Dr. Dean Elterman on Men’s Health (The Globe and Mail)


For me, improving men’s health is personal. I am a man in my mid-thirties and the statistics for living a life free of disease and health complications are not in my favour, unless I take action now. I know this because I am urologist. Every day I see male patients and colleagues who have put off taking care of their health because we live in a society where masculinity forces us to focus on our careers, abuse our bodies and neglect our health-care needs. Across all age groups globally, men die earlier and live more years in poorer health compared to women. Men are at increased risk of premature death related to heart disease, stroke, workplace accidents, suicide and risky behaviour such as drunk driving.

In some respects I’m about to make sweeping generalizations that don’t apply to all men. But bear with me.

Is there a faulty or self-destruct gene on the Y-chromosome or does being “manly” lead men to engage in riskier physical activities and socially-influenced neglect of their own health? Historically, men’s health seemed to fall off a cliff once they reached their late teens. After the days of routine pediatrician visits, boys are noticeably absent from doctors’ waiting rooms.

We become men. And men don’t see doctors. Men are fearless and strong. Men avoid asking for help or acknowledging vulnerability or weakness. We get caught up in life, starting careers and families. And society doesn’t make it easy for us. When’s the last time you ordered a kale salad and carrot juice at the hockey game? Exactly.

Men eat poorly, drink and smoke too much, don’t get enough sleep or exercise, and don’t see doctors regularly. They vanish only to show up at my office door 30 years later with a urologic complaint or in the emergency department with something much more serious.

These generalizations, I’m pleased to say, appear to be on the wane.

More young men are being inspired by campaigns like Movember to know their health risks and make changes earlier in life. Boomers are turning back the clock and men of all ages are taking a more open and proactive approach to their health.

Men never used to talk about their erections or the way they urinated. Now I have men coming in to my office, who after seeing their family doctor for the first time in decades, are asking about their testosterone or ways to improve their urinary/sexual health after hearing about it from friends. As a urologist, working in collaboration with my primary care colleagues, I am in a unique position to talk to men for perhaps the first time in many years about their cardiovascular health, lifestyle habits as well as urologic concerns.

Urologists used to see men for a single system complaint, such as an enlarged prostate, cancers or infertility. Problems were isolated and treated in a targeted fashion with little consideration for the interrelatedness of bodily systems. We now recognize the association between metabolic dysfunction, such as diabetes, and urologic disorders like lower urinary tract symptoms, low testosterone and erectile dysfunction. We also know that these urologic complaints can be the early warning signs for more serious, life-threatening conditions just a few years down the road. When a middle aged man comes into my office with a new complaint of erectile dysfunction, the first thing I think of his is heart, cholesterol, blood sugar and blood pressure, not which little erection pill I can prescribe him.

We are making great strides in both health policy and technology in the domain of men’s health. Australia and Ireland, as well as British Columbia have national/provincial men’s health initiatives that approach the issues facing men through a uniquely gendered lens, just as had been done for women’s and children’s health in the late 20th century. New minimally invasive technologies, like the laser surgery that I perform for benign prostate enlargement, are making the prospect of medical treatment and recovery that much easier for men to palate.

Men’s health is a personal issue for me. But it should be a personal issue for everyone. Men’s health affects spouses, families and communities. The health of men impacts our economy, culture and social fabric. Having healthy men is a women’s health and children’s health issue. It’s time to think about your health or the health of the men in your life. It’s never too late to make a change.

Dr. Dean Elterman is a urologic surgeon at the Toronto Western Hospital/University Health Network with a special interest in men’s health. He is the Medical Director of the Prostate Cancer Rehabilitation Clinic at Princess Margaret Hospital Cancer Centre. Dr. Elterman specializes in voiding dysfunction, sexual dysfunction and pelvic reconstruction in both men and women.

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