"Men are in danger of becoming extinct," is the name of the course for senior doctors given by Prof. Steven Lamm, medical director of New York University's Langone’s Preston Robert Tisch Center for Men’s Health. In his clinic, Prof. Lamm focuses on more than the quality of erections, the quality of sperm or prostates but also the overall health of men, and he says that today requires fundamental treatment.
What is a men's health doctor from your point of view? Isn't every doctor first and foremost a doctor treating men?
"Surprisingly no. Women treat their health far better and in a more proactive way than men. For women there is an ongoing connection with their doctors and with their body. They come to their doctors on matters related to their menstrual cycle, contraception, and then pregnancy and birth. They undergo periodical pap smears and breast examinations. In contrast, men leave their pediatrician and go to college and the next time they see a doctor is when they're rushed to the emergency room with a heart attack."
"The male," says Prof. Lamm, "is a sensitive creature. He has to speak with another man in order to evaluate his health. If you pass criticism on men, or talk down to them with instructions, they won't listen to you. They don't take care of themselves.'
And that's in contrast to women?
"Women have a greater tendency to comply with instructions from health organizations. They'll undergo a mammography once every two years because they have understood the importance of it to their lives and the quality of their lives. Men need to be approached differently."
"The thing that motivates the men who come to me is the desire to continue to be successful, competitive and vital. That is especially true of the younger generation. While the older generation will not even admit having a medical problem and therefore health doesn't apparently interest him, young people understand that concern for health is not necessarily a sign of weakness."
"When a young man comes to me, together with him I mark out a line - on one side I write 'healthy' and on the other side 'sick' and then I ask him where are you on this line. Most likely he will put himself somewhere closer to 'healthy.' And then I ask 'what do you plan to do so that the next time we meet you will be closer to 'healthy.' It naturally works in the opposite direction, so I am handing patients responsibility for their health. Most of them will tell me, 'I work out five times a week,' and I respond, excellent now put more effort into nutrition, sleep and preventing excessive stress. I tell him, 'You are a young father, you have to look after yourself. Think about your child and how their life will change if you were to die when they are 15 rather than 40."
If your patient's routine requires him to choose between an hour of sleep or an hour of sport, what is better?
"Sleep is as important as food and water and more important than physical exercise. When I'm talking about physical exercise, I'm looking more at movement and less at exhausting yourself in intensive and difficult activities. I think that you need to look after your joints rather than flex them and that's my approach with myself. It's a shame that I haven't been a little bit more cautious. I didn't need to tear my muscles and my tendons. There is no need to lift weights to keep fit that are several times heavier than anything you'll ever need to lift on a daily basis. It's only a mental game with yourself. It's just to be macho. It's important to engage in a lot of movement and do things that are functional for your life. It's a very significant thing.
"You mustn't give up on a patient"
Obesity is a critical part of the metabolic syndrome that you deal with. If you approach to treatment is based more on physical activity or nutrition?
"My approach is based on biological tracks, on signs that the body transmits to the brain and when they are disrupted then obesity occurs. This approach, in locating the biological mechanisms causing obesity won those who discovered it the Nobel Prize and has even entered official instructions on treating obesity but it hasn't really gained a foothold among nutritionists and doctors.
"For many years I asked myself, why do people get fat? And in particular, why do the absolute majority of cases involve a rise in weight after making so much effort to diet? Or they are stupid, or they don't care, or there is a biological block. Because the first two possibilities are not logical, it has to be the third. And it is indeed clear that obesity prevents hormones from signaling to the brain what and how to eat.
"It seems that the body stabilizes around a certain weight and is not prepared to budge from it. And then every few years there is a gain in weight and it stabilizes around a heavier level. And when does that happen? In 95% of cases people gain weight when their lives are in chaos. It is an almost direct response to emotional pressure and the mess of life that causes a discharge of adrenaline, sleeping disorders and then also obesity.
"I ask doctors why they think that good treatment is simply to say to people to do something that they cannot do? Is it logical to ask a disabled person to walk without offering any support or assistance? What are the chances that it will help? A patient comes to the doctor who tells him that there will be significant benefits for his problem if he will go on a diet. The patient comes back and he is still no thinner. The doctor again suggests that he go on a diet and then he comes back a third time and has not lost weight, if he comes back at all because he is embarrassed by the situation and so the doctor has already given up in effect on the health of that patient, even though the doctor has many ways to help the person, to lose weight and generally. This doctor is not okay. You must not give up on a patient."
What will help the patient?
