“It's nothing,” says your partner, father or son when you suggest that he see a doctor.
But if his snoring or frequent nocturnal bathroom trips keep you up at night, it's something. Ditto if you're troubled about his lack of energy, irritability, inactivity, libido or never-ending back pain.
“Along with the Y chromosome, we men have a denial gene. We tend to minimize and deny,” says urologist Nathaniel Barnes, MD, FACS, with Memorial Hermann Medical Group (MHMG) Urology Associates.
That resistance only rises when symptoms might be embarrassing.
The following information may help your family decide when it’s time for your dad, husband or son to seek medical attention.
Signs: Persistent snoring, snorting or gasping for air are signs of obstructive sleep apnea, a disorder of disrupted dozing, Dr. Barnes says. “Especially if he goes to the bathroom four to five times a night but doesn’t have a problem during the day.”
Take Action: Symptoms must be addressed, he says. “The risk of high blood pressure, heart attack, stroke and premature death is significantly higher in those with sleep apnea,” says Dr. Barnes.
Screening: A sleep study will show if he has sleep apnea.
Treatment: Weight loss or drugs help manage sleep apnea for some. Otherwise, minor surgery to remove soft tissue in the throat (adenoids) may be needed. If apnea continues, the sleeper can wear a nasal continuous positive airway pressure mask (CPAP).
Signs: Urgent and frequent urination may be due to poorly controlled diabetes, particularly when accompanied by blurred vision, unexpected weight loss and a family history of the disease, says family medicine physician Alfred Boyd, MD, affiliated with Memorial Hermann The Woodlands Medical Center.
Take Action: Act soon after symptoms start. Diabetes’ destruction to eyes, nerves, organs and limbs stems from the body failing to make any or enough of the hormone insulin. This causes glucose to camp out in the bloodstream rather than migrate to cells. That process, in turn, harms blood vessels, which is why heart disease often accompanies diabetes.
Screening: Doctors will review his family history and run blood tests to reveal glucose and hemoglobin a1C levels. Your optometrist or ophthalmologist may be the first to report vision changes, via an exam in which eye drops dilate pupils.
Treatment: Primary care physicians, endocrinologists and registered dietitians can help patients monitor and control blood sugar levels. Dietary changes, exercise and weight loss can help.
Signs: Grouchiness, anger, insomnia, overeating, withdrawal, lower libido, difficulty concentrating, loss of interest in favorite activities and reluctance to get out of bed are all signs of depression.
Take Action: You might try talking with your partner about his feelings first, Dr. Boyd says. “But if you’re concerned, it’s time to make an appointment.”
Screening: Doctors often screen for depression at annual checkups, but the pandemic has fueled it. Symptoms also may be due to low testosterone.
Treatment: Medication, therapy and exercise may help.
Signs: “High blood pressure is a silent killer, so there may be no symptoms,” says Dr. Boyd. But dizziness, headaches, chest pain, swelling of lower limbs, shortness of breath and a flushed face or chest pain with activity all suggest high blood pressure or heart disease that needs addressing. Smoking, obesity, inactivity, diabetes, high cholesterol and family history of cardiovascular disease hike the risk.
Take Action: It’s time to talk about his ticker if your man has any of those symptoms or risks. Hypertension harms the heart and hardens blood vessels. Blood flow to the heart may be blocked. And with loss of oxygen and nutrients, the heart may be permanently damaged, raising risk of heart attack, stroke and death. If that’s not motivation enough, alert him that clogged arteries can cause erectile dysfunction.
Screening: Blood pressure reading, possibly followed by blood and urine tests, an electrocardiogram (EKG) to record the heart rate and rhythm, and other tests can reveal the health of heart muscle.
Treatment: Doctors may prescribe drugs, including beta blockers to allow his heart to beat with less effort; angiotensin converting enzyme (ACE) inhibitors to expand blood vessels; blood thinners to thwart heart-attack-inducing blood clots; and diuretics to lower swelling.
Signs: Men may suffer pain, stiffness and pain that radiates into legs.
Take Action: According to Dr. Boyd, if back pain lasts more than two weeks, or persistent back pain is accompanied by numbness, tingling or weakness in the legs, alert your man’s primary care physician.
Screening: His doctor will review symptoms and possibly order X-rays or other exams for musculoskeletal or prostate problems.
Treatment: Stretches, anti-inflammatory drugs, cold or heat packs and weight loss may relieve pressure.
Signs: Chest pain, chronic dry cough, a sour taste in the mouth, difficulty swallowing, hoarseness or belching may signal gastro esophageal reflux disease (GERD), says general surgeon Brett D. Solomon, MD, FACS, affiliated with Memorial Hermann Southwest Hospital and Memorial Hermann-affiliated Surgery Associates of Houston.
