Men’s Health

PHAY 2001 – Clinical considerations

Mrs Louise Brown

Principle Teaching Fellow

2014-15

Learning outcomes

• Identify what are the factors that might prevent

men accessing healthcare

• Define Erectile dysfunction and its treatments

• Increased awareness of checking for the

symptoms of testicular cancer

• Explain the OTC treatment options for men with

male pattern baldness

• Describe the issues related to urine symptoms in

Men and the possible causes

Background to Men’s Health

• One man in …….. dies before he reaches 65

• Men are more likely to have a poorer diet than

women

• Less likely to be aware of cancer risk factors and

symptoms

• Men on average visit a pharmacy …… x a year

while women visit…… a year

• Not always delay in seeking help but varies

Background to Men’s Health

• Men visit their GP…. less frequently than women

and are also much less likely to use pharmacy,

smoking cessation, weight management and

health trainer services

• …..% of premature deaths from CHD are male

• …..% of men are overweight or obese

• …..% higher chance of dying from non gender

specific cancers

• ….. x more likely to have diabetes as women

• ….. /5 suicides are by men

What about the internet…..

• The internet has helped men access health

information but that it doesn't change social norms

• Health-seeking behaviour is a complex and

dynamic phenomenon

• The internet has assisted in transforming the way

we acquire health information, support and advice

• However, simply making the internet available

does not guarantee uptake by men.

• For men to change, a change in social norms is

required

Possible reasons….

• Less knowledgeable about healthcare / lifestyles / risk

factors

• Screening campaigns traditionally focused on female

cancers

• Do not want to appear “ unmasculine” or not strong

• Feel embarrassed talking about sexual areas of the body

• Feel treatment will affect their sexuality or performance

• Communicate in different ways – not geared to men

– magazines, websites

• Access to healthcare services

• Partner to collect prescription medicines or purchase

healthcare related items

Men's Health Forum – results of research

• The project found that across all the segments, there was a lack of

knowledge as to what preventative services were actually provided by

primary care, or to which GPs could refer patients on to. There was

also confusion around the term ‘preventative’ - what it actually meant

and who the services were designed for.

• The second factor was around ‘fear’ and possibly ‘denial’. ‘Fear’ was

not solely related to the outcomes - what tests might find - but also the

process. These fears were heightened if individuals were attending GP

services as GPs were seen as ‘generalists’ who would just refer to a

hospital specialist.

• Thirdly, men preferred to have physical examinations and tests (such

as blood tests), as opposed to simply ‘talking’ about their problems to

the health professional.

• Fourthly, ethnicity does not appear to be a factor. Although familial

patterns, behaviours and cultural norms were seen to be important

within families, no evidence was found that some ethnic groups are

more or less likely to access preventative services.

How to encourage men to access healthcare

services

Men’s Health Forum

• The Men's Health Forum is a charity that works to improve men's health

services and the health of men.

• Our goal is the best possible physical and mental health and wellbeing

for all men and boys. There is one premature male death every five

minutes and far too many men and boys suffer from health problems that

could be prevented.

What they believe:

• There is an urgent need to tackle the unnecessarily and unacceptably poor

health and wellbeing of men and boys.

• The health of the whole population should be improved through an approach

that takes full account of the needs of both sexes.

• Men and boys should be able to live healthy and fulfilling lives, whatever their

backgrounds.

Mens Health Forum - support

Communication skills

Fact

• Its hard talking about peoples sexual organs……

• Its sometimes embarrassing for us but …

• Its about the patient NOT us so…..

• We need to do our best to remain professional!

When a male patient comes to a pharmacy

setting for advice about a personal condition

how might they be feeling?

• What non / verbal clues might there be?

Supporting mens’ health

• You may have lots of clinical knowledge but if you

embarrass the patient or make them feel

uncomfortable – you will loose them entirely

• Small aspects of our behaviour can make a big

impact

• Importance of building a professional rapport

• Taking cues both ways

• Ask open questions and be ready to listen

Erectile Dysfunction

• What it is?

• How many men are effected?

• Main treatments

Erectile Dysfunction

There is a changing focus of treatment goals:

The old understanding

• ED is the inability to attain and/or maintain penile erection sufficient for satisfactory sexual performance

- National Institutes of Health

A new appreciation

• ED is the inability to attain and/or maintain penile erection sufficient for satisfactory sexual performance

- National Institutes of Health

NIH Consensus Statement 1992 Dec 7-9;10(4):1-35

ED Causes and risk factors

Bortolotti A et al. The International Journal of Andrology 1997;20:323-334

Smoking Psychological

Diabetes

How common is it?

