Archive for the ‘heart disease’ Category

Low T-Review of New York Times Editorial, March 28, 2017

March 29, 2017

 

Low testosterone affects millions of American men.  Testosterone prescriptions in the United States nearly doubled in recent years from 1.2 million in 2010 to 2.2 million in 2013. Testosterone replacement is not the panacea to restore a middle aged man’s fountain of youth.  However, testosterone replacement can improve a man’s sex drive or libido, can increase his energy level and does improve bone strength and a protector for osteoporosis in men.

That’s the good news.  The bad news is that a single study comparing testosterone gel to placebo for one year found a “buildup of noncalcified plaque” in the coronary arteries of the men treated with testosterone.  However, other studies have not demonstrated any increase in heart problems in men using testosterone.

Although the positive changes were modest in the testosterone group there was a significant improvement in men’s mood in the group using testosterone gel.  The study also pointed out that older men with low testosterone levels often have other chronic health conditions, like obesity, than can affect hormone levels but these can often be managed by lifestyle changes such as an exercise program and diet.

It is important to mention that the results of the recent study do not support the promise implied by advertisements for testosterone that using it “will make you stronger and fitter,” though many men said they simply “felt better” while on the drug, and some improvements in walking could be seen when findings were analyzed.

Again, I would like to emphasize that testosterone has no place in men using these hormones for bodybuilding purposes.  At the present time use of testosterone is snot approved by the FDA for bodybuilding purposes.

The Bottom Line: Hormone replacement therapy has a role in men who have symptoms of low T and documented low blood levels of testosterone.  All men who receive testosterone need to have close follow up with PSA testing, a digital rectal examination and a blood count to check for overproduction of red blood cells.

Testosterone Replacement-Relationship With Heart Disease

March 27, 2017

Much has been written about the use of testosterone in men with symptoms of low T and documented low levels of testosterone.  One of the issues is the use of testosterone replacement therapy and its impact on cardiovascular health.

First, there have been documented trials that demonstrated clinically improvements in bone density and low blood count or anemia.  Another recent study demonstrated an impressive reduction in cardiovascular events such as heart attack and stroke in men taking testosterone for low T levels.

A two year study was conducted comparing testosterone replacement therapy using topical gels containing testosterone to placebo that had gel only and no testosterone. At one year after starting the study, there were no heart attacks, strokes, or deaths in either group. At two years there were more heart attacks and strokes in the placebo group (nine events for placebo versus two events for testosterone).  The study concluded that testosterone replacement may be cardioprotective or can protect your heart.

A key additional finding was significant improvement in bone density and strength in men treated with testosterone.

Bottom Line:  These new, exciting results provide even more evidence to support the importance of using testosterone replacement therapy in men with low levels of testosterone and who are symptomatic from their decrease in testosterone levels.

Safety of Testosterone Reported In Two Medical Journals

August 26, 2015

Two recently published studies significantly contribute to current knowledge regarding testosterone therapy and cardiovascular health. Researches from Harvard reported that 3 years of testosterone replacement therapy (TRT) in older men with low or low-normal testosterone does not cause progression of subclinical atherosclerosis o hardening of the arteries. The clinical trial was published in JAMA (2015; 314:570-81).

In addition, an article in the European Heart Journal (Aug. 6, 2015), showed that testosterone replacement therapy significantly reduced risks of death, myocardial infarction, and stroke.

The findings of both studies add to the ongoing evidence of testosterone treatment safety, cardiovascular safety in particular.

Bottom Line: These studies provide substantial confidence regarding the use of testosterone therapy when administered and monitored appropriately in well-selected individuals. These are men who have symptoms of low testosterone and confirmed by a blood test that documents low testosterone.

WHAT’S KEEPING YOU AND YOUR ERECTIONS DOWN?

