The importance of men’s health

Sam Craft: I’m her co-host, Sam Craft.

Mary Leigh: And we are here today with Dr. Brandon Williamson, he is a clinical assistant professor at the Texas A&M College of Medicine. And he works a lot with our family medicine residency program. Thanks for coming on the show!

Brandon Williamson: Thanks for having me guys, I really appreciate it.

Mary Leigh: Yeah. So it is men’s health awareness month, and so we brought you here today to talk a little bit about some hot topics, some important things men should generally know about their health.

Sam Craft: It’s like the stuff that men don’t want to talk about but they need to talk about it, because it’s health related. Like some of those come out today, I bet.

Brandon Williamson: Sure, what I think a lot when I think of men coming to the doctor’s office, is usually there with their wife. Or their significant other dragging them. Which you like to make fun of, right? But also I think a lot of times men just don’t want to be a burden.

Sam Craft: Oh for sure.

Brandon Williamson: They’re used to being, going to work, not complaining, all that stuff. So it can be hard whenever you are sick or do need to be taken care of. But there are definitely things men need to think about in their life. You know, I think something we see people a lot for in the hospital is just heart disease, right? People that come in either worried about heart disease or have a heart attack in the hospital. And I think we’ve done a great job about raising awareness for women in that situation, but men, they don’t have the typical symptoms sometimes, and they need to keep track of what’s going on. And men, they end up with all the risk factors, it feels like. It hits them younger, higher blood pressure, high cholesterol. All of our jobs are behind a desk now, and then family history, I bet just in this room we probably have family history of cardiac disease. Yep, you’ve got it.

Sam Craft: Yep. Grandfather.

Brandon Williamson: And so it is something you just need to think about. And I don’t want to get too into the weeds, but really they’ve expanded the guidelines for who needs to be on medications to lower cholesterol and things like that.

Sam Craft: What are the stats on men and heart disease? Is it the number one killer of men?

Brandon Williamson: I believe so. Really, I think about just all the things that go together. We end up with diabetes and high blood pressure and all that stuff. Just wrapping up into a perfect storm of heart disease.

Sam Craft: Yeah, heart problems seem to be kind of overlapping into a bunch of other problems.

Mary Leigh: Yeah, and they’re all married together too.

Brandon Williamson: Yes, they all travel together, unfortunately.

Sam Craft: Yeah, it’s obesity, and then diabetes, and then high blood pressure, cholesterol. It just dominoes downhill, it feels like.

Brandon Williamson: Yeah, exactly.

Mary Leigh: What does high cholesterol do? Why is it bad? Because I know we need, it shouldn’t be high, and I know there is good cholesterol and there’s bad cholesterol.

Sam Craft: I’ve had good cholesterol be bad, and that was confusing. Like I had too much of it or something, that was confusing.

Mary Leigh: It’s all just beyond me

Brandon Williamson: Yeah sure. So you can’t avoid eating fats and cholesterol. Well maybe if you’re very strict. But I think for the vast majority of us, you can’t avoid it. So your body has to figure out a way to move it where it needs to go, to the liver to make other things. Well in the process of moving it, it has to go around the blood vessels. And depending upon the kind of cholesterol you have, which is a big area of research right now, it may be predisposed to getting put into the vessel walls. Your arteries around your heart, or really any place in your body. Your brain, for instance. And so how can we prevent it from going there, and being in the place we want it to be, which is helping your body sustain itself. So that’s where, for instance, everyone I think has heard of statins recently.

Sam Craft: Mm-hmm (affirmative).

Brandon Williamson: And those are probably the biggest advancement in improving heart attacks in the last 20 years.

Sam Craft: And that’s a good point, the technology of health care in terms of treating heart disease, seems like it’s come a very long way.

Brandon Williamson: Yeah, for sure.

Sam Craft: I mean even in the last 10 years, it’s just multiplied so much, because it’s become such a big problem. I guess it’s become more of a focus.

Brandon Williamson: Yeah, and if we can keep people from having that heart attack, being in the hospital, or having other complications from it, that is ideal, that’s where you need to go see your primary doc for, is to talk about that. I tell guys, I have a lot of friends that ask questions, and I tell them, if you’re pretty healthy you can probably get away with things until you’re in the 35 or 40 range, but you really ought to go at least establish a relationship with someone and just talk with them about how you’re doing.

