Clinical Decision Making - Men's Health

Clinical Decision Making - Men's Health

• Men generally delay seeking help for health issues compared to women
• Common reasons include fear, anxiety, working patterns, or embarrassment
• Some medical concerns cause unnecessary anxiety, impacting quality of life
• The most common concerns presented to community pharmacies are male pattern baldness and erectile dysfunction.

Lecture Overview

• Men's health issues include erectile dysfunction, prostate problems (enlargement, prostatitis, cancer), hair loss (male pattern baldness), low testosterone (hypogonadism), and mental health.

Erectile Dysfunction (ED)

• Definition: Inability to achieve or maintain an erection suitable for sexual intercourse.
• Causes: Stress, tiredness, excessive alcohol consumption, recreational drugs, medical conditions (high blood pressure, high cholesterol, diabetes, depression, anxiety), hormone problems.
• Risk factors: Sedentary lifestyle, obesity, smoking, hypercholesterolaemia, hypertension, certain medications (beta-blockers, antidepressants, corticosteroids), heart and blood vessel problems, diabetes, high blood pressure, high cholesterol, liver disease, alcoholism, kidney disease, multiple sclerosis.
• Non-pharmacological management: Lifestyle changes like exercise, weight loss (if BMI is high), reduction of alcohol consumption, and smoking cessation. Vacuum pumps.
• Treatment: Topical gels (e.g., Eroxon, containing Aqua, ethanol, propylene glycol, glycerine, carbomer, or potassium hydroxide). Phosphodiesterase type-5 inhibitors (first-line treatment) – avanafil, sildenafil, or vardenafil (short-acting) or tadalafil (long-acting).

Prostate Problems

• Prostate: A gland found only in men and trans women, surrounding the urethra.
• Prostate gland function: Produces a thick, white fluid that mixes with sperm to create semen.
• Prostate Enlargement (BPH): A common condition associated with aging. The prostate gland enlarges, causing symptoms like difficulty starting or stopping urination, weak urine flow, feeling of incomplete bladder emptying, frequent urination, and nocturia(waking repeatedly during the night to urinate).
• Prostatitis: Inflammation of the prostate gland. Includes acute and chronic types.
• Causes: Hormone changes associated with aging.
• Treatment: Lifestyle changes (reducing alcohol, caffeine, fizzy drinks, artificial sweeteners, and evening drinks), medicine (alpha-blockers like tamsulosin and alfuzosin, 5-alpha reductase inhibitors like finasteride or dutasteride), or surgery (only in severe cases).
• Symptoms: Difficulty starting or stopping urination, weak urine flow, straining during urination, frequent urination, feeling of incomplete bladder emptying, and nocturia.

Prostate Cancer

• Epidemiology: The most common type of cancer in men in the UK, with over 45,000 new cases diagnosed annually.
• Risk factors: Age (men over 50), ethnicity (Black men more often diagnosed), family history, obesity.
• Symptoms: Early stages are often asymptomatic, but symptoms can include needing to urinate more frequently, particularly at night, difficulty starting or stopping urination, straining to urinate, weak urine flow, feeling that the bladder has not been emptied completely, and blood in urine or semen.

Hair Loss

• Male Pattern Baldness (Androgenetic Alopecia): A common type of hair loss, often beginning at temples and gradually thinning on top of the head.
• Prevalence: Up to 80% of men experience some hair loss by age 70.
• Time frame: Hair loss can take 15-25 years.
• Causes: Genetic, part of aging.
• Diagnosis: Visible receding hairline and gradual thinning of the scalp hair.
• Treatment: Some hair loss treatments are available (including Minoxidil, Finasteride), however results are not guaranteed, and hair may not grow back permanently.

Low Testosterone (Hypogonadism)

• Definition: A condition where the body produces insufficient testosterone.
• Causes: Defects or injury to the testes, pituitary gland, or hypothalamus.
• Symptoms: Unexplained reduction in muscle mass, increase in body fat, difficulty concentrating/memory loss, fatigue, loss of body hair, mood changes, insomnia, erectile dysfunction, low sex drive, and osteoporosis (weak bones).
• Treatment: Testosterone replacement therapy (TRT), such as testosterone gels, injections, patches, buccal testosterone (mouth), and pellets (injected under skin).

Mental Health

• Pharmacist's role: Signposting patients to appropriate healthcare agencies like GPs, nurses, or mental health charities.
• Issues: Mental health conditions can sometimes be impacted by medications.
• Supporting patients: Active listening, understanding, and creating a supportive conversation environment.
• Managing conditions: referring patients to appropriate healthcare personnel.