August 7, 2015

Millions of American men suffer from ED or erectile dysfunction. For young men having difficulty achieving an erection, here are some common causes:
Stress : Among men in their teens, 20s and 30s, most cases of ED are linked to psychological issues. Anxiety and stress are a major factors especially if these are factors right before sex. Many young men who are inexperienced feel pressure to perform the best sexually and also have concerns about size. This stress can lead to performance anxiety. This buildup of stress can cause an influx of adrenaline or epinephrine which can inhibit an erection.
Too much bike riding : Now, just to be clear, if you’re an avid biker, it doesn’t mean you’re going to develop ED. But if you experience numbness as you ride within the first few miles or after biking marathons you may be causing long-term damage. Below the prostate (and what directly rests on the bicycle seat) are the nerves responsible for bringing blood the penis, which is what happens during an erection. Try getting fitted for a better seat if you’re experiencing this.
Medicines : Cold medications like Sudafed contain pseudoephedrine, which acts as epinephrine in the body and decreases the ability to achieve an erection. It increases your body’s natural fight or flight reaction and makes your body think you’re scared of something. The effects of the drug aren’t permanent.
Partying : Drinking and recreational drug use may also serve as a proponent of ED. Alcohol is a depressant and relaxes you but can cause the inability to perform. Cocaine for example, will lower your testosterone levels.
Cancer treatments : If young men have been diagnosed with testicular cancer or another cancer and are being treated with chemotherapy and radiation may lower testosterone levels which affect blood flow to the penis. Radiation can also directly damage the lining of the blood vessels or cause nerve damage.
Diabetes and high blood pressure are other causes of ED because diabetes impacts the body’s ability to produce nitric oxide. Another major factor is being obese or overweight. Anything that’s bad for your heart is bad for your penis. Blood vessels are tiny in the penis and if they’re clogged the blood won’t flow there. Eating right and exercising makes everything work better.

1. STOP SMOKING

Heart problems aren’t the only issue keeping men down. Erectile dysfunction is commonly caused by stress, medications, partying, cancer treatments, or even bike riding.

Smoking can cause blood vessels to narrow, which can have a detrimental effect on blood flow to sex organs. Similarly, smoking diminishes your stamina, limiting the amount of rigorous activity one can handle – which unfortunately can leave your partner wanting more.
2. WORK IT OUT
Notwithstanding my earlier comments about biking, moderate regular exercise has been shown to help improve blood flow to the sexual organs. Exercises focused on thighs, buttocks and pelvis are especially good for genital circulation. In addition, exercise boosts self-image and confidence. Anything that improves self-esteem will in turn improve libido.
3. LOSE WEIGHT
Study out of Duke, found that up to 30% of obese people seeking help controlling their weight indicate problems with sex drive, desire, performance, or all three. This is because being overweight can reduce blood flow and lower testosterone levels. High cholesterol as well as type 2 diabetes, both associated with being overweight, impact sexual performance. Both can cause penile arteries to shut down when arteries get clogged with fat deposits. Erectile dysfunction leads to decreased sexual desire and libido.
4. GINGKO BILOBA
Herbal remedies like tea or supplements derived from ginkgo biloba can have a positive effect on sexual desire and even orgasm. This age-old remedy is known to improve circulation, yet again enhancing sex.
5. TRY SOME LIBIDO-BOOSTING FOODS
Certain foods, like those high in zinc (think oysters!) can increase sperm production and testosterone- the hormone in men responsible for sex drive. Also, foods high in essential fatty acids like flaxseeds, sardines, and nuts help to increase testosterone production and increase libido.

This article was written by Dr. Samadi a board-certified urologic oncologist trained in open and traditional and laparoscopic surgery, and an expert in robotic prostate surgery in New York City.

50 Shades of Sex In the Golden Years

February 24, 2015

So many seniors think that after sixty sexual intimacy goes into the tank. This is hardly the case as an interest in intimacy and sexual activity continues throughout life even in the golden years. Our society tends to have ageist concept of intimacy, portraying sex among seniors as inappropriate or unnatural. The truth is that many seniors, both men and women, continue to be sexually active and are interested in meeting others with whom they can become intimate. There is documentation that 70% of men and 35% of women continue to be sexually active over the age of 70. This blog will discuss sex and the senior and what you can do if you are having problems with sexual intimacy in your senior years.

While most long-married individuals reported steady declines in sexual activity, those who passed the 50-year marriage mark began to report a slight increase in their sex lives.

And notably, frequency in the sex lives of long-married couples continued to improve. The study, published last month in The Archives of Sexual Behavior, researchers noted that an individual married for 50 years will have somewhat less sex than an individual married for 65 years.

