Men’s health doctor — what does that mean? After all, both men and women have many health needs in common. Routine blood pressure checks, screening and maintenance for conditions such as heart disease, diabetes and cancers, treatment for injuries, infections and chronic illnesses, mental health screening and referrals can all fall under the umbrella of primary care — regardless of sex or gender.
As children, boys and girls see the same pediatricians. Some kids may see adolescent medicine specialists for issues such as reproductive health, eating disorders and mood changes as they transition into adulthood. By the time they reach 18, however, health maintenance and scheduled doctors’ visits really begin to diverge.
Certain health needs are largely unique to men, such as low testosterone (which can occur in women, but is more often treated and better-researched in men), benign prostatic hyperplasia (enlarged prostate), erectile dysfunction and male infertility. But that’s only part of the constellation of health issues for which men need screening, evaluation, treatment and ongoing management.
“There’s this unmet need for comprehensive men’s health care,” says urologist Dr. Jesse N. Mills, director of the Men’s Clinic at UCLA, an associate professor at David Geffen School of Medicine at UCLA and director of UCLA Urology — Santa Monica. “Because we don’t have quite the same structure as women’s health, where when a woman turns 18, she gets her first cervical cancer screening or pap smear.”
Although often done by a gynecologist, he notes, these services can also be given by a primary care provider with specialty training within women’s health.
“The model doesn’t really hold up on the male side,” Mills says. “We don’t necessarily have that primary care physician that thinks about men’s health, because we don’t have that annual screening. We really don’t see a physician until we’re 45 now and start to think about colon cancer screening, and 50 to 55 before we think about prostate cancer screening. So, it’s a little confusing,” says Mills, author of “A Field Guide to Men’s Health,” published in January 2022.
[SEE: Top Vitamins for Men.]
Men’s Primary Care
Men (and women) have access to a variety of primary care physicians who can provide routine screening and treatment, as well as ongoing preventive and wellness care. Some focus on patients of all ages, while others, like pediatricians, concentrate on a specific population (in that case, children).
Primary care providers also serve as a gateway or referral source to specialists such as cardiologists, endocrinologists, oncologists, surgeons, mental health therapists and more.
These are the main types of primary care and related physicians that men may visit for routine care:
— Family practitioner. Family physicians see patients from infancy through end of life. They undergo additional training, including a three-year residency, to provide patient care across the lifespan, according to the American Academy of Family Physicians. They provide continuing and comprehensive medical care, health maintenance and preventive services to every family member. Typically, they serve as a patient’s first contact for health concerns and make referrals for complex conditions.
— Internal medicine doctor. Internal medicine doctors focus on adult patients, those who are 18 and older. Also called internists, in addition to providing routine care, they receive critical care training to help patients with multiple or uncontrolled medical problems.
— Geriatrician. A geriatrician is a primary care doctor with specialized training in treating older patients. Although patients often wait until they’re in their mid-60s and beyond to start seeing a geriatrician, these specialists can also help somewhat younger adults experiencing frailty, age-related diseases such as dementia and osteoporosis or who need management of multiple medications such as blood pressure, cholesterol-lowering and anti-inflammatory drugs.
— Urologist. A urologist specializes in conditions that affect the urinary tract in both men and women. In addition, urologists treat conditions affecting men’s reproductive systems and male fertility. Some men see a urologist for primary care of conditions such as kidney stones or prostate cancer.
“If you interviewed five physicians and asked them what men’s health was, or who provided men’s health, you would probably get at least three different answers,” Mills says. “Basically, it comes down to urologists and primary care physicians who have a specialty training or interest in male hormone replacement and sexual dysfunction.”
[See: Questions to Ask Your Doctor About Prostate Cancer.]
Meeting Men’s Health Needs
“We really need to do a better job of engaging and educating men about the type of care they need,” says Dr. Lee Ponsky, chairman of the urology institute and executive director of the Cutler Center for Men at University Hospitals Cleveland Medical Center and a professor at Case Western Reserve University School of Medicine. “And making it easier for them and less intimidating and less burdensome even in terms of just scheduling.”
Many men have good intentions when it comes to maintaining their overall health, but following through is another matter. “You talk to guys and say: ‘Do you have a primary doctor? Have you gotten your cholesterol checked? Have you had a colonoscopy?'” Ponsky says. “And they go, ‘Yeah, I’ve really got to do that’ — and it just gets put on their list of things to do.”
Besides time constraints, he says, multiple factors play into that gap, such as fear, trust and cost.