Sam Craft: That’s a good point, that age gets everybody. I think it’s, for what you do in men’s health, when should a man be really concerned about…they should always be really concerned about their health. But we really need to get established with the system, going to see a doctor every 6 months or whatever.

Mary Leigh: And especially, because things like high cholesterol, you don’t know. If you don’t go to the doctor, or the…

Sam Craft: They sneak up on you.

Mary Leigh: Yeah, you just don’t know until you come down with…

Sam Craft: It’s too late.

Brandon Williamson: Yeah, nowadays, we’re screening kids even for cholesterol problems.

Sam Craft: Really?

Brandon Williamson: And so if you have something that’s really bad, it’s typically picked up when you’re a kid. Really, once you’re a young adult, you’re in your early 20s, you need to have at least one visit where you can see somebody and establish. And then find somebody you trust, and then they’ll kind of guide you as to how often. So yearly, if you’re healthy, is pretty common. But if you, and I’m talking to everyone who’s listening. If you are 35 or 40 and you haven’t been to a doctor, you need to go. So make that appointment. It may be that he just says “hey, I’ll see you in a year or two”, but just go.

Sam Craft: Yeah, and go get some blood work done, make sure everything’s okay, and yeah.

Mary Leigh: And this might be a silly question, but what is the difference between having heart disease and then having a heart attack? Do you have to…if you have heart disease, is that just the chronic state of possibly having a heart attack? Like what is… I’ve always, I’ve never known.

Brandon Williamson: Yeah, so when we’ve done, when they’ve looked, you actually develop cholesterol deposits in your arteries when you’re pretty young, like late adolescence. But as they build up over time, they form what we call plaques, and if those are unstable, they can break apart, and then block the vessels around the heart, which lead to a heart attack. So if you do have heart disease, or you have atherosclerosis, the fancy word for it, it predisposes you for having a heart attack, which is what we’re trying to prevent.

Sam Craft: So with congestive heart failure, I know that’s like a… I always thought that was just a…”he died of congestive heart failure”, it was a one-time event. But knowing what I know now, my father in law has congestive heart failure, that’s a long term disease, is that? Is that considered heart disease, does that fall under that category of things, or is that it’s own?

Brandon Williamson: It’s definitely a form of heart disease. A lot of heart failure is caused by cholesterol issues, maybe you’ve had small heart attacks in the past. But also, the other things, high blood pressure, it’s hard for a heart to squeeze against a really high blood pressure. Diabetes, all of those things can affect your heart, and lead it to have heart failure, which is really not squeezing the way it should.

Mary Leigh: And so are there any specific symptoms men notice that they might not know?

Brandon Williamson: Yeah, so we have to go over, men are just predictable. Most of the times we have the usual symptoms.

Sam Craft: Well, like your left arm hurts, it goes numb, like those are the ones, like that’s the one I know of. And what are the, I’m interested to know what the other ones are.

Brandon Williamson: So when I talk to my residents, they tell me, I’m like well is it chest pain or pressure, does it move into an arm or up to a neck, are they sweaty or nauseous with it? Does it get worse if they go for a walk or run, does it get better when they rest? Those are all really concerning signs.

Sam Craft: So left arm numbness, sweating, somebody stepping on your chest. Is there an order to those or is it just kind of random? Or do they all tie in together?

Brandon Williamson: Your heart does what it wants.

Sam Craft: Oh.

Brandon Williamson: Yeah. But like a third of people…

Mary Leigh: That was oddly romantic!

Brandon Williamson: I know. See I’m referencing the Valentine’s video.

Sam Craft: Oh, I see what you did there!

Brandon Williamson: Yeah, I got it. Okay. But yeah about a third of people don’t have chest pain when they show up.

Sam Craft: Really?

Brandon Williamson: And so you can just have shortness of breath, fatigue, the nausea that we talked about, some people have some palpitations where they just feel like their heart flip flopping in their chest. And so if you’re feeling those, and I get tired right, so everyone gets fatigued, but if you’re really feeling bad, you need to let somebody know. Either call…

Sam Craft: Something like more out of the normal.

Brandon Williamson: Mm-hmm (affirmative), exactly.

