Men's health

Erectile dysfunction

Erection problems include being unable to get or sustain an erection, only getting partial or soft erections, and inconsistently getting erections. It is estimated that 25% of men over 65, and 45% of men over 75 experience erection dysfunction. According to Men’s Health NZ, occasional erection problems are not concerning, but if you experience erection troubles more than half of the time, then you may need to treat the underlying cause. Erectile dysfunction is cause by less blood flow, which can be linked to physical or psychological factors. Other factors that may cause erection trouble include tiredness, alcohol, and stress. Some common causes of erectile dysfunction include:

  • Heart disease
  • Diabetes
  • Depression
  • Brain and nerve damage, such as stroke
  • Anxiety
  • High blood pressure
  • Some medications, such as antidepressants, heart medications, bladder and prostate medications, and corticosteroids

If you frequently experience erectile dysfunction, you should visit your doctor. Your doctor will be able to run tests to ensure your erection difficulties are not due to underlying issues and will be able to prescribe the correct treatment. Some tests may include a physical examination, a review of your current medications for side effects, and tests to measure the function of your thyroid, hormones, liver, kidneys, and for diabetes.

Some treatment options to improve erectile function include:

  • Lifestyle changes, such as eating a healthy diet, exercising regularly, losing weight, getting enough sleep, drinking less, and stopping smoking
  • Strengthening your pelvic floor
  • Counselling to talk about psychological reasons for erection difficulty
  • Changes in your medications
  • Taking erection medications through tablets or self-injections

If your erectile dysfunction is concerning you, talk to your doctor to decide the best options for you.

Male menopause or andropause

As men get older, the amount of testosterone they produce decreases. From your 40s, you may experience symptoms related to andropause (male menopause). Unlike female menopause, andropause occurs more gradually and is not experienced by all ageing men.

Some symptoms of a decline in testosterone levels may include:

  • Mood swings and depression
  • Lack of energy or fatigue
  • Poor concentration
  • Decreased libido and erectile dysfunction
  • More aches and pains
  • Hot flushes and sweats

Many of these symptoms are considered a normal part of ageing and can be managed, however if you are testosterone deficient your doctor may prescribe testosterone replacement therapy to treat abnormally low levels. Your doctor may also be able to prescribe medication to alleviate other symptoms such as erectile dysfunction.

Some lifestyle changes can be made to improve your symptoms. These include:

  • Eating a better diet
  • Getting regular exercise
  • Decreasing alcohol intake and stopping smoking
  • Getting enough sleep

For more information on low testosterone levels, visit this article at Best Practice Advocacy Centre NZ. For information on andropause, symptoms, and treatments, visit Family Doctor. If your symptoms become unmanageable, see your doctor.

Enlarged prostate (benign prostatic hyperplasia)

The prostate is a male sex gland about the size of a walnut that surrounds the beginning of the urethra. From the age of 40, some men experience prostate enlargement which may be caused by hormonal changes associated with ageing. This enlargement can cause the urethra to narrow and obstruct the flow of urine. An enlarged prostate does not cause prostate cancer, but it can still occur.

An enlarged prostate may affect your urination. These changes may include:

  • Increased frequency
  • Increased urgency
  • Difficulty starting to urinate
  • Poor flow or dribbling
  • Nocturia (frequently needing to urinate in the night)

If prostate enlargement is severe, it can lead to UTIs, bladder stones, a back up of urine to the kidneys, or the inability to urinate at all. If you think you may have an enlarged prostate, you can visit your doctor who can perform physical exams, take blood tests, and ultrasound to diagnose you.

If your symptoms remain mild, your condition may be monitored and not require any treatment. If it does become more severe, you may need medical or surgical treatment. It is important to talk to your doctor if you have any concerns about your prostate. For more information on enlarged prostates, check the Southern Cross Medical Library.

Prostate cancer

Around 3,100 New Zealand men are diagnosed with prostate cancer each year, who are mostly over the age of 50. You are more at risk of prostate cancer as you get older, or if you have family members who have had it. Prostate cancer usually develops slowly and in older age.

While the early stages of prostate cancer typically show no symptoms, some later symptoms may include:

  • Dribbling or leaking urine
  • Blood in your urine
  • Urgently needing to urinate
  • Poor flow
  • Nocturia (frequently needing to urinate in the night)

Prostate cancer tests can be completed by your doctor. Common testing for this includes a blood test for prostate specific antigen (PSA), which is made in the prostate, a digital rectal exam, or a transrectal ultrasound biopsy.

If you get diagnosed with prostate cancer, treatment options may differ depending on the stage of your cancer, how old you are, your general health, and your personal choice. Since this type of cancer generally affects older men, treatment options must consider age. Some common treatments include:

  • Watchful waiting – in the early stages your doctors may recommend just monitoring your condition as this type of cancer is usually slow growing
  • Surgery – this can help with urinary blockages, or can remove the prostate gland (prostatectomy)
  • Radiotherapy
  • Hormonal treatment (androgen deprivation therapy) – this option is often recommended if the cancer has spread beyond the prostate
  • Chemotherapy – often used in advanced metastatic prostate cancers, and usually after other treatments have been trialled

If you are concerned about prostate cancer, you can find more information on the Cancer Society website.

Testicular cancer

While being rare, testicular cancer can occur in older men. Testicular cancer is most common in younger men between 20 and 40, but can occur at any age. If detected early, there is a very high chance of recovery. You are more at risk of testicular cancer if you:

  • Are born with undescended testicles
  • Have testicles that did not develop normally
  • Have previously had cancer in one testicle
  • Have a family history (father or brother) with testicular cancer
  • Are infertile (testicular cancer can cause changes in testosterone levels)
  • Have congenital defects such as hypospadias or inguinal hernia

Testicular cancer may not cause any noticeable symptoms, but in some cases, you may notice:

  • Swelling or a lump in the testicle
  • A change in the testicle’s size or shape
  • Heaviness in the scrotum or an unevenness between testicles

If you think you may have testicular cancer, you need to see your doctor. Your doctor will diagnose you after completing a physical examination of your testicles and scrotum, completing an ultrasound, and running a blood test for tumour markers. In most cases, the testicle is completely removed to finally diagnose and stage the cancer.

Removal of the testicle (an orchidectomy) is the safest way to fight testicular cancer. In most cases, the removed testicle is probably not producing healthy sperm or testosterone anyway, and you will still be fertile with one testicle. Depending on the stage of your cancer, further testing may be done to see if the cancer has spread beyond the testicles.

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