Take It Like a Man

BY Frank Spinelli, M D

August 11 2010 1:15 PM ET

 September is Prostate Cancer Awareness Month. What's yours telling you?

Your boyfriend may be experienced at, uh, examining your prostate. But if you're age 50 or older, it's your doctor's turn. Though there's no evidence that gay men are at greater risk than straight guys, prostate cancer is the second-leading cause of cancer-related deaths in men (lung cancer retains the top spot). It affects about one in six during their lifetime, but the good news is that only one in 35 will die of it, thanks to effective screening. Early detection remains the best medicine.

According to the American Cancer Society, men in this age group should discuss screening with a physician. African-American men and those with a strong family history of the cancer should begin this discussion at age 45. Screening involves a physical exam of the prostate via the rectum (not a pleasure, but it lasts only a few seconds) and a blood test to measure levels of prostate specific antigen (PSA). Though recent studies have questioned the utility of PSA testing, I agree with current cancer society guidelines. Your doctor should explain the potential risks and benefits of screening beforehand, however.

A few words of advice: Avoid receptive anal play 24 hours prior to your doctor visit, because stimulating the prostate can elevate PSA levels. If your prostate is enlarged, don't freak out. The vast majority of older men share your predicament. Similarly, an isolated increase in PSA levels isn't automatic bad news either. Most doctors agree that tracking the trajectory of the increase is a better indicator, and a biopsy is the only definitive way to diagnose prostate cancer.

If you are diagnosed, talk to several doctors about treatment and study up on radiation therapy and the various surgical interventions available. Since prostate cancer typically is slow-growing, rushing into surgery during early stages of the disease is not always wise, particularly if you have existing serious health problems. Ask your doctor if observation is an option.

Gender Construct

I recently interviewed Dale, a transgender man, about the decisions he's made. Dale opted to bind his breasts instead of undergoing a double mastectomy. In the coming months he'll electively have a hysterectomy (removal of the uterus) and an oophorectomy (removal of the ovaries), and he'll begin taking testosterone, which will increase his muscle mass and deepen his voice. Dale is undecided on whether to have genital reconstruction surgery. The procedure is more complicated than its male-to-female analogue, due to the difficulty of building a functioning penis from the clitoral tissue. Regardless of the procedures a person chooses to undergo, most clinicians working with transgender patients agree that a supportive network inclusive of a partner, family, and friends is vital to ensure satisfaction with the final outcome. The Transgender Health pages at LGBTHealth.HealthCommunities.com contain more information on hormone therapy and female-to-male gender-reassignment surgery.











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