Mary Leigh: Yeah, I know somebody who was very healthy. He ran half marathons every other month, it felt like. And he had a heart attack. So can healthy people have them too?

Brandon Williamson: Of course. We can’t get a picture of the inside of your arteries unfortunately. We know now that part of having a heart attack is that there’s some form of inflammation, and that’s part of the reason we think statins help, is they don’t just decrease bad cholesterol, but they decrease inflammation. And so even if you are perfectly healthy, the heart does what it wants.

Sam Craft: That’s so scary to think. You know, you get out and you’re a runner and you train every day, and you’re “Oh, I’ll run 10 miles a day”, and then you have a heart attack, it’s like what happened? I thought I was doing everything I could to prevent this. It’s terrifying.

Mary Leigh: And what in the world is a small heart attack.

Sam Craft: It’s a little baby heart attack.

Mary Leigh: Yeah, I think they’re such a big, significant event, so putting the descriptor “small” in front of it is strange.

Brandon Williamson: Yeah, so there’s 2 big arteries that go to the heart, left and right. Very simply named, but then as you go farther down, they get smaller and smaller. And so if instead of one of those big arteries getting blocked, if you have a smaller one blocked, that’s all that means. Is a small heart attack.

Mary Leigh: Oh, so it’s not necessarily the severity of the heart attack?

Brandon Williamson: Well the big one is certainly more severe, right? A classic kind in men is called a widowmaker, that’s where a specific artery gets secluded and it’s because a lot of folks with those don’t survive to make it to the hospital.

Sam Craft: Oh, that’s terrifying. In addition to heart attacks, I think another major killer, so to speak, in men, and I think everybody, would be cancer. And prostate cancer is a real thing, and it’s really really treatable, I think, in the first few stages if they catch it early enough, is that correct?

Brandon Williamson: So prostate cancer is one of the biggest areas of debate right now. So if you talk to your parents for instance, your dad probably had his PSA, prostate specific antigen, checked every year, for a long time. And so we were doing this for awhile where we could check everyone. And then you have to go and get it biopsied to see if everything’s okay, and then if you find cancer you have a big surgery.

Mary Leigh: Every year was a biopsy?

Brandon Williamson: No.

Mary Leigh: Oh good lord.

Sam Craft: Right?

Brandon Williamson: If your level was elevated.

Sam Craft: Okay.

Mary Leigh: Okay, thank goodness.

Brandon Williamson: Oh my goodness, yeah, no one would get screened if it involved the biopsy every time. Yeah, you’re gonna do what? No, I’ll pass. Yeah, so you would get a blood test every year and if it was high, you would get a biopsy. And if you had cancer you would get surgery or radiation. And then we found out that surgery has some bad effects, and even the biopsy does. The biopsy is, they take pieces of the prostate and you have between a 1 and 4 percent chance of having to go to the hospital for that for infection. And then the big 2 complications men care about after having your prostate out, is 1, sexual disfunction, and 2, is incontinence. So you end up urinating on yourself and having to wear diapers for a long time. Or pads. And that’s a big deal. So not too long ago, and if you just survey guidelines in North America, a lot of them are saying, “you really need to have this discussion with men before you order a test”. Because what we’ve found is that a lot of men don’t die of prostate cancer, they die with prostate cancer. Meaning your heart disease, for instance, is much more likely to take you than prostate cancer.

Prostate cancer, we’re diagnosing all the time. It’s just you need to know when to screen for it.

Sam Craft: Okay.

Brandon Williamson: Because a lot of people will have it, and it’ll just stay at a low grade for the rest of their life, and then something much more benign will take their life.

Mary Leigh: Are there any symptoms to it?

Brandon Williamson: So unfortunately, there aren’t any great specific symptoms, meaning that’s what it is. Just think about what a large prostate does to men.

Mary Leigh: Can you remind what a prostate does?

Brandon Williamson: Yeah, I’m getting there, I’m getting there. So all the older men will know.

Sam Craft: You have to pee a lot.

Brandon Williamson: Yeah, you urinate a lot at night. You sometimes feel like you haven’t finished peeing, because you’re being obstructed, it’s obstructing your urethra. You’re having to go more often than usual, you have a weaker stream, things like that. So those are, they’re called lower urinary tract symptoms.

Sam Craft: Well and for a guy, you know, especially in that department, you know when something’s wrong.