The analysis of this study showed that the warm glow after the 50-year marriage mark, although flickering, was steadier than that of those in marriages of shorter duration. The researchers are sociologists at Louisiana State University, Florida State University and Baylor University.

Sexual frequency doesn’t return to two to three times a month, but it moves in that direction, which was reported by the investigator from LSU.

But the finding that some long-married couples continue to have sex decade after decade was not news to Jennie B., an 82-year-old widow who lives in a village in upstate New York. She married her first and only husband, Peter, in 1956, when they were in their mid-twenties. The couple, married 47 years, remained sexually active until he had quintuple heart bypass surgery two years before his death in 2003.

In this snapshot study of older adults, some were not having sex at all. And a few were even having sex daily. But in the main, the study looked at trends. The average older adult who had been married for a year had a 65 percent chance of having sex two to three times a month or more. At 25 years of marriage, the likelihood of that frequency dropped to 40 percent. If the marriage lasted 50 years, the likelihood was 35 percent. But if the marriage — and the lifespan — of the older adults continued, at 65 years of being together, the chance of having sex with that frequency was 42 percent.

And so, as adults age, their social circles shrink, they know time is limited, they look around and what do they see? Each other. Seniors will often place intimacy as a high priority.

I might add that seniors often engage in intimacy without having intercourse but that intimacy can occur with touching, holding hands and kissing is often just as satisfying and gratifying as sexual intercourse which occurs at an earlier age.

Bottom Line: Sex after sixty is an activity that is normal and should be encouraged. It may take a little creativity and it may take a little more planning and effort but it can happen and both partners feel a sense of enjoyment and pleasure.

Recommended Reading 30 Lessons for Loving, by Karl Pillemer, PhD.

Perhaps even 50 Shades of Grey!

A Walk A Day, and Not An Apple, Keeps the Doctor Away

February 10, 2015

The baby boomers have arrived in large numbers. They are taking responsibility for their health and are eager to stay well and out of the doctor’s office. This blog will discuss the importance of exercise, even walking, to make you healthy and well. This blog will emphasize exercise and not weight loss as the road to good health and longevity.

A brisk 20 minute walk each day could be enough to reduce your risk of early death. A study of over 334,000 European men and women found that twice as many deaths may be attributable to lack of physical activity compared with the number of deaths attributable to obesity, but that just a modest increase in physical activity could have significant health benefits.
Physical inactivity has been consistently associated with an increased risk of early death, as well as being associated with a greater risk of diseases such as heart disease and cancer. Although it may also contribute to an increased body mass index (BMI) and obesity, the association with early death is independent of an individual’s BMI.
To measure the link between physical inactivity and premature death, and its interaction with obesity, researchers analyzed data from 334,161 men and women across Europe participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study. Over an average of 12 years, the researchers measured height, weight and waist circumference, and used self-assessment to measure levels of physical activity. The results are published today in the American Journal of Clinical Nutrition.

TThe authors estimate that doing exercise equivalent to just a 20 minute brisk walk each day — burning between 90 and 110 kcal (‘calories’) — would take an individual from the inactive to moderately inactive group and reduce their risk of premature death by between 16-30%. The impact was greatest amongst normal weight individuals, but even those with higher BMI or with obesity saw a benefit.
Using the most recent available data on deaths in Europe the researchers estimate that 337,000 of the 9.2 million deaths amongst European men and women were attributable to obesity (classed as a BMI greater than 30): however, double this number of deaths (676,000) could be attributed to physical inactivity.

Bottom Line: So what is the message? This is a simple message: just a small amount of physical activity each day could have substantial health benefits for people who are physically inactive. Although we found that just 20 minutes would make a difference. Physical activity has many proven health benefits and should be an important part of our daily life.

