is very large, open surgery may be a good option (see BPH section for more information).
Prostate cancer is the most common cancer in men. Early diagnosis and treatment is very important. It is important that if there is a family history, men over the age of 40, and if there is no history the age of 50 should be screened.
First, digital rectal examination and afterwards PSA, urinalysis, urea, creatinine and ultrasonography are performed to the patient. If PSA is high and / or there is suspicion on examination, prostate biopsy is performed.
If cancer is diagnosed, its staging is done and treatment principles are determined accordingly (read about prostate cancer for detailed information).
3.Male Infertility
Not having pregnancy despite regular sexual intercourse for a year is called infertility.
30-40% of infertility is due to women and the rest to both sexes. The most common correctable cause of male infertility is varicocele, and the best treatment method is microsurgical varicocelectomy.
There are other causes of infertility such as male genetic disorders, previous surgeries, hormonal disorders, and occupational involvement. If there is no pregnancy in the normal way, inutero insemination (IUI), i.e. vaccination or in vitro fertilization (IVF, ICSI) can be performed.
If there is no sperm normally, ICSI can be performed by finding sperm with microTESE (for more information, see the section on male infertility).
4.Sexual Dysfunctions
Erectile dysfunction (impotence), premature ejaculation, postmature ejaculation (late ejaculation): Especially erectile dysfunction and premature ejaculation are very common conditions between 30-40% throughout life.
Erectile dysfunction increases in frequency depending on age. Diabetes, vascular diseases, hypertension, previous surgeries, hormonal disorders are among the most common causes.
The diagnosis is made by a good medical history, physical examination, laboratory, and tests such as penile doppler. In the treatment, first oral medication, then injection treatment into the penis if there is no response, and penile prosthesis (happiness stick) if there is no response.
Penile prosthesis has a 98% chance of success (see the section on erectile dysfunction for more information).
Premature ejaculation can be primary, ie from the beginning of sex life, or secondary, ie later. It is quite common. In general, if the penis is ejaculated in less than 3 minutes after anesthetic creams, premature ejaculation is used. However, there is no exact definition of the duration.
Generally, a pathology cannot be found in the examinations of the congenital. Later, hormonal disorders, previous surgeries and medications may be factors.
In the treatment of premature ejaculation, antidepressants, that is, depression medications, are among the most used drugs and this side effect is used because the side effect is delayed ejaculation.
In addition, a drug called dapoxetine is used only for premature ejaculation. Local anesthetic creams are used for this job. If there is no response from all these treatments, a psychiatric consultation should be requested.
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