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Integrative Men’s Health

June 2014
BY Victor S. Sierpina, MD, ABFM, ABIHM Director, Medical Student Education Program, WD and Laura Nell Nicholson Family Professor of Integrative Medicine, Professor, Family Medicine University of Texas Distinguished Teaching Professor AND Myers Hurt, MD Assistant Professor of Family Medicine, UTMB-Health, Galveston with special interests in integrative medicine and men’s health

The study of women’s health issues has long been an important and major contribution to improving medical care. Women use 70% of medical services and usually make the medical choices for their spouses and families. Thus issues such as menopause, premenstrual syndrome, breast cancer, and osteoporosis have long gotten much attention in the medical and popular press.

Proportionately, men’s health has been a bit of a stepchild, almost an afterthought as we review the literature on gender-related medicine. Into this gap are now arriving more books and articles on men’s health and wellness. A few issues ago, we mentioned Dr. John LaPuma’s book, Men Don’t Diet, They Refuel as one of this genre for the popular market.

A new offering from the Weil Integrative Medicine Library series for the professional sector is Integrative Men’s Health by Drs. Myles D. Spar and George E. Muñoz. We were so pleased to see this latest addition to the extensive library of now about a dozen titles.

Men’s health is definitely more than urology as Dr. Andrew Weil notes in the forward. Men die younger than women, are disproportionately affected by cardiovascular disease, engage in higher risk health behaviors, and seek medical care less frequently. Reaching this population with integrative medicine approaches to healthier lifestyles remains a challenge.

The first two chapters tackle the meat of the entire volume by highlighting nutrition and dietary supplements first and foremost. The authors of these chapters lay an impressive foundation of the impact of nutrition on overall wellness, fitness, and recovery, as well as disease states more prevalent in the male population - specifically cardiovascular health, obesity, and insulin resistance. As expected, a strong emphasis is placed on both the Mediterranean and the anti-inflammatory diets, with a robust discussion of evidence-based use of multivitamins and omega-3 fatty acids. The authors also briefly entertain the role of “niche” diets (Paleo, Atkins, Ornish, etc.) in order to compare and contrast risks and benefits of each. A focus section on the role of nutrition on erectile dysfunction, BPH, and athletic performance remind us of the target patient audience.

The editors scattered a handful of chapters throughout the book to address male wellness through the eyes of different staple integrative disciplines: a list of homeopathic remedies for arteriosclerosis to orchitis; acupuncture and acupressure for sports injuries and addiction; the role of stress in cardiovascular disease with evidenced based resources for hypnosis and biofeedback for stress reduction; and tools to help facilitate obtaining a spiritual history and to facilitate discussion for the reluctant male who finds himself in your office. Particularly well written however, the Ayurveda chapter stands apart. After briefly defining the theory behind Ayurvedic thought, Dr. Mills and Friedman offer the reader a concise “Dosha Questionnaire” to use as an in-office patient assessment tool followed by a brief but thorough preventative care toolbox - stressing the importance of sleep, early morning exercise, yoga, herbs, simple daily routines, and again, the cornerstone of proper nutrition. We found this to be one of the most useful tools in the book.

A second handful of chapters offer practitioners an integrated approach to male health through different organ systems, with chapters on cardiology, urology, gastroenterology, bone health, and common cancers found in males, each with a discussion of traditional therapies, as well as recommendations on specific herbal remedies, nutrients, or other modalities shown to produce positive results. The American Cancer Society recommendations on nutrition for cancer prevention further reinforce the role of diet in health throughout these chapters.

The third groups of chapters are those most specifically suited to the subject of the work – men’s health. These include physical activity, sexual health, and testosterone deficiency. Drs. Campbell and Spar write a bulleted, almost PowerPoint slide of a chapter with cut and dry results- driven data on the benefits of physical activity as a key component to optimal health in men, as well as techniques for injury prevention. The sexual health chapter is by length the shortest in the book at nine pages, but it reads much like an ideal patient encounter would - a concise explanation of the pathophysiology of erectile dysfunction as a gateway into chronic disease management. The testosterone chapter, by comparison, is one of the longest, and covers diagnosis, treatment, surveillance, and health impact of this arena still struggling to define concrete guidelines. Twelve entire pages of references are available for this controversial topic and guide the reader towards a wide variety of source material for additional research.

The editors close with another “News You Can Use” list of quick tips to avoid environmental toxins specifically detrimental towards men - endocrine disruptors and agents that impair sperm health. They also express hope for the future of men’s health as a well defined discipline revolving around “executive physicals” - annual physicals similar to a well woman exam that would include a genomic risk screening, nutritional (macronutrient and micronutrient) assessment, stress management evaluation, exercise tolerance testing, and hormonal analysis - far beyond the digital rectal, lipid panel and BMP we are so used to.

We found the chapter by long-time colleague and friend Mary Hardy on Integrative Treatment of Common Cancers in Men to be incredibly thorough, detailed, practical , and evidence-based. The dermatology chapter, which followed, contains a surprising number of pearls and integrative approaches to skin care.

Overall, this is an incredibly important resource for those who take care of men, whether primary care or specialty physicians. It offers a full range of topics and therapies unique to men. The final chapter entitled “The Future of Integrative Men’s Health” points out that men’s health is developmentally nearing adolescence. It suggests ways to customize and individualize the assessment of the male patient including nutritional, metabolic, and genomic assessment. Systemically, we are encouraged to partner with women’s health and utilized their methods of advocacy to improve men’s health. More focus on low testosterone, obesity, and sleep issues is recommended.

The “black hole” in men’s health seems to occur after college athletics, as men don’t automatically get ongoing screening as women do. Integrative Men’s Health is a call to fill this hole with holistic and integrative care that is personalized, proactive, wellness oriented, and tailored to the men we treat. We enthusiastically recommend reading this latest and long-awaited addition to the Weil Integrative Medicine Library.