Story Source:

Journal Reference:
1. Ulf Ekelund, Heather A Ward, Teresa Norat, Jian’an Luan, Anne M May, Elisabete Weiderpass, Stephen S Sharp, Kim Overvad, Jane Nautrup Østergaard, Anne Tjønneland, Nina Føns Johnsen, Sylvie Mesrine, Agnès Fournier, Guy Fagherazzi, Antonia Trichopoulou, Pagona Lagiou, Dimitrios Trichopoulos, Kuanrong Li, Rudolf Kaaks, Pietro Ferrari, Idlir Licaj, Mazda Jenab, Manuela Bergmann, Heiner Boeing, Domenico Palli, Sabina Sieri, Salvatore Panico, Rosario Tumino, Paolo Vineis, Petra H Peeters, Evelyn Monnikhof, H Bas Bueno-de-Mesquita, J Ramón Quirós, Antonio Agudo, María-José Sánchez, José María Huerta, Eva Ardanaz, Larraitz Arriola, Bo Hedblad, Elisabet Wirfält, Malin Sund, Mattias Johansson, Timothy J Key, Ruth C Travis, Kay-Tee Khaw, Søren Brage, Nicholas J Wareham, and Elio Riboli. Physical activity and all-cause mortality across levels of overall and abdominal adiposity in European men and women: the European Prospective Investigation into Cancer and Nutrition Study (EPIC). Am J Clin Nutr, January 14, 2015 DOI: 10.3945/ajcn.114.100065

Why Sex Is Good For You?

December 27, 2014

Sexual intimacy has been associated with having a heart attack, contacting a sexually transmitted disease (STD) or having an unplanned pregnancy. However there are some significant health benefits for engaging in regular sex.

Immune Boosting

Eating well, getting enough sleep, and getting vaccinated are all important in boosting your immune system. Add regular sex to these and you have a great immune system that defends your body against infective organisms. This is because research has shown that those that are sexually active had a higher blood level of certain antibodies than those that were not so active sexually and these antibodies help you fend off infections.

Bladder control for women

About 30% of women will have urinary incontinence at one time or the other in their lives. This is when a person passes urine without intending to. Studies have shown that women who had sex regularly were less likely to develop urinary incontinence as sex helps strengthen their pelvic muscles which is important for bladder control.

Lowers Blood Pressure

People who had more sex have been found to have a lower blood pressure compared to others, ensuring that they stay healthy. One study found that those who regularly had sex had a lower blood pressure compared to those who did not.

Sex is good exercise

It’s been found that on the average, you burn about five calories per minute while having sex. This can be a good source of exercise for those that hardly have time to exercise. The benefits of exercise are quite numerous and sex delivers some of those benefits. For a reference, jogging one mile burns about 100 calories.

Reduces Risk for Heart Attack

Men who had sex regularly were found to have a 50% lesser risk of developing a heart attack. This is not only because it raises your heart rate which is great; it also keeps your sex hormone, estrogen and testosterone, in balance which are important hormones and their balance can help avoid conditions such as osteoporosis and heart disease.

Better Sleep

You may have noticed that you sleep better after sex. This is because the hormone prolactin and melatonin is usually released after an orgasm. This hormone helps with relaxation and the feeling of sleepiness.

Reduces Stress

The arousal associated with sex is great in easing stress. This is because your brain releases some chemicals that help in exciting your entire body. Sex can also help stimulate happiness and boosts self-esteem.

Reduces Pain

Sex can help reduce the feeling of pain. Sex helps release a hormone, endorphins, which are much more potent than morphine, that usually raises your pain threshold. Sexual stimulation can combat chronic pain such as the pain associated with arthritis.

Bottom Line: Sexual intimacy is a healthy activity for consenting adults. This blog provides many of the reasons to engage in sexual activity.

Testosterone and Its Impact On the Heart-Here’s the Good News

October 22, 2014

I am frequently queried by my patients about the safety of using testosterone and the risk of developing heart disease or a stroke. I would like to give you the evidence from the medical literature, and then help you make an informed decision if testosterone replacement is right for you.

Men have more than twice the risk of dying from coronary disease than women. It has been assumed that testosterone is deleterious to the male cardiovascular system and contributes to the risk of heart disease. In fact, there is little evidence that testosterone produced in body by the testicles is an adverse risk factor but the role of testosterone status and replacement therapy on male health is controversial.

High doses of anabolic steroids often used by body builders and athletes are undoubtedly associated with cardiac disease but these are doses much higher than what the body normally produces. Testosterone levels within the normal range do not appear to be harmful. Indeed, low rather than high testosterone levels in men are associated with several cardiovascular risk factors including an atherosclerosis or hardening of the arteries, insulin resistance, and obesity.

