Men's Health Treatments from UK-Registered Doctors

Men's health encompasses a range of conditions that disproportionately affect quality of life yet remain undertreated due to cultural barriers around help-seeking.

Data from the Men's Health Forum shows that men in the UK die on average 3.7 years earlier than women, with avoidable causes accounting for much of the gap.

Benign prostatic hyperplasia (BPH) is the most common urological condition in older men, affecting 50% by age 50 and 80% by age 80.

Prostatic enlargement compresses the urethra, producing lower urinary tract symptoms (LUTS) classified as storage (frequency, urgency, nocturia) or voiding (hesitancy, weak stream, incomplete emptying, terminal dribbling).

The International Prostate Symptom Score (IPSS) quantifies severity:

• Mild: 0-7
• Moderate: 8-19
• Severe: 20-35

Testosterone deficiency syndrome (hypogonadism) affects 2-6% of men aged 40-79, based on the European Male Ageing Study.

Symptoms include fatigue, reduced libido, erectile dysfunction, loss of muscle mass, increased visceral fat, depressed mood, and reduced bone mineral density.

Diagnosis requires two morning serum testosterone levels below 8 nmol/L (or below 12 nmol/L with symptoms and low free testosterone).

Prostate cancer is the most common cancer in UK men (approximately 52,000 new diagnoses annually).

PSA screening remains controversial — it detects cancer early but also identifies clinically insignificant disease, leading to potential overdiagnosis and overtreatment.

NHS guidance mandates informed consent and shared decision-making before PSA testing.

Other men's health conditions addressed in primary care:

• Male-pattern baldness (covered separately under hair-loss)
• Erectile dysfunction and premature ejaculation (covered in dedicated categories)
• Gynaecomastia: breast tissue enlargement, may indicate hormonal imbalance
• Peyronie's disease: penile plaque causing curvature, affecting 3-9% of men

Pharmacotherapy for BPH and testosterone deficiency follows well-established guidelines from NICE, the British Association of Urological Surgeons (BAUS), and the British Society for Sexual Medicine (BSSM).

Alpha-1 adrenoceptor blockers are first-line for moderate-severe LUTS:

• Tamsulosin 400 mcg modified-release once daily is the most prescribed alpha-blocker for BPH. It selectively blocks alpha-1A receptors in the prostate and bladder neck, relaxing smooth muscle and improving urinary flow. Onset is rapid — within 48 hours. Common side effects include postural hypotension (2-5%), dizziness (3%), retrograde ejaculation (4-11%), and nasal congestion.
• Alfuzosin and doxazosin are alternatives. Doxazosin additionally lowers blood pressure by 5-8 mmHg, making it suitable for men with concurrent hypertension.

5-alpha reductase inhibitors for prostates above 30 mL:

• Finasteride 5 mg daily blocks conversion of testosterone to DHT in the prostate, reducing gland volume by 20-25% over 6-12 months. It halves the risk of acute urinary retention and the need for surgery. The MTOPS trial showed that combination therapy (tamsulosin + finasteride) was superior to either drug alone for BPH progression.
• Dutasteride 0.5 mg daily inhibits both type I and type II 5-alpha reductase, achieving slightly greater prostate volume reduction.

Testosterone replacement for confirmed hypogonadism:

• Testosterone undecanoate IM (Nebido) 1 g every 10-14 weeks after loading doses
• Testosterone gel (Testogel, Tostran) applied daily to the skin — flexible dosing, steady-state levels within 2-3 weeks
• Testosterone patches (Androderm) — less commonly used due to skin reactions

Before initiating testosterone, the BSSM requires:

• Baseline PSA (testosterone is contraindicated if PSA above 4 ng/mL without urology assessment)
• Full blood count (testosterone increases erythropoiesis; haematocrit above 0.54 requires dose reduction)
• Lipid profile and HbA1c
• DXA scan if osteoporosis suspected
• Monitoring at 3, 6, and 12 months, then annually: PSA, haematocrit, testosterone trough levels, liver function, lipid profile

Prostate cancer awareness and appropriate screening are fundamental to men's health.

Balancing early detection against overdiagnosis requires informed, shared decision-making between clinician and patient.

