Men's Health
Core concepts
Prostate cancer screening is the classic shared-decision topic: PSA discussion starting at 50 (or 40–45 with high risk - Black men, family history, BRCA carriers), with the recognition that screening reduces mortality but carries overdiagnosis and overtreatment risk. Abnormal PSA → repeat PSA, then biopsy/MRI pathway. Benign prostatic hyperplasia: symptom score (IPSS), start with behavioral changes and alpha-blockers (tamsulosin) for lower urinary tract symptoms; add 5-alpha reductase inhibitors for larger glands or progression risk. Watch for postural hypotension with alpha-blockers and sexual side effects with 5-ARIs.
Testosterone: diagnose hypogonadism with two morning total testosterone levels plus symptoms; treat only with confirmed deficiency and counsel on fertility suppression. Erectile dysfunction is often a marker of cardiovascular disease - work up risk factors. Peyronie's, priapism (urologic emergency), and testicular torsion (acute scrotal pain, high-riding testis, absent cremasteric reflex - surgical emergency) are high-yield.
Screen for AAA in men 65–75 who ever smoked (one-time ultrasound). Colorectal and lung cancer screening follow general rules. Address depression, alcohol, and intimate partner violence.
Traps
- Treating a single low testosterone without confirmation.
- Missing testicular torsion as a surgical emergency.
- PSA screening without shared decision-making - the answer is a discussion.
- Forgetting AAA ultrasound in older male smokers.
Rule of thumb
Acute scrotal pain in a young male = torsion until proven otherwise; do not wait for ultrasound to call surgery. In older men, think of ED as a cardiovascular warning sign.