In recent years, significant advances in the evaluation and treatment of conditions such as erectile dysfunction, benign prostatic hyperplasia and adenocarcinoma of the prostate have occurred. All of these conditions have more prevalence in older men. Now with increase in life expectancy in recent decades and enhanced public awareness, more men are expected to seek medical consultation for their specific health problems.
In this issue of Jacksonville Medicine, a broad set of topics in "men's health issues" is presented. Dr. Mark Barraza reviews the embryological development of the male genitalia and their associated anomalies. Dr. David Dalton describes the common inflammatory conditions of the male genitalia which includes prostatitis, epididymitis and fourmier's gangrene. I have attempted to present an overview of the pathogenesis of benign prostatic hyperplasia and discuss the treatment options. As our guest authors, Drs. Cristoforo L. Cama, Inoel Rivera and Zev Wajsman, from the University of Florida College of Medicine, Division of Urology, present a comprehensive overview on the variety of male genitalia's malignancy. New information about the discovery of non-invasive options for the management of erectile dysfunction is discussed by Dr. Howard B. Epstein.
I hope that you find these articles informative and useful. For me it has been a wonderful experience working with such distinguished individuals as the authors of these papers assembled in this issue of Jacksonville Medicine. This is also a unique opportunity to wish you a Prosperous New Year.
Ahmad Kasraeian, M.D., Guest Editor
Men and women age differently, both in terms of physical health and psychological well being. This is particularly striking, physically and physiologically during middle age. Typically the American male loses 12-20 lbs. of muscle between the ages of 40 and 70, 15% of bone mass and nearly two inches in height. The testicles shrink and sperm production falls off, though not enough to totally prevent 90 year olds from fathering children. At the same time the prostate gland starts to amass dense and connective tissue that will eventually complicate urination and ejaculation. This slow decline is evident even in the brain drain which affects men the most. Men lose brain tissue faster than women. This is particularly greatest in the frontal lobe, which is involved in attention abstract thinking, reasoning, mental flexibility, and impulse control. Physiologically the number of special cells required for muscle growth decreases making it more difficult to replace muscle lost because of atrophy and lack of exercise. Maximal heart rate decreases at a rate of 220 minus age and the increase in peripheral vascular resistance due to non compliant vessels reduces cardiac stroke volume.
However none of this these changes in men qualify as menopause due to the gradual declines in function. While a woman's ovaries shut down entirely around age 50, causing an estrogen crash that affects everything from bone cells to brain cells, men typically lose some testosterone as they age, but the decline is far more subtle and the impact in physiological terms more protracted.
Pathologically the aging process bodes poorly for the male gender. From age 25 - 65 the death rate from heart disease is 3 times that of women. Men are at also higher risks for other fatal diseases including lung and liver disease, hypertension, and cancer. Not only does a man's mental state deteriorate more frequently (Alzheimer's) but also suicide rate is 4 times that of women.
Even though the aging process can be difficult for both sexes, research has shown that men have generally a harder time in adjusting to the changes. Conditioned throughout life to be strong, controlling and independent, men can be devastated by the losses associated with aging. The World War II generation that has valued toughness and stoicism has been discouraged from revealing their feelings socially. In not being able to express emotions, many elderly men are at risk of developing depression, turning to alcohol or drugs and committing suicide.
This journal issue will explore some of the physiological and pathological changes and unique disorders afflicting males at various epochs of life, specifically the genitourinary disorders. While the focus is more on genitourinary tract disease and how best to manage the pathophysiology of the male, maintaining a broader perspective and a healthy appreciation of the aging process in men and its impact on body systems will contribute to a better understanding and more effective care of male patients. Much of the change in the aging process can be positively impacted through good health habits such as challenging the mind, developing physical fitness and recognizing and reducing stress.
Larry Tremonti, M.D., Associate Editor
January, 1998/ Jacksonville Medicine
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