Brandon Williamson: That’s a true statement.

Sam Craft: Well you know you’re not yourself. You talk about low stream is a good example. It’s like when you get there and it’s like this is just not normal me.

Brandon Williamson: It’s amazing what guys will deal with. So if it’s not prostate cancer that causes a large prostate, vastly more common is BPH, benign prostate hyperplasia. Where your prostate gets big and that’s just part of becoming an older man. And if you talk with older gentlemen, they’ll go pee 3 or 4 times at night and it’s just their life and they deal with that.

Sam Craft: Oh, I can’t imagine that many times.

Mary Leigh: It kind of sounds like a UTI.

Brandon Williamson: Yeah, except for they shouldn’t have any burning when they pee.

Mary Leigh: Fair enough.

Brandon Williamson: Yeah. Men can get urinary tract infections. So who to screen, I guess is the question. If someone’s listening like “should I get screened?”

Sam Craft: Is it like 40 and on?

Brandon Williamson: Yeah.

Sam Craft: Like I’m 38, and I think I started getting prostate exams when I was 34, 35.

Brandon Williamson: So maybe HIPAA violation, but are you a high-risk patient is the question.

Sam Craft: I don’t believe so. What are the qualifications?

Brandon Williamson: Yeah, so I think high risk mostly is if you’ve had at least one relative that’s had prostate cancer. And some organizations say more than one. And then the other one is African American race, you have a higher risk for whatever reason.

Sam Craft: I think my doctor is just being over cautious. Which I am perfectly fine with.

Brandon Williamson: And yeah, that’s a big thing. You just have to have a discussion with the patient. Most people are not recommending screening less than 50 or 55 years old, unless you’re a high risk patient. And then talking with the patient before you screen, in that 55-69 age range. So you need to know if something comes back positive, are you willing to deal with the downstream effects?

Sam Craft: Those crazy side effects of what you said, the biopsy and all that. I had never heard that before.

Brandon Williamson: Yep.

Mary Leigh: Oh, I was going to ask, how far does that family history reach? My grandfather had prostate cancer. So does that mean my brother should be more aware of it? Or if I ever have a son, would…how far does that family line travel I guess?

Brandon Williamson: In general, unless we’re talking about genetic syndromes, they mean the first degree relative. So your father, your mother, your siblings, your kids, those are all your first degree relatives. So if your great-grandfather had something, then you’re probably okay.

Mary Leigh: So what about testicular cancer? Because that’s another man-specific cancer.

Brandon Williamson: Testicular cancer is about 1% of men’s cancers, but what is really good about it, is it’s probably one of the most curable forms. And if that’s the case, then no one has recommended screening in an average risk patient. So if you’re very paranoid, just like women do breast self exams, you can do a testicular self exam, once a month. But really they usually just recommend those in patients that are high risk. So those are folks that have had an undescended testicle when they were kids, if they’ve already had testicular cancer once, you don’t want to miss it again, and then if you have a family history like we talked about.

Mary Leigh: And does any treatment for that impact any male hormones or create any sexual disfunction?

Sam Craft: They usually just remove the testicle, don’t they? Is that the normal procedure?

Brandon Williamson: Yep, usually you take out the testicle, and make sure it hasn’t spread anywhere else, and most men do very well afterwards. Very well. You have a backup in place. Yeah.

Sam Craft: I got another guy, it’s okay. So I guess cancer and heart attacks, those are the big scary things. What about the lesser things? I say lesser, just because they’re not as scary as heart attacks or cancer.

Mary Leigh: They’re not life threatening.

Sam Craft: Yeah. I mean low testosterone is a thing I think a lot of men deal with, especially in older age. What age do you start to lose testosterone?

Brandon Williamson: Yeah, so that’s an area of debate. So probably your testosterone goes down, especially after you’re 60 years old, especially as you get older, even after that. But the question is, is that normal? Or is that abnormal? Right? Because if it’s normal then maybe we shouldn’t be trying to do anything about it. And I don’t know if you guys, I haven’t seen any around Bryan College Station, but I was in Dallas-Fort Worth before moving here, and there were Low T shops all over the place.

Sam Craft: Really?

Brandon Williamson: Mm-hmm (affirmative). And so that’s what the clinics were for, you’d come in and you’d take your test, and I bet a large percentage of men ended up with testosterone replacement therapy after that.