• ED can be caused by a number of different things including:

– Medical conditions such as diabetes, disease of the heart and

blood vessels and Multiple Sclerosis (MS)

– An injury to the spine, especially if cause nerve damage

– An unhealthy lifestyle, for example, smoking, drinking too much,

being overweight and not getting enough exercise can put you at

risk

– ED can also be brought on by anxiety, worry, stress and

depression

• In studies of UK men aged 18-75 years, 13 - 39% reported that they had experienced ED sometime in their life

• During one study 26% of men reported they were having current erection problems

Impact of ED

• ED is associated with depression, anxiety, and low self-

esteem

• Has a severe effect on psychological and social well being

• Can negatively impact on personal relationships

• ED and cardiovascular disease share common risk factors,

including diabetes, hypertension, dyslipideamia and

smoking

Main treatment

• Viagra has been available since 1998

• Per chance discovery

• One of many phosphodiesterase type-5 inhibitors

currently marketed

(vardenafil, tadalafil, avanafil, sildenafil)

• Highly effective in men with all degrees of ED severity

• Safe and well-tolerated treatment at all doses

• Most common side effects of Viagra are headache (11%) and flushing (11%)

Mechanism of action Nitric oxide-cGMP pathway

Communication skills

- Most community pharmacies now offer as a PGD

- NHS certain groups only eg: DM, MS, Parkinsons,

polio, prostate cancer, spinal injury, dialysis, pelvic

surgery

- Desensitize to the language and get the

terminology right!

- It is common

- HOPE

- Manage expectations

- Upto 8 attempts for full effect

- Sexually stimulated

- 30 mins to action

- Lasts 4 hours

26

Provision of a Private PGD for ED

• Pharmacist must be trained

• Inclusion and exclusion criteria

• Initial consultation

– General health check , look for anyone that is cautioned or

contra-indicated or drug interactions (BNF)

– Background to symptoms

• Measurements

– Check of cardiovascular health (BP, cholesterol, BG)

• Supply of medication with counselling

• Repeat supplies

• Review yearly

• Age restrictions

Is it a male only problem?

No, it is not exclusive to men BUT...

1. Men’s Health Forum information.

Mens Health - Screening

• Focus on testicular cancer

• Swelling or lump –painless to painful

• Not that common (2,100 men diagnosed annually)

• Rates increasing worldwide

• Most men who are treated will be cure

– Less if its left to become more advanced

• Treatment – surgery, chemo, radiotherapy

• BUT

– Affects younger men (common type of cancer 15-49)

– Giving up smoking will halve your risk

• Key is men doing regular self-examination

http://www.checkemlads.com/v1.htm

Male pattern baldness

• Androgenic alopecia

Male pattern baldness

• Very common (6.5m in UK)

• Age range from late teens to 60s

• Strong genetic component

• Caused by hair follicles over sensitive to

Dihydrotestosterone

• Leads hair follicles to shrink and then cease

working

• Seek treatments – cosmetic reasons

• No cure – treatments to slow progression

Male pattern baldness

Treatments

• OTC

– Minoxidil 5% solution , apply topically twice a day , if not

improved stop after a year

– BNF – limited benefits

– P medicine and not available on NHS

• Prescription

– Finasteride , 1 mg daily – private prescription only

• Use for 3-6 months before any benefit apparent

• Effects reversed after 6-12 months of stopping

• BNF 13.9

Urine symptoms in Men

• Common with age progression

• Like…

• Issues with storing or passing urine

• By 40 years – upto ½ of adult affected

• Cause for concern about possible conditions

– Prostate cancer

– Enlarged prostate gland – Benign prostatic hyperplasia

– Diabetes

Treatments – non drug

• Drink a reasonable amount (1500-2000ml)

• Avoid lots of tea, coffee, fizzy drinks

• Drink less close to bedtime

• Avoid leakage after urination by massage of back

of testicles

• Look at general health eg weight and exercise

• Bladder training

Treatment - OTC

• Flomax relief MR

• Tamsulosin 400mcg

• BPH in men 45-75yrs with urinary difficulties

• 1 OD with a meal

• Symptoms check questionnaire can be used

• Supply 2 weeks – then 4 weeks if improvement

• Patients should still check in with GP (6 weeks)

• Can continue OTC supplies

• Review yearly with GP

References

• https://www.menshealthforum.org.uk/

• Pharmacy Magazine – November 2014

• http://www.checkemlads.com/index.htm

• http://www.macmillan.org.uk/Cancerinformation/Cancertyp

es/Testes/Symptomsdiagnosis/Symptoms.aspx

• https://www.pharmacypgd.co.uk/about-pgds/available-

pgds/erectile-dysfunction-pgd

• http://www.pfizer.co.uk/content/healthcare-professionals-0

• http://www.selfcareforum.org/fact-sheets/

• http://www.flomaxrelief.co.uk/

• RPS Quick reference guide on OTC Tamsulosin