Hmmm. As I typed the word "andropause," my computer's spell-check program immediately underlined the word in red. Only in the last decade or so have health professionals given more serious attention to andropause, rather than the flip and sexist term "male menopause."
Recently I taught a unique shiatsu CEU workshop combining men's and women's health, with a Five Element close-up on menopause/andropause.
It was so balancing to highlight some of the similarities (hormonal changes, urinary problems, osteoporosis, insomnia, depression, and changes in libido.) It was good to challenge stereotyping and misconceptions about things such as heart disease being a typically "male" domain (when it's the biggest killer of women in the U.S.) and midlife depression being a typically "female" disease (and too often underdiagnosed in men). It also felt good to discuss the value of working on couples, giving shared advice on the importance of weightbearing exercises, dietary modifications and cross-training.
Ninety-nine percent of my workshop participants were women, with one lone, brave male. Alas, this imbalance reflects something of a phenomenon, a "catch-22" situation in medicine. Men's health is a taboo when topics leap outside of the popular obsession with muscular strength, image, and sexual prowess.
Male Cycle/Female Cycle
Generally speaking, male-to-female ratios among students are more evenly distributed in acupuncture training than in ABT, but this is changing. When I give as much emphasis to the subtleties of the "male cycle" as the "female cycle," on the "Earth" days of my Five Element classes, my students (especially male students) express wonder and relief. One of them talked about the subtle changes he feels in his body, smell, beard and moods during monthly cycles, but admitted that "guys don't normally share these things." Another student told me he once kept a journal on his own physical and emotional shifts, but tore it up out of embarrassment. We encouraged him to renew his journal writing, especially as a way of sharpening insights to help him treat male patients in the future.
When I ask my male colleagues (in acupuncture and ABT) why they aren't giving more time to men's health in workshops, and why there seems to be an obsessive concentration on women's health issues, the frequent answer is, "Most of our patients are women. Men are reluctant to discuss their intimate health problems." One colleague added, dismissively, "Ninety percent of TCM advice on sexual dysfunction refers to women."
Hello? How about all those Viagra "spam" e-mail messages? If we don't give equal time in our teaching and textbooks to women's and men's health issues, we perpetuate the taboos, myths, and embarrassment. God forbid anyone should run for online Viagra instead of first seeking medical advice!
Good Texts, East and West
Prior to giving my recent workshop, I performed a "spot check" on good texts on men's health in both Western and Asian medicine. What an eye-opener! The best and most detailed study on the acupuncture and Chinese herbal shelves was A Handbook of TCM Urology & Male Sexual Dysfunction by Anna Lin, published by Blue Poppy Press. The health section at my local Barnes and Noble offers a splendid display of books on women's health, but no display on men's health. "Oh - you'll find men's health mixed in with general health," the store manager giggled nervously, adding, "One day we'll probably face a lawsuit about this." The best book I found was (surprise?) Your Husband's Health, written by Kathleen W. Wilson, MD. (Her husband is also an MD - but she wrote the book!) Dr. Wilson sprinkles her user-friendly text with great case studies on every possible aspect of men's health, with relevant dietary and exercise advice. She highlights the importance of prostate-specific antigen (PSA) tests. (Normal is less than 4, but should be less than 2.6 in men under 45, and higher than 4 in men over 60.) "If PSA is higher than 10," she writes, "the probability of prostate cancer is over 50 percent." She also advises readers not to be overconfident when results are low, and quotes the case of a 49-year-old patient with a 3.9 PSA who, on closer examination, was discovered to be in the early stages of prostate cancer.
A spot check of men's health magazines reveals a dearth of info and advice on men's health problems. Most men's magazines feature gorgeous hunks with eye-boggling pecs and washboard abs, and advice on how to satisfy women. Very little, if any, advice was given on the importance of self-examination; specific exercises to strengthen the pelvic muscles to ease or help prevent urinary problems; how to recognize warning signs in enlarged testicles or burning urination; or anything resembling the depth and breadth of frank advice on women's health issues given in women's magazines. One of my patients told me he consults Discover magazine, Scientific American and the Web to update himself on men's health issues.
While in Germany, I came across a great article in a pharmacy "freebie" publication on just this topic: detailed information about men's health issues with useful checklists and tables and advice. I photocopied it for my students in Germany, Switzerland and Austria. I'll prepare an English translation for my American students, because I have yet to discover equally detailed advice in magazines here. One refreshing local exception is the article "Perfect Prostate Health," by acupuncturist/herbalist Christopher Hobbs.
The statistics about the increase in both testicular and prostate cancer are alarming. Champion Tour de France cyclist Lance Armstrong has become the poster boy for cancer survivors. I hope his all-too-familiar comment, "I ignored my symptoms until it was almost too late," is widely heard by men aged between 15 and 35, the most common age group for testicular cancer. Indeed, I have heard from other cyclists that Armstrong's example prompted them to seek help and never assume excessive friction from the saddle alone causes testicular or urinary discomfort. Others find immediate relief by cross- training, or using special male-friendly saddles.