"Medications. There are new and good medications for reducing weight. The one I prefer is GLP1. It creates satiation, and slows down the emptying of the stomach. This solution seems better to me than 'will power.'"
Is that not the rule for all addictions?
"Yes and also in the case of alcohol addiction, for example, there are medications that are more effective than saying to people 'stop drinking.' Abstaining through will power alone works over the long-term in only 5% of cases, the same as with obesity. However, I don't see obesity as just an addiction. It is a more complicated situation."
"Viagra is medication against sexual diseases"
As a specialist in men's health, the man reason that people come to you is surely erectile dysfunction?
"Erection is a barometer of health for men. If you were to tell me that you were a health insurer then you need to ask a patient just one question before deciding if it is worth insuring him. I would ask him if he had an erection when he woke up this morning. The penis has the smallest blood vessels, and so the erection can testify on blood disease, which is the most significant part of all the metabolic syndromes long before there are other signs.
"When your blood is not flowing well, you are not healthy. Your skin is not healthy, your liver is not healthy, your heart is not healthy - and your penis is not healthy. So Viagra is not the right answer for somebody who has problems with erection. For sure take Viagra but understand that you have a deeper problem. If you sleep better, your penis will stand up. If you stop smoking - your penis will stand up. If you have gotten fat, you're probably producing less testosterone, and so there is a decrease in sexual performance. The penis tells you that you need to be healthier."
"When I was interviewed on Howard Stern's radio program I told him, I can tell who here in the room has erection problems. And it's true. But I meant to say that I can know who is smoking, for example. What I cannot know who has anxiety performance. That's a whole other problem and is more typical of young men. For a young man erection problems stem from anxiety about performance, addiction or a severe sleep problem"
Lamm makes an interesting connection between erection problems and sexual diseases. "Adult men are not prepared to use condoms because they fear they will lose their erection. The classic case is the divorced man who begins to go out with women after a long time and is obviously scared about the situation and was also unable to obtain an erection when he was young. So he tends to refrain from using a condom. He says, from this point of view, Viagra is a medication against sexual diseases."
Lamm treats psychological factors as well as the sociological ones, as he defines them. "I would be remiss in my role as physician if I did not ask the patient who his partner is and did not find out whether it is possible that he is not attracted to her or concerned that she is not attracted to him," he says. With this he claims that "sociology" is more relevant when talking about treating women.
"I'm glad that I treat men and not women. Everybody who has tried to understand the sexuality of women has failed. When you know about the sexuality of one man, you know something about sexuality of men. When you know the sexuality of one woman, you know one woman."
"Sexual dissatisfaction among women is much more common than among men. I did not say 'performance' but dissatisfaction and that's much more complicated and not possible to treat. This includes arousal, orgasm, pain, connection to the partner and body image. With men, for the most part sex will soften anger about the relationship with the partner and body image. With women, it doesn't exactly work like that, or at least with some women. If my wife has not removed the hair from her legs then there won't be any sex today. For men that makes no difference, they first of all want sex and then think about what's going on around them, about the relationship. Don't get angry about what I'm saying, I'm only the messenger."
"Therefore the medications that have been tried out for 'treating' the female libido have only gained limited success. One should be very cautious about the 'medicalization' of female sexuality because of the great social complexity. I'm very happy that I deal with male sexuality."
A problem that is less spoken about is premature ejaculation says Lamm. "And in contrast to the problem of erection, it has no connection to the metabolic syndrome and I cannot identify those who suffer from it. I don't ask people directly about it but ask 'if you are satisfied about your sexual performance? Perhaps there is something I can help with?' And then it becomes clear that it is a very common problem. Very aggravating that hurts the relationship. The source is sometimes genetic - high sensitivity in the penis. Other times it is fear of losing the erection and so it leans to hurry up."
"Medication for this situation was discovered by accident. For the most part, these are medications against depression and those who use them complain that they can't reach orgasm. We've transformed this problem into an opportunity for somebody else."
And there is also late ejaculation.
"This is for the most part a side effect of the medication or learned reaction that people cannot get out of and then the recommendation is cognitive treatment."
Is testosterone an important component of male sexuality?
"Testosterone is critical for sexuality. There are men who for various reasons do not have enough of it and that harms their sexual performance and libido, and it is worth giving them additives as well as procedures to improve their sleep and reduce weight. For those who do not suffer from a lack of testosterone, it is really not recommended and I don't check hormone levels in people that aren't complaining."
"The penis is not made for acrobatics"
One of the most painful problems that men have to cope with that come to you is, how should I put it, that their penis is broken.