Take Action: Head to his primary care physician or gastrointestinal specialist if symptoms occur daily or every other day. Chronic irritation of the esophagus, the route between the throat and belly, can erode the lining, which can lead to esophageal cancer.
Screening: A blood test can rule out h. pylori, a germ that causes gastric ulcers. Also, helpful may be X-rays, a manometer (to measure pressure and motion in the esophagus) or an upper endoscopy, where a scope down the throat into the stomach may reveal a defective valve between the esophagus and tummy or an enlarged hole in the diaphragm.
Treatment: He may be urged to stop smoking and refrain from eating three to four hours before bed. He also may need to cut stress and trigger foods such as red wine, chocolate, mint, onions, caffeine or hot peppers. Smaller meals and weight loss also may help. Raising the head of your bed with small wood blocks can make a difference.
His primary care physician or gastrointestinal specialist also may suggest over-the-counter antacids to resolve mild acid reflux and antibiotics to heal gastric ulcers. Doctors also may prescribe acid blockers (histamine H2-receptor antagonists) or proton pump inhibitors (PPIs), which block enzymes that produce acid. Minimally invasive surgery may be needed after prolonged use of PPIs or if other treatments fail.
Lower Sex Drive or Erectile Dysfunction
Signs: Stress and pressures have ramped up during the pandemic, among them unemployment, shaky finances and divorce.
Take Action: “Once you’re unable to perform on demand, anxiety often kicks in,” Dr. Barnes says. “Men are motivated to see their doctor.”
And they should if the problem persists. The culprit could be cardiovascular disease and diabetes, both of which clog not only the heart’s arteries but also blood vessels throughout the body. Lower sex drive may be due to abnormally low levels of the male hormone testosterone.
Screening: Doctors check whether testosterone and prostate specific antigen (PSA) are within the healthy range and may order heart or diabetes tests to rule out vascular disease. “We also screen for prostate cancer, because if we give them testosterone to treat erectile dysfunction, we can potentially accelerate cancer growth.”
Treatment: Testosterone levels, which decline with age, can be restored via gels, injections or long-lasting pellets—with a caveat: It can make men infertile, so sperm must be banked in advance, Dr. Barnes says. “Giving testosterone replacement will shut off a man’s sperm production, and there’s no guarantee we can restart that production.” Other drugs, such as Viagra and Cialis, boost blood flow to the penis, helping men maintain erections. “They also help men overcome the psychological concerns about their performance,” Dr. Barnes says. When needed, prostheses and vacuum pumps also can help.
Signs: Urgent, frequent peeing, an intermittent, weaker or slower urine stream and nocturnal bathroom trips most likely signal an enlarged prostate. The reason prostate size matters is that the gland sits just below the bladder, and the urinary tract passes through the prostate. The bigger the gland, the smaller the passage for urine, Dr. Barnes says.
Take Action: Act as soon as your man’s quality of life erodes. Remind your partner that his pals and male doctors of the same age likely are facing the same symptoms, as the size of the prostate grows after age 50. By 55, most men have some urinary inconveniences, and by age 70, four of five do.
Screening: Ask for a PSA (prostate specific antigen) blood test, urine test and digital rectal exam. They can rule out cancer and determine the culprit of inconvenient bathroom trips, including urinary tract infections.
Treatment: Medications help, by shrinking the prostate gland or relaxing the bladder and urinary tract, making voiding easier. Drugs can be used alone or together. If they fail, minimally invasive procedures can be done in an urologist’s office or on an out-patient basis. “This is a problem we can manage more easily than you would imagine,” Dr. Barnes says.
Signs: Prostate cancer has few or no symptoms until quite late in the disease. Therefore, screening with PSA is very important in its detection.
Take Action: Don’t wait for his doctor to offer a PSA blood test. Ask for one not only when your man has symptoms, but also at each annual physical, Dr. Barnes says. African Americans and those with a family history of prostate cancer should be particularly attentive to it, as their risk is higher.
Screening: If a PSA is elevated, a biopsy can be ordered to alert doctors to the presence and stage of prostate, which is the No. 1 cancer and No. 2 cause of cancer death in American men. “Prostate biopsies are done in doctors’ offices, take about six minutes and are nearly painless,” Dr. Barnes says. Since prostate cancer grows slowly, most doctors screen men after age 75.
Treatment: The man’s age and stage of cancer at diagnosis determine whether treatment is needed. Possibilities include surveillance with more frequent PSAs, radioactive pellets (called brachytherapy) implanted in the prostate. “Cancer needs male hormones to grow, so we can block testosterone production,” he says. “We can manage patients for years prior to them needing chemotherapy.” If needed, the prostate can be removed, known as prostatectomy.