PSA (prostate-specific antigen) is a serine protease produced by prostatic epithelium.

Serum PSA is elevated in prostate cancer but also in BPH, prostatitis, urinary infection, and after vigorous exercise or ejaculation. This limited specificity is the central challenge.

Age-specific PSA thresholds used in UK practice:

• Age 50-59: referral threshold 3.0 ng/mL
• Age 60-69: referral threshold 4.0 ng/mL
• Age 70+: referral threshold 5.0 ng/mL

The NHS does not offer a population-based screening programme due to the false-positive rate (approximately 70% of men with raised PSA do not have cancer) and the risk of detecting indolent disease.

However, any man over 50 (or over 45 with a family history or Black ethnicity) can request a PSA test after informed consent discussion.

Risk factors for prostate cancer:

• Age: 75% of diagnoses occur in men over 65
• Family history: first-degree relative with prostate cancer doubles risk; BRCA2 mutation increases risk 3-5 fold
• Ethnicity: Black men have 2x the incidence and 2.5x the mortality of White men in the UK
• Obesity: associated with more aggressive disease at diagnosis

Symptoms warranting investigation:

• Visible haematuria (blood in urine): 2-week urgent cancer pathway referral
• Progressive difficulty urinating not responding to BPH treatment
• Bone pain (especially lower back, pelvis, hips) in men over 50
• Unexplained weight loss combined with urinary symptoms

Modern diagnostic pathways use multiparametric MRI (mpMRI) before biopsy.

The PROMIS and PRECISION trials showed that mpMRI detects clinically significant cancer with 93% sensitivity, reducing unnecessary biopsies by 27% and improving detection of aggressive disease.

Active surveillance is the recommended management for low-risk localised prostate cancer (Gleason 3+3, PSA below 10), avoiding treatment side effects while monitoring for any progression through regular PSA, MRI, and biopsy.

Lifestyle modification forms the foundation of men's health management, both for disease prevention and for optimising pharmacotherapy outcomes.

Exercise and testosterone: Regular resistance training increases testosterone by 15-20% acutely and, when sustained over 12 weeks, modestly raises baseline levels.

Compound movements (squats, deadlifts, bench press) produce the largest hormonal response.

Overtraining, conversely, suppresses testosterone via elevated cortisol — a phenomenon seen in endurance athletes exceeding 60-70 miles per week of running.

Weight management: Adipose tissue contains aromatase, which converts testosterone to oestradiol.

Men with BMI above 30 have 30-40% lower total testosterone on average compared with normal-weight men.

Losing 10% of body weight raises testosterone by 2-3 nmol/L, often crossing from deficient into the normal range.

Diet for prostate health: The strongest dietary evidence comes from the Health Professionals Follow-Up Study and EPIC cohorts:

• Lycopene (cooked tomatoes): associated with 10-20% reduced prostate cancer risk in observational studies
• Cruciferous vegetables (broccoli, cauliflower): glucosinolate metabolites show anti-proliferative effects in preclinical models
• Oily fish (2 portions/week): omega-3 fatty acids reduce systemic inflammation and may slow PSA velocity
• Limit processed red meat: WHO classifies it as a Group 1 carcinogen; colorectal risk is more established than prostate risk

Reducing LUTS through lifestyle:

• Limit evening fluid intake to reduce nocturia (stop drinking 2 hours before bed)
• Reduce caffeine (bladder irritant) and alcohol (diuretic effect worsens frequency)
• Timed voiding every 3-4 hours and double voiding (urinate, wait 30 seconds, urinate again) improve bladder emptying
• Pelvic floor exercises strengthen the external urethral sphincter and improve post-void dribbling

Sleep and hormonal health: Testosterone production peaks during REM sleep. Men sleeping fewer than 5 hours per night have testosterone levels 10-15% lower than those sleeping 7-8 hours.

Prioritising sleep hygiene supports endocrine function, mood, and metabolic health.

Mental health: Men account for 75% of UK suicides.

Depression and anxiety are significantly underdiagnosed in men, partly because symptoms manifest as irritability, risk-taking, and substance misuse rather than classic low mood.

Normalising help-seeking behaviour is a clinical priority.