Sam Craft: I guess for the people who don’t know what testosterone controls, could you explain a little bit about what testosterone actually does for men?

Brandon Williamson: Yeah. So the main thing is libido, of course, but then muscle mass, and you just think about all the things that distinguish a man from a woman. You have a lower voice, again more muscle, you have a distribution of body hair, like your beard for instance, testosterone.

Sam Craft: Yeah. And I think low testosterone, I would assume, probably plays into some mental health issues as well if you can’t, if you’re losing your voice, so to speak, from a male perspective. There’s other areas where that plays into I think that can really get you in a depression and could just multiply into other things.

Mary Leigh: And I bet like a lack of libido, or trouble in that area, can cause a lot of anxiety or stress.

Sam Craft: Stress on your marriage, stress on you, anxiety, depression, all that falls into that category of things.

Brandon Williamson: I think because these low t shops are around, I think people are trying to cut down on inappropriately prescribed testosterone, and so if you just think about…when I was younger, I just could do a lot more, I wouldn’t get tired, I wouldn’t get sore, all that stuff. And even now, like I pick up my kids the wrong way and I’m paying for it the next day.

Sam Craft: Oh yeah, you sneeze the wrong way and you’re done.

Brandon Williamson: How did this happen? How does this happen?

Sam Craft: Yeah, I understand.

Brandon Williamson: But a lot of things are just getting older. You are not going to have the same energy as a 70 year old man that you did when you were 18. And playing 3 sports, doing 2-a-days, all that stuff. Nor are you going to have that same muscle mass as when you were younger. And so one is telling people, do we have realistic expectations here? You know, Schwarzenegger and what’s….oh my goodness.

Sam Craft: Sylvester Stallone?

Brandon Williamson: Thank you so much.

Sam Craft: Those are the 2, I mean they’re in their 70s now, and they still look like they’re in their 40s, or 30s even.

Brandon Williamson: And I don’t think that’s quite the natural course for Mr. Stallone.

Sam Craft: Oh I’m sure that’s not the natural course.

Brandon Williamson: So anyways. Some of those things, like a very specific sign of low testosterone is if you lose the body hair that you had before. The decreased libido, we talked about. Partially, that’s like decreased morning erections that’s a sign that you have a normal testosterone. If you have a low bone mineral density. If you have a concerning history, like maybe you’ve had radiation in your brain for cancer before, or you’ve had a bad trauma, or you’ve had testicular cancer, things like that. Those are all reasons why you probably ought to be, if you’ve had those symptoms, you should be screened for low testosterone. But we’re really cracking down on this, is it fatigue, depression, or just you’re not as strong, or you have more body fat than before. Those aren’t necessarily due to testosterone. Normal testosterone necessarily fixes all those things. And so, if you have a concern, don’t go to a low T shop, but go…

Sam Craft: Go see a doctor.

Brandon Williamson: Go chat with your doctor. Because there are things that affect all of that. Those are very non-specific symptoms, you could be depressed not because of low testosterone, but because maybe you have some hard things in your life that you’re going through, you need to get through, you need to talk to someone about. You could be tired all the time because you have 4 kids and you are just in the thick of it for the next 10 years, it’s gonna be that way. You could have other issues too, other medical problems that are causing this that isn’t necessarily low testosterone. So I would just caution people. You know, it’s what we look for, we want a fix, that’s like something is missing, we want a fix. Things like have you done the basics? Are you eating better? Are you sleeping enough? We have a thousand reasons to not sleep at night guys, and it’s not just kids walking up in the middle of the night.

Mary Leigh: I always see those sketchy commercials late night about the different supplements and the different probably not-FDA regulated type of stuff.

Brandon Williamson: You already caught onto it. They can put whatever they want in those things.

Sam Craft: That’s what’s so terrifying. People will be like “Oh, I’ve got low T”, just for example. And I’ll go to the T shop and just buy some. You don’t know what’s in there. I think it’s like a crapshoot. Lord knows what you’re going to be putting in your body.

Brandon Williamson: Mm-hmm (affirmative) for the supplements you have to be careful. We’re supposed to ask everyone what supplements are you on as well, because some can interact with your medications. The statins we talked about before, there are other drugs that can interact with those and other supplements that can interact with them. But yeah, if you go into a low T shop and they prescribe you testosterone…

Sam Craft: Wait, they actually prescribe you that there?

