Men’s Health – Protecting Men by the Decade ( Dr Vinayak S Hiremath, Consultant Physician Endocrinologist & Diabetologist)

The average man pays less attention to his health than the average woman. Compared to women, men are more likely to drink alcohol and use tobacco, make risky choices, not see a doctor for regular check-up’s.

Men are assailed by the diseases that can affect anyone—heart disease, stroke, diabetes, cancer, depression, But they also have unique issues such as prostate cancer and benign prostate enlargement.

Many of the major health risks that men face can be prevented with a healthy lifestyle: regular exercise, a healthy diet, not smoking, stress reduction, and alcohol consumption in the moderate range (no more than two drinks a day) if at all. Regular check-up’s and screening tests can spot disease early, when it is easiest to treat.

Here I would like to define few risk factors and what you can do to spot diseases at early age and what you need to be cautious at your age.

1. Define your 20’s

Invincible – that’s how we all feel at 20. Most people in their 20s don’t think about their future health. But once health issues arise, sometimes it’s too late. If you are in your 20s, here are things you should do now to keep feeling ‘invincible’ for years to come!

• Osteoporosis – prevention – Sounds like something only “old people” get, but do you want to be the person afraid of falling and breaking a hip in their 60s? Start now – Osteoporosis prevention should being in your late teens/early 20s. Why? Because these are the prime years to build your bone strength – an ability we lose as we age. Here is what you need to do: ◾️Make sure your testosterone levels are optimal. Low testosterone levels contribute to osteoporosis risk. In fact, testosterone prevents OP progression even after diagnosis.◾️Weight train – Heavy lifting and pressure force your bones to strengthen. We don’t skip leg day!
• Heart disease and Lp(a) – Heart disease presents in your 50s and 60s but starts decades before. Lp(a) (lipoprotein little ‘a’) is a genetically determined marker that significantly increases the risk for heart disease.. Knowing your Lp(a) status (most labs can test this) will determine how aggressive you need to be in preventing heart disease. Here is what you need to do:◾️Test your Lp(a) ◾️Test your lipids (especially ApoB and LDL-P) in your 20s will give you a great baseline to compare to in your 40s, 50s…
• Check your insulin levels – insulin predicts diabetes MUCH earlier than fasting blood glucose. [See my post on Insulin]
• Testicular cancer – Although rare, testicular cancer is most common in young men. Thankfully, also very curable. Seeing your doctor yearly and doing regular self-exams is your best defence

2. 30s – Your Prime Starts Now

Your 20s left you feeling invincible, but now some wisdom made you realize you aren’t immortal.

Here is what men in their 30s need to do to stay sharp!

• Mental Health – 61% of all death in men in their 30s is due to accidents/injury including suicide and homicide (compared to all-cause mortality). Self-care matters, because it is not all in your head! Your mental health is REAL, and I make sure each and every one of my patients have plans to reduce their stress and tolerate all of their stressors. My favorite tools are:▫️Make time to unwind – 1 hour before bed should be your time with yourself or your loved one.▫️Meditation – Everyday. Meditation is an exercise, like weight training. You don’t get huge biceps after one workout, the same with meditation. The more you do it, the more effective and helpful it becomes. My favourite app is 10% Happier. ▫️Adaptogens – Herbs like Ashwagandha, Rhodiola, Holy Basis, and non-herbs like theanine and phosphatidyl serine can help us tolerate our stressors better.
• Fertility – The 30s are the common baby-making years. Approximately 40% of infertility cases are due to a male factor. If you are having issues conceiving, it may be worth doing some blood work and a semen analysis to assess the cause. Things to test:▫️FSH▫️LH▫️Zinc – RBC▫️CoQ10 ▫️Selenium▫️Semen analysis
• Joint health – Your 20s left you feeling fluid and strong. But chronic overuse and maladaptive movement patterns can lead to chronic joint disease. Think about it, do you want to grunt or hunch trying to pick up your kids or walk up the stairs?! No! Find yourself a physical therapist, chiropractor or qualified trainer/movement specialist.

3. If you’re starting to “feel your 40s,” then we have some work to do.

The top 3 conditions on my radar for men in their 40s:1. Diabetes 2. Adrenal dysfunction 3. Fatty Liver disease 

• Diabetes – The average age of onset of Type 2 Diabetes is 45 years old. Keep in mind, this is based on the VERY outdated standard of diabetes diagnosis (HbA1c and fasting blood sugar). This tells me diabetes doesn’t occur in your 40s, it just get’s diagnosed then. To do: Test FASTING INSULIN. This is the most sensitive marker for predicting diabetes.
• HPA Axis Dysfunction – Formerly known as “Adrenal Fatigue,” HPA Axis Dysfunction is not a formal diagnosis but a functional presentation of men who are overworked, under-slept, and Mal-nourished. Men in their 40s are now starting to feel the perils of the stressors of their 20s and 30s, but their lack of sleep, exercise, meditation have made it hard to handle the stress. End result – Chronic fatigue, high cortisol, weight gain, hormonal imbalance. To do: Complete Hormone Study or Get a DUTCH test and see a physician who can help identify and manage these symptoms. Serum cortisol levels do not count.
• Fatty Liver and Liver Disease – Your 40s is when your liver starts yelling back at you. Fatty liver disease is usually caused by high fructose (fruit juice, soda, sports drinks), alcohol, processed foods, some medications and some viruses. Most men think their liver will just regenerate on it’s own, and yes while the liver is very resistant DO NOT PUSH the limits. Fatty liver is reversible but Cirrhosis is not.To do: Monitor ALT, AST, and GGT. Most labs say anything less than 40 U/L is “normal,” but if you look at ALT and AST levels from 50 years ago, <30 U/L was normal. Aim for an AST and ALT of <30 U/L

4. Men in their 50’s 

Men in their 50+ think they’re old. My patients easily knock that thought out! There is no tap outs in this long game. To stay young here are the top 3 conditions on my radar for men in their 50’s : 1. Erectile dysfunction 2. High blood pressure 3. Colon cancer

• Erectile dysfunction – About 15% of men in their 50s will experience erectile dysfunction (ED). Not what any man wants to hear in their 50s but it that 15% is likely higher since most men won’t admit to it. ED is a sign for other conditions, particularly heart disease and diabetes.To-Do: ED is not a Viagra deficiency, its usually a lifestyle and metabolic issue. Get your doctor to check for high blood sugar, ApoB or LDL-P, lp(a) and other cardio risk factors. [this deserve a whole post I think!]
• High blood pressure – Sounds pretty boring but aside from CHD, high blood pressure is the second leading cause of vascular death in men at the age of 50.To-Do: Get a home blood pressure cuff and test it in the morning and evening. Knowing when your BP is the highest helps guide treatment.
• Colon Cancer – Aside from lung cancer, colon cancer is the second leading cause of cancer deaths in men at 50. If you correct the stats for non-smokers, then Colon Cancer is top on the list for cancer screening. The best part is it is preventable with nutrition, exercise and screening.To-Do: Get a colonoscopy screening. Eat a huge salad daily (one of the easiest ways to get your veggies). Include a vegetable with every meal. Ease off the fruit juice – fructose and insulin promote cancer growth.

As the saying goes He who cures a disease may be the skillfullest, but he that prevents it is the safest physician, Take care of your body it’s the only place you have to live.