Let me give you information first from animal studies where the scientists can control the variables. Studies in male animals have shown that castration or induced hypogonadism increases atherosclerosis and testosterone replacement prevents this. In addition, testosterone has beneficial effects in men with cardiac disease. Testosterone is a potent coronary artery vasodilator. Testosterone therapy reduces total cholesterol, fat mass, waist circumference and pro-inflammatory cytokines associated with atherosclerosis, diabetes and the metabolic syndrome. Testosterone also improves functional capacity of the heart and insulin resistance in men with heart failure.

In an ageing male population low serumotal testosterone is common and has a prevalence of 30% in men over the age of 60 years. Testosterone deficiency may cause undesirable effects such as loss of bone and lean body mass, increased adiposity, low energy and impaired physical and sexual function. Until recently, these effects were viewed as the natural physiology of aging; however, four recent major studies have found low testosterone to be associated with increased all-cause mortality after controlling for baseline morbidity and age.

The effect of testosterone on mortality has demonstrated an increased risk of death due to cardiovascular diseases in men with low testosterone. One report found that mortality due to any cause and cardiovascular mortality was increased with a reduction in serum testosterone. Low testosterone status is therefore associated with mortality and vascular mortality, yet no study has specifically examined patients with established cardiovascular disease. This is important because men with manifest coronary artery disease are at a higher risk of cardiovascular mortality and represent a patient population prone to testosterone deficiency. In addition, those men with angina, chronic heart failure or diabetes may derive particular symptomatic benefit from androgen replacement therapy.

This study had two aims: first to assess the impact of testosterone status on life expectancy in men with pre-existing coronary disease, and second to identify the prevalence of biochemical testosterone deficiency in men with coronary disease. Our hypothesis was that low serum testosterone would be associated with an adverse survival.

One excellent study that was peer reviewed showed that the prevalence of testosterone deficiency is common in men with coronary disease and is present in 25% of the men. The data have confirmed that low T is related to all-cause and vascular mortality in a coronary disease population. Therefore, the study also concluded that borderline low levels of T may also have an adverse impact on survival.

This study is entirely consistent with previous studies of low testosterone as a cause of decreased life expectancy.

What is the pathophysiology of low testosterone status and the apparent increased mortality of atherosclerotic disease? Animal data show that testosterone deficiency accelerates atheroma or atherosclerosis and replacement with testosterone prevents this. Human studies have shown an increased progression of atheroma in men with lower testosterone. These data therefore suggest that testosterone deficiency is associated with progressive atherosclerosis and replacement, in animals at least, prevents this progression of the heart disease.

We have demonstrated that testosterone deficiency is associated with premature death in male patients with vascular disease; many of these patients died and will continue to die from cardiovascular disease. There is scientific evidence and several documented trials showing benefit in terms of risk factor modification and symptoms. If androgen deficiency is part of the underlying pathophysiology of atherosclerotic disease in men, then the serum testosterone level could be viewed as a modifiable risk factor as men can increase the T level by testosterone replacement therapy. Physiological testosterone replacement is an inexpensive and well-tolerated therapy but does require careful monitoring.

Bottom Line: Testosterone deficiency is common in middle aged and older men. Low testosterone levels appear to cause men to be at an increased risk of cardiovascular disease and even increased risk of death. Hormone replacement therapy for men who are symptomatic may be protective of heart disease but these men require close follow up consisting of a PSA test, a digital rectal exam, and a blood count to check that there is not an increased production of red blood cells.

ED or Impotence May Be Sending A Message To Your Heart and Brain

October 22, 2014

Having trouble with your erections? You are not alone as nearly 30 million American men suffer from this problem. That’s the bad news. The good news is that erectile dysfunction or ED may be harbinger of something more ominous that may affect your health and well-being. This blog will discuss the connection between ED and heart disease.

No man wants to be diagnosed with erectile dysfunction (ED), but believe it or not, it could save your life. In many cases, ED is a precursor to cardiovascular disease and when diagnosed properly could reduce the chance of having a heart attack or stroke.

ED is the inability to obtain or sustain an erection. It is extremely common, affecting more than half of men over 60. Given our rising rates of obesity and sedentary lifestyles, there is a good chance that performance in the bedroom is not about emotional issues or the male anatomy itself. It may sound strange but the penis is the barometer of a man’s overall health.