Brandon Williamson: It’s a prescription. An injection, or a foam, or whatever.

Sam Craft: Is it a medical professional doing this?

Brandon Williamson: Mm-hmm (affirmative) and so…

Sam Craft: I’ve just never heard of these shops before.

Mary Leigh: Like a licensed professional?

Brandon Williamson: Uh huh, it’s a prescription.

Sam Craft: I’m so confused, I’m sorry, I’ve just never heard of these shops before.

Brandon Williamson: Yeah, well go on your road trip to Houston this weekend, go look around and see if you can find some.

Sam Craft: I feel like it’s a pill factory waiting to happen.

Brandon Williamson: Yeah, I think so, unfortunately. And there are risks to testosterone too. We don’t have great studies, but things like your prostate can get bigger, which we talked about earlier.

Sam Craft: Okay.

Brandon Williamson: Sleep apnea can either start or get worse. Your cholesterol will probably get a little bit worse. And probably the biggest controversy is are we increasing your cardiovascular risk?

Sam Craft: Oh yeah.

Brandon Williamson: And so some studies say oh no, but some studies say that it does get worse. But I haven’t heard of a study that says it gets better, so I would just strongly consider not replacing it unless you really meet criteria for low testosterone.

Mary Leigh: I think everything we’ve spoken about today just sounded like a bunch of random symptoms that could be something. I think that sounds terrifying.

Sam Craft: I think that’s what life is though, I feel like. If you have one thing happen to you and you’re like, “oh, this is what it is”. No it’s really like 6,000 other things that are happening to you that are just like this one other big thing.

Mary Leigh: And I guess that’s the role of your primary care of your family medicine doc, that’s your resource. If something doesn’t seem right or if something, you just have that little question pop into your head, I guess that’s what you’re here for.

Brandon Williamson: Definitely. I think one of the things I… there are a lot of things people come to the doctor for and we don’t have a diagnosis, and that’s frustrating for everyone involved. I just want you to know it’s frustrating for the doctor to when they’re like “I don’t know what’s going on”. I tell my residents that one of the most important things that they can say to a patient is “I don’t know what’s going on, but I’m not concerned”. Part of your training and seeing patients for so long is seeing the concerning things, and knowing what does need to be worked up, when labs need to be ordered, or X-rays, or even just the follow up to talk with someone again. And so if you’re concerned, by all means make an appointment. Spend 15 or 20-30 minutes with a doctor once a year isn’t a bad way to spend your time.

Sam Craft: No, and I think as a male myself, and having those lower body problems, it’s embarrassing to talk to people about it. But if there’s one person you can, it’s your doctor. And you should make a point to do it because if that one thing is bothering you, if it spirals into something else, which sounds like it easily could, it’s going to be a lot worse in the long run.

Mary Leigh: And it’s even better, that way you just stop thinking about it. Like if you’re worried something’s an issue, at least with me, I’ll always think it’s an issue until I hear otherwise. Even just for sanity purposes.

Sam Craft: Just stress, anxiety. I mean those two things right there just grow and cartwheel on themselves.

Brandon Williamson: I think things that people get embarrassed about are things that a doctor hears every day.

Sam Craft: Oh for sure.

Brandon Williamson: Like a couple of times. You’re never going to surprise a doctor, it’s never going to…it really isn’t. Even if you’re uncomfortable, the doctor’s probably heard what you’re gonna say many many times over.

Sam Craft: Oh probably two times before he saw you that day, or he or she saw you that day.

Brandon Williamson: It would be surprising at all. Yeah for sure.

Mary Leigh: So we know the importance of spending a little of time with your doctor every year.

Sam Craft: See your doctor.

Mary Leigh: And I’m glad our listeners have spent a little bit of time with us today. Brandon, thank you so much for coming on the show, I think everyone learned, I learned a lot.

Sam Craft: Yeah, I did too.

Mary Leigh: Hopefully everyone listening did.

Sam Craft: Thanks for coming.

Brandon Williamson: Yeah, I really appreciated it, it’s been fun.

Mary Leigh: Yeah, so thank you everybody for listening. This has been another episode of “Sounds like Health”.