“Significantly less men than women see a doctor every year,” Ponsky says. According to the National Health Interview Survey 2014, conducted by the Centers for Disease Control and Prevention, twice as many men had not seen a doctor within the past two years, compared to women, and three times as many men had not seen a doctor in more than five years.
About 70% of men have a place they go for care and medical advice when they’re sick, compared with more than 85% of women, according to the “Gender Differences in Health Care, Status, and Use: Spotlight on Men’s Health” report from the Kaiser Family Foundation.
It’s important for men to get on top of their overall health. Men are at more risk of early heart disease, for example. “Women catch up to us about 10 years later,” Mills says. “Men start to really get hit with cardiovascular disease in our 40s and 50s. Women tend to get hit as hard, but usually postmenopausal.”
Men’s mental health needs too often go unmet, Mills says. In 2020, the suicide rate for men was nearly four times that of women, according to the American Foundation for Suicide Prevention. “We have a three-plus to one depression rate that often goes untreated because we don’t seek care,” he says. “There’s a lot of strain but men don’t feel they can reach out for help, especially with mental health issues.”
Looking Beyond ED Symptoms
Online telehealth platforms such as Roman and Hims offer convenient, all-virtual access to men’s health requests like prescriptions for erectile dysfunction drugs. However, they can’t replace primary care that includes in-depth medical histories and in-person physical exams when needed.
Sexual health is connected to overall health, Mills points out. “When a guy turns 40, the clock starts ticking on loss of sexual function,” he says. At that age, “A good 40% of us have some difficulty with sexual health and erectile function — and a lot of that goes back to cardiovascular health. Because we know that men who have erectile dysfunction in their 40s have a two- to threefold risk of developing severe cardiac disease within the next 10 years.”
Erectile dysfunction may be related to circulation problems involving the inner lining of blood vessels and smooth muscle, causing inadequate blood flow to the penis. Blood supply impairment can affect the heart, as well, according to the Mayo Clinic website.
With all that in mind, “When I look at engaging with men for sexual health issues between the ages of 18 and 50 if they come in for that, it’s a great opportunity for me as a more comprehensive health specialist to check their mental health needs, check their cardiovascular health,” Mills says.
“And at the end of the visit, often they’ll still get a prescription for those medications”, says Mills. “But we would have done a much deeper dive into making sure that we weren’t missing an opportunity to lower their blood pressure or their cholesterol or anything else we could do to have them lead a much healthier life.”
[See: 7 Signs of Depression in Men.]
Reconnecting With Primary Care
The journey to connecting with a health care provider is individual to each man. “Everyone needs a quarterback they can trust,” Ponsky says. “So it’s about finding a physician they can get along with, who they trust. That might start out as a primary care doctor. It might be their urologist, just because they’re seeing a urologist for a specific problem.”
Once a man has a regular provider, he now has a conduit to other physicians. “A good primary care doctor will be someone who is going to get you to see the cardiologist when you need your heart checked, get you to see the GI specialist when you need your colonoscopy or to a urologist when you need a urologist,” Ponsky says. “Or a mental health specialist. That is really the point of having a primary care doctor — to get you plugged in.”
As of March 2022, the Cutler Center for Men is in the midst of its internal rollout. Ultimately, the aim is to make a significant impact in the population of men, in their health and their lives.
“We have multiple specialists across the different specialties who have said, ‘Yes, I have an interest in this,'” Ponsky explains. “And we recognize where the needs are in cardiology and mental health, in GI and urology, and primary care and sports medicine, and nutrition and physical therapy — and it can go on and on.”
That, he says, along with navigation and reminder services, will make it easier for men to come to one place and connect with providers they need.
Many men get lost in the transition from childhood health care managed by their parents to adult health care on their own, Ponsky says, with a major drop-off in visits after the age of 18: “It’s not infrequent to talk to 20, 30 or even 40-year-olds and ask, ‘When was your last doctor visit?’ and they’ll say, ‘My pediatrician.'”
The Cutler Center has developed a program for that transition period of care with physicians who’ve completed residencies in both pediatrics and adult primary care, Ponsky notes. “The 19- to 25-year-old men don’t necessarily want to see the same doctor as their father or grandfather,” he says. “So, there has to be a degree of relatability for that age group.”
Men’s Doctors Near Me
Many university health systems have men’s health centers or men’s health clinics that offer comprehensive health services, starting with primary care.
You also can find men’s primary and related health care in your area through the U.S. News doctor finder. Depending on your needs, search for these types of local physicians:
— General/primary care doctors.
— Internists.
— Urologists.
— Preventive medicine physicians.
— Sports medicine specialists.
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Primary Doctors for Men originally appeared on usnews.com