"The worst thing that a man can hear is 'snap.' It is impossible to mistake the feeling and it comes with massive pain. The penis is not a bone but it has cartridge that can crack in certain positions. Let us suppose that you have sex in the shower and the woman slips and falls and the penis is broken. It can happen during a soccer game, if you have an erection. It is very rare but not so very very rare. You have to be a bit careful with the penis. It is not something completely flexible. It is not meant for acrobatics."
"The damage is as said painful, bleeding but you probably won't die from it, and the damage will be expressed in sexual performance problems and curvature in the penis, which in most cases can be corrected through surgery. There are cases where people are born with a curvature in the penis and this also happens gradually with age. It is not known exactly why this happens but it can prevent penetration. It can be solved through surgical intervention."
But the penis, as already said, is always only part of the story. "We need to get back to holistic medicine. The most important ability in my profession is the ability to connect with the patient. If the doctor connects to the diseases and not to people, then he has a problem."
But medicine as you offer it is not accessible to most people
"That's right as long as a doctor sees 50 people a day, he is actually not a doctor. The patient is the one who diagnoses himself and asks for treatment, which the doctor approves or refuses. But the patient is not a doctor and that is one of the most difficult problems in the system."
"Sleep lays the foundations for health, as well as nutrition, exercise and preventing smoking"
"When you haven't slept well, you might die from it, and not only from an accident that resulted from tiredness," Prof. Lamm says. "It is not only a quality of life problem. Bad sleep generally means that you are not very healthy. Beyond that there is a risk of forming a negative food cycle. Whoever hasn't slept well over time and mainly whoever suffers from sleep apnea begins to also suffer from metabolic diseases, that is to say obesity and diabetes and damage to blood vessels that cause heart disease. All this damage makes the sleep situation worse and worse."
Lamm began dealing with sleep problems following his general involvement in "evaluated disorders deficiency in the average US male."We want to do for sleep what we have done for the erection," he says. In other words, to understand the connection between the quality of his sleep for the overall healing of the patient and to see how the improvement in the health of the patient can give him improved sleep and vice-versa.
According to Lamm, good health includes the correct weight, healthy nutrition, correct blood pressure, correct sugar levels, physical activity and sleep. He wants to change the perceptions of doctors no less than of patients. "If doctors do not put the subject of sleep into their health questionnaires, they'll never succeed in treating the remainder of the problems because everything influences everything else. There has recently been a change in the method of indemnity for doctors so that if a problem is not solved then they won't receive payment from the insurance company, even if they have undertaken complicated and expensive procedures. Therefore, today they understand that they have to deal with sleep. Otherwise, other problems simply won't be solved. And when you are treating sleep problems, you must treat them from the source. Giving a sleeping pill by itself won't help."
"Going to work tired is like going to work drunk. It not only influences your feelings but also your dealings. You wouldn't want to give anti-anxiety or anti-depressant medication, or Ritalin, or God forbid undergo heart surgery only to discover that the problem with your heart stemmed from a lack of sleep and it went away when your sleep improved. I have discovered that the best 'customers' for this thesis are anesthetists of all people because the recovery of a patient after surgery is their responsibility, and the quality of sleep influences recovery."
The problem, he says, is that it is impossible to refer every patient to a sleep doctor. There are only 5,000 sleep doctors in the US, while 30% of the population suffers from some sort of sleep disorder. In fact, this problem is what connects him to Israeli company Itamar Medical, which has developed a home diagnostic device for sleep quality, which is marketed mainly by cardiologists rather than sleep doctors.
Lamm claims that sleep problems are far more common than people think. "If you say, I have no sleep problems because I can fall asleep in any place," you probably have a sleep quality problem or you don't sleep enough. If you take tiredness for granted - just know that it doesn't have to be that way. If you have a headache that wakes you up, if you have a problem concentrating, try checking out your sleep. If not, with men at a certain stage, the erection gets harmed perhaps in an irreversible way, because the damage created by lack of sleep in the small blood vessels. I have found that that is the most effective thing to say to men so that he will treat himself."
Prof. Steven Lamm
Status: Married + 5
Position: Medical Director of New York University's Langone’s Preston Robert Tisch Center for Men’s Health.
Education: Graduate Columbia University and MD New York University
Something More: Served as the house doctor in ABC's The View. Among the books he has published: The Hardness Factor, on the importance of the erection and the way of treating it.
Published by Globes [online], Israel business news - www.globes-online.com - on July 18, 2018
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