You can imagine how a heart artery gets clogged in a person with high blood pressure, high cholesterol or diabetes. When that coronary artery, which measures around 1\8 inch, gets obstructed that little to no blood flows through it, that man is going to experience chest pain (angina) or a heart attack. The same holds true for the carotid arteries, which measure 1\2 inch and take blood up to the brain. When the carotid artery gets blocked, that man will experience symptoms of a stroke. Now imagine the tiny penile artery, measuring only 1\16 inch. Its smaller diameter makes it ultra-sensitive to blockages, resulting in erectile dysfunction the penile artery becomes blocked.

Our entire vascular system is connected and the same things that harm our big blood vessels to our heart and brain will affect our smallest ones as well. The common cause of all this is what’s called atherosclerosis. As the same systemic process takes place throughout our vascular system, it’s these small arteries in the penis that will feel the effects earlier and manifest the symptoms of ED before other organs such as a man’s heart or brain start to suffer.

A lack of erections or difficulty holding an erection may be one of the earliest signs of impending heart disease or a stroke. When a man experiences ED this should an alarm should for men, their partners and their doctors. It’s important to realize that ED and cardiovascular disease have the same risk factors. These include high blood pressure, diabetes, high cholesterol, smoking and excess weight. Realize, too, that all these risk factors are modifiable, meaning you can actually improve them to reverse or halt the damage that is being done.

The message is: the recognition of ED as a warning sign of silent vascular disease has led to the concept that a man with ED and no cardiac symptoms is a cardiac (or vascular) patient until proven otherwise. Studies show that men presenting with only mild ED have a significant amount of undiagnosed high blood pressure, high blood sugar and high cholesterol, among other things. This is why men with mild ED, particularly if they are younger than 50, need to be screened for cardiovascular risk factors and have those risks treated aggressively. This means a visit to a doctor, having an EKG, and a stress test to see if there any decrease in blood supply to the heart.

We’ve come a long way since the days when ED was something men kept to themselves, too embarrassed to discuss with their friends or doctor. The introduction of pills (Viagra, Cialis, Levitra) to treat ED over 15 years ago opened the door for conversations about the condition.

The good news that lifestyle changes to modify risk factors, such as high blood pressure, elevated cholesterol level, obesity, and diabetes, that will provide the greatest benefit to a man’s overall health, not just his penis.

Bottom Line: ED can be a harbinger of impending heart disease or stroke. Don’t dismiss difficulty getting or holding an erection as this may indicate a future heart attack or stroke. See you doctor or urologist.

Issues To Consider Regarding Vasectomy

October 12, 2014

Men who consider a vasectomy often ask questions about the risks involved. This blog will discuss the risks and the consequences of vasectomy and what every man needs to know before proceeding with the procedure.

There are three main concerns regarding the long-term consequences or general health hazards of vasectomy. These concerns have arisen mainly from isolated studies over the past 50 years. Remember that it is important to show that several things be true when trying to link two medical conditions: a) that the link makes physiological sense and that this is shown in either animal models or in humans, and b) there should be excellent evidence of this link in populations of humans.

Heart Disease Risk

In 1979 a study was published that suggested that atherosclerosis or coronary artery disease might occur prematurely after vasectomy in monkeys. In this small study, monkeys fed high cholesterol diets were found to have what appeared to be increased amounts of atherosclerosis following vasectomy. Subsequent animal studies did not agree with these initial findings, and large epidemiological studies, including an extensive study of U.S physicians followed for 259,000 person-years have concluded that neither early atherosclerosis nor heart attacks or strokes occur more frequently in men who have had vasectomies compared to men who have not.

It is true is that after vasectomy, approximately 60-70% of men develop a form of allergy to their sperm in the form of antisperm antibodies. The body, either during the vasectomy or after, is exposed to sperm proteins that it commonly does not see and antibodies against these proteins can be observed in some patients. However, it has not been shown conclusively that the presence of these antibodies has any significant effect on other organs.

