MEN IN THEIR FORTIES (40s) AND ABOVE

The age of 40 is a prime age for men, which officially marks the middle age group. After the age of 40, many of the cells and tissues of the human body begin to undergo enhanced apoptosis (natural cell death) without corresponding regeneration of these cells and tissues. For example, the body experiences a decline in homeostatic hormones that enable adequate sleep, sexual urge, withstand stress, etc; baldness of the hair or a receding hairline; kidney function begins to decline; reduced sense of organ perception; These are physiological processes that accompany aging and they are noticeable after age 40.

After age 40, men become prone to many clinical conditions such as hypertension, type-2 diabetes mellitus, prostatic diseases, kidney diseases, erectile dysfunction, etc. It is very pertinent for men to be on the constant lookout for their health as their bodies begin to wear out when they clock 40. Unfortunately, the financial responsibility of men has made them neglect their health in pursuit of financial freedom. This has shortened their lifespan significantly. In Nigeria, the average lifespan of men is 54.1 years, and it’s less than that for women (World?Bank, 2020). This shows that men die faster than women and this is because a lot of men neglect their health.?Apart from the fact that women are more health-conscious than men, the antenatal services they receive during their reproductive ages put them at an advantage over men. Also, men engage in more risky behaviors than women, which is detrimental to their health. Some of these risky behaviors include unprotected sex, alcohol, smoking, use of hard drugs, and overzealous adventurous behaviors. These are contributory factors as to why men die earlier than women. Health issues and the aging process in men are quickened by the aforementioned behaviors.

For the purpose of this discussion, this article will focus on key medical conditions affecting men, such as hypertension, type-2 diabetes mellitus, and prostate disease.

HYPERTENSION

Hypertension is a chronic medical condition that is characterised by persistently elevated blood pressure of 140/90 mmHg or the use of blood pressure-lowering medication (Chobanian et al., 2003). Values between 130 and 139/80-89 mmHg are considered pre-hypertensive. Hypertension is a silent killer because of the fact that it can exist for years without any symptoms. 1 in 4 men and 1 in 5 women are hypertensive, and because men are more unlikely to visit the hospital, this goes unchecked until complications set in from long-standing uncontrolled hypertension. Some of the symptoms that may arise include headache, blurred vision, palpitation, confusion, etc. Other symptoms may arise from complications.

The cause of hypertension is either primary or secondary. The primary or essential causes are widespread (90-95%) and can be attributed to genetic or environmental factors.?From the genetic theory, an individual has a high chance of becoming hypertensive if their parents are hypertensive compared to an individual who does not have hypertensive parents. Environmental factors such as sedentary lifestyle, chronic stress, obesity, alcohol, smoking, and diet/high salt intake are all contributory factors to the development of hypertension. Secondary causes of hypertension are uncommon (5-10%) and are caused by medical conditions such as kidney disease, renovascular disease (kidney and blood vessel disease), drugs, and endocrine diseases.

Hypertension is incurable. However, it can be managed with medications only when taken correctly and appropriately. Uncontrolled hypertension leads to complications and, invariably, death. Complications include stroke, memory loss, heart attack, heart failure, kidney damage, and death.

It is advisable to keep regular appointments with your health facility to monitor your blood pressure and, if hypertensive, ensure compliance with medications and lifestyle modifications such as alcohol and smoking cessation, low salt intake, exercise, and healthy dieting.

T2DM (TYPE 2 DIABETES MILLETUS)

At 40, there is an increased chance of T2DM. This is the commonest form of diabetes and it is characterised by increased blood sugar (hyperglycemia) and inadequate insulin and/or inappropriate glucagon secretion. The incidence of T2DM is increasing worldwide due to the interplay of both genetic and environmental factors. DM tends to run a genetic course in a family, with few sporadic cases. There is a higher likelihood of an individual being diabetic if their parents are diabetic compared to an individual without diabetic parents. Environmental factors can also quicken the onset of the disease, such as alcohol, smoking, obesity, high fatty and carbohydrate diets. The symptoms of DM include excessive urination (polyuria), excessive water intake (polydipsia), and excessive eating (polyphagia). Others include weight loss, blurred vision, and complication-specific symptoms.

The complications from T2DM are grouped into microvascular and macrovascular. The microvascular complications include retinopathy (damage to the retina, cornea opacity, and impaired vision), nephropathy (damage to the nephrons resulting in impaired kidney function), and neuropathy (damage to the nerves that conduct signals in the body resulting in paraesthesia). The macrovascular complications include heart diseases, strokes, vascular diseases, and diabetic foot ulcers, a leading cause of amputation globally.

The bad news about Diabetes Mellitus (DM) is that it can not be cured and it is a lifelong condition (same with hypertension). But the good news is that it can be managed effectively with compliance with the right medications and lifestyle modifications. For a diagnosis of DM, the fasting blood sugar (FBS) must be 7mmol/L or 126mg/dL. This is usually done in the morning before breakfast (6–8 am) after 10–12 hours of overnight fasting. A random blood sugar (RBS) of 11.1mmol/L or 200mg/dL with symptoms of DM is also diagnostic. The RBS can be done any time of the day.

It is important for those already diagnosed with diabetes to have a glucometer to help them monitor their sugar level and also maintain a regular clinic visit for strict control of blood sugar. Individualized treatment and lifestyle modification are key to the management of DM. Thus, a routine health check is important to diagnose and manage DM.

PROSTATE DISEASES

The prostate is an important sexually reproductive organ only found in men. The size of the organ grows as men age. Prostate diseases are on the increase in men over age 40. These diseases include prostate cancer, prostatitis, and benign prostatic enlargement. 1 in 8 men will have prostate cancer (Prostate Cancer UK, 2017).

Some of the symptoms associated with prostate diseases include urinary frequency, hesitancy (difficulty initiating urine or sustaining urine flow), nocturia (waking up to urinate more than twice every night), straining (using force to urinate, which may or may not improve urine flow), feeling of incomplete bladder emptying, severe waist pain, weight loss, and urinary incontinence.

The best indicator to check for prostate health is the Prostate Specific Antigen (PSA). The normal PSA value is between 0 and 4ng/dL. When the prostate is diseased, this value is raised. Physiologically, the PSA is raised immediately after sexual intercourse, digital rectal examination, and increasing age (elderly men). PSA levels should be checked every two years, and even more frequently if you have prostate cancer, to monitor disease progression or treatment outcomes. Routine PSA checks provide an avenue for early diagnosis and prompt treatment of prostate diseases.

CONCLUSION

Men must take the initiative and make a conscious effort to live longer by prioritizing their health. They must realize that, as the head of the family, they require a healthy body to carry out their responsibilities at all times. Men must create a routine medical plan for health check-ups at an approved medical center/clinic, and adhere strictly to lifestyle changes, and treatment protocol for a healthy and prolonged life after 40.

Emmanuel Oisakede (MBBS, MSc)