Recently I met "Roland" - a prospective student of acupuncture, a cancer survivor in his mid-twenties, and a big, beefy, muscular guy who actually believed his swollen testicles were (in his own words) a "macho" sign. He was shocked to learn he had cancer. "Share this experience with your buddies," I suggested. "You could save a life." He looked away shyly and said, "We don't discuss things like this." I told him, "Be the first to break that taboo, especially if you want to be an acupuncturist!"
"Bruce," a survivor of breast cancer, speaks about the day he watched his office buddies poke fun at a group of breast cancer activists demonstrating in the street outside. "Guys," he said, lifting his shirt to show his own scars, "I'm also a survivor." The jokes and laughter soon stopped. Men account for between 1 percent and 2 percent of all breast cancers in the U.S., but the statistics are higher in Europe.
Prostate cancer among men (one in five in the U.S.) is actually more widespread than breast cancer in women - but compare the huge disparities in information, campaigns, public awareness, demonstrations, funding, literature, etc., for breast cancer, compared with the modest campaigning for prostate cancer. Michael Korda was one of the first to break the silence with his landmark Man to Man account of his own experiences. My uncle, a retired brigadier general in the U.S. Army, and a caricature (cigar-chomping, tight crew cut, square face), developed prostate cancer, allegedly from exposure to Agent Orange during service in Vietnam. He experienced hot flashes and enlarged breasts as a result of post-radiation hormone therapy. "Hell," he told me, "I'll never laugh again when a woman tells me she's going through hot flashes." Fortunately he has a wonderful sense of humor and no embarrassment at all about sharing all of this with us.
I'm sure everyone reading this column knows someone with prostate problems: a patient, father, lover, husband, brother, etc. How many of these men suffer from frequent or infrequent urination or related problems before they finally seek medical advice after repeated requests from wives, lovers, daughters or sisters?
In his "Perfect Prostate Health" article, Christopher Hobbs describes the case of "Mark," who sought acupuncture for "plumbing problems" because he was desperate, experiencing a frequent urge to urinate, but an inability to empty his bladder. Hobbs diagnosed Mark as an excessive heat, possibly inflammatory condition. As Mark was needle-shy, Hobbs prescribed 360 mg of saw palmetto (serenoa repens) twice daily with meals, with success. Dietary recommendations included dropping red meat in favor of beans, fresh fruit, vegetables, garlic and onions. Hobbs also recommended flaxseed, olive oil, salmon and halibut to help reduce inflammation.
As benign prostatic hyperplasia (swollen prostate or BPH) is a common problem experienced during andropause, caused by a drop in testosterone and a rise in estrogen levels, more men are consulting acupuncturists over invasive Western medical procedures that can result in impotence, writes Hobbs.
National Public Radio (NPR) reported an increase in testosterone replacement therapy (TRT) for a range of andropause-related problems (prostate, urinary difficulties, impotence and depression), but experts warn that long-term results of TRT may be as harmful and counterproductive as HRT in women. This is a heavily researched area for women, but alarmingly under-researched for men. NPR also reported a research project underway at Bastyr University, involving 350 women in herbal and placebo studies, as viable alternatives to HRT. I hope they conduct a similar follow-up for men.
Tips and Case Studies
In my shiatsu practice, depending on the precise diagnosis, I have often found Bladder, Kidney, Liver and Spleen meridians especially helpful for andropause-related problems, together with stretching, and maximizing meridian stretch positions during the session. Working with the Bladder meridian in the yoga baby pose helps urinary problems, with emphasis on Bl 23 (Kidney back shu) and K3. Exercise and dietary advice are equally crucial, as is developing more self-awareness about bodily changes, and encouraging men to realize they are not the only ones experiencing these problems. Ren and Spleen meridians are useful for enhancing fertility, along with practical advice (such as avoiding wearing tight underpants, and giving testicles the "cold water" routine).
I'll share one of my most fascinating case studies as an example of how ABT works through diagnostic layers in subtle ways. One of my patients in Europe, "Stefan," suddenly began to experience severe memory lapses. A battery of standard medical tests eliminated the possibility of brain tumors, seizures, neurological damage, and so on. His PSA tests were normal.
Stefan has been a patient of mine for several years, but as we both travel frequently, I only see him every few months or so. The memory lapses were new and baffling. Hara diagnosis (abdominal palpation) showed a deep deficiency in his san jiao, a unique texture of deficiency I have felt in patients with a past history of drug addiction. Warning bells went off in my mind. Stefan talked about recent efforts to escape depression through alcohol and marijuana. Again, this was a departure from his usual behavior. He's 50, so we discussed the nature of his depression. He admitted to experiencing a fear of losing his youth: a typical andropausal problem.
I talked to him about jing and andropause and associated symptoms, including memory loss, but his recent and severe memory lapses were so extreme I suspected the major culprit was substance abuse. I knew he was in therapy for the latter, so I also advised him to keep a journal so we could pinpoint every possible factor contributing to his memory problem. Frequent flight travel and binge eating turned out to be a double-prompt, which didn't surprise me, because jet lag also hits san jiao. Both Water and Fire elements needed harmonizing. In Stefan's case, treating san jiao and Bladder, or Heart and Kidney, helped, along with weekly counseling sessions from a therapist in his home town. All of this inspired him to return to his regular exercise routine and watch his diet, especially when traveling. Stefan has quit binging. The memory lapses are over.