Prostate Cancer Risk

There has been much discussion over the past 15 years about whether vasectomy is associated with the development of prostate cancer later in life. The Journal of the American Medical Association published 2 reports suggesting that men who have had a vasectomy may be at risk for developing prostate cancer. Both studies were coauthored by Dr. Edward Giovannucci. One study evaluated men married to female nurses: men with vasectomies were compared to men without. The second study evaluated men in the health professions (veterinarians, pharmacists etc) who had had a vasectomy, and, again compared them with other male health professionals who had not had vasectomies. In both studies, there appeared to be an increased risk of developing prostate cancer in men who had a vasectomy more than 20-22 years before. On the contrary, several other studies, including several in the U.S showed no statistically significant increase in the risk of prostate cancer following vasectomy. Indeed, it was suggested in the same JAMA issues that a true cause-and-effect relationship could occur by chance alone, or because of biases (selectivity) or other unaccounted variables in these two studies.

Concerns raised from these studies include the fact that the men in the study might not represent the larger population of all men who get vasectomies. This means that the study cannot be used with certainty to predict a similar occurrence in the general population. It is also possible that the men who had had vasectomies in these studies would be more likely to see a urologist rather than an internist or family practice physician for later evaluation of a urologic problem than the men who had not had vasectomies. Urologists are better at finding prostate abnormalities than other kinds of physicians and therefore cancer might have been detected earlier than it would have otherwise. This is called “detection bias.” It has also been suggested this study design makes it impossible to identify all of the factors that might contribute to this end result with two events (vasectomy and cancer) occurring several decades apart. A prospective study is really necessary here to answer the question. A prospective study evaluates groups of patients at the time they have the vasectomy and follows them regularly for years to see, if indeed, cancers do occur. This is the most powerful way to study this relationship, but was not used in the Giovannucci papers. In addition, no study has ever established that there is an increased risk of death after prostate cancer following vasectomy.

Because the question of a relationship between vasectomy and prostate cancer was raised, the American Urological Association first recommended that men who had a vasectomy more than 20 years ago or who were > 40 years of age at the time of vasectomy have an annual examination of their prostates as well as a blood test for prostate cancer (serum Prostate Specific Antigen or PSA). However, given the recent lack of support for this relationship between vasectomy and prostate cancer, this recommendation has been revoked. Finally, no mechanism is known, nor is there any animal model proof of the plausibility of the link between these conditions.

Dementia Risk

There is a recent, single, small paper that has linked vasectomy to the later development of a rare form of Alzheimer’s disease. The issue is that a researcher found that, among a group of patients suffering a form of dementia called primary progressive aphasia (PPA) that is often confused for Alzheimer’s disease, the men had a higher percentage of vasectomy than was thought normal. The study found that 40% of 47 men with PPA had had a vasectomy, while among another 57 men from the community without PPA there was a vasectomy rate of 16%. What this means is simply that the rate of vasectomy among PPA patients is a little over 2 fold higher than in otherwise healthy patients. This study did not find an increased rate of vasectomy in patients with Alzheimer’s.

The most common form of dementia caused by brain deterioration in individuals over age 65 is Alzheimer’s disease. A very unusual form of Alzheimer’s disease is called primary progressive aphasia. This condition robs people of their ability to speak and understand language, but they are still able to maintain their hobbies and perform other complicated tasks for a long time. By contrast, Alzheimer’s patients lose their memory, interest in hobbies, family life and become idle.

A “mechanism” for the association between PPA and vasectomy was also proposed in the study. It involves the fact that men can have antibodies form to sperm after having a vasectomy (see above risks) and these antibodies may somehow cross-react with the brain and cause PPA. There is no animal model data to support this theory, however.

Problems with this study are similar to that described for prostate cancer risk and vasectomy. How unique were these patients that they gathered from all over the US twice annually to participate in a support group with such rare disease? We really need a prospective study to show this relationship as retrospective studies have too much “bias” or too many uncontrolled issues that could produce the same result. In addition, the study groups were very small: fewer than 20 PPA patients had a vasectomy and fewer than 10 healthy patients had a vasectomy. It is hard to generalize at all from so few patients in a study. Also, the study methods were faulty in that the vasectomy condition should have been confirmed by reviewing the medical charts on the PPA patients, since their disease alters their ability to understand, hear and remember what has happened to them! Indeed, like the issue of prostate cancer and vasectomy, this issue will take at least a decade or two to confirm or disprove.

Bottom Line: Vasectomy remains an effective method of sterilization. Certainly there are risks with any procedure and the risks of prostate cancer, dementia, and heart disease need to be considered by every man who wishes to proceed with the vasectomy.