Bodybuilding drugs sold online often contain unapproved substances, study says

(CNN)Selective androgen receptor modulators, known as SARMs, are pharmaceutical drugs that mimic the effects of testosterone. Not yet approved by the US Food and Drug Administration, these compounds are often marketed to bodybuilders online as “legal steroids” that can help them look leaner and more muscular.

Most of the products sold online as SARMs contain either these unapproved substances alone — sometimes in amounts different from what is specified on the label — or other unapproved hormones and steroids, according to a study published Tuesday in the medical journal JAMA.
“There are serious potential side effects, and there’s this wide-held misperception that these compounds are safe,” said Dr. Shalender Bhasin, co-author of the new study and director of the research program in men’s health at Brigham and Women’s Hospital.
    About a dozen pharmaceutical companies have been developing SARMs since the mid-1990s, Bhasin explained. Designed to help people with diseases such as muscle wasting, they are intended to have beneficial effects similar to those of testosterone, which can increase muscle and energy, without negative side effects such as blood clots and enlarged prostate.
    Some SARMs have undergone limited human testing, but others have not, so their overall safety and efficacy remains unknown, Bhasin said. Still, early research has shown that in large doses, they can suppress natural production of testosterone and induce infertility. They also might have psychiatric side effects, including mania and suicidality.
    Life-threatening reactions, including liver toxicity, have occurred in people taking SARMs, which also have the potential to increase the risk of heart attack and stroke, according to the FDA.
    “Young men, almost exclusively young men, they’re using these compounds to improve their appearance,” Bhasin said.
    He collaborated with researchers from the US Anti-Doping Agency and the Uniformed Services University of the Health Sciences to conduct the new study, which began with a simple Google search.

    Testing the products

    Common names for SARMs include ostarine, andarine, RA140, ibutamoren, GW501516 and SR9009. Searching for these terms online, Bhasin and his colleagues found more than 210 products, most of which were either out of stock or unavailable. However, the research team was able to purchase 44 drugs that they evaluated using the World Anti-Doping Agency’s approved chemical analysis procedures.
    About half — 23 products — contained SARMs. An additional 17 products (39%) contained one or another unapproved drug, such as growth hormones or steroids, that have been banned by the anti-doping agency.
    Meanwhile, only 18 of the 44 had an active compound that matched what was listed on the label, and a quarter of the products had detectable amounts of the listed compound at a different amount than stated on the label. In eight products, label ingredients remained undetectable.
    When he first heard the “unsubstantiated reports of SARMs and other appearance- and performance-enhancing drugs” being sold online, he was “incredulous,” Bhasin said.

    Regulation and enforcement

    “The whole basis of commerce is that you buy something either on the internet or in a store, and it has a label that shows what is in the container, and it tells you what the product is and how much is being sold,” Bhasin said. “Just imagine, you go to the grocery store and you want to buy baby food for your children” — but the contents are not what the label says, or “worse, it contains something else whose safety is unknown.”
    Drs. Richard J. Auchus and Kirk J. Brower of the University of Michigan wrote in an editorial that accompanies the new study, “How can these pharmaceutical agents be widely available to the public without FDA approval, prescription, or manufacturing oversight?”
    “Rapid developments in information technology, consumerism, medicine, and public policy” all play a role in the availability of these substances, explained Auchus and Brower, who were not involved in the new study.
    Noting that the 1994 Dietary Supplement Health and Education Act exempted products classified as “dietary supplements” from rigorous studies prior to marketing, the “result was a flood of unregulated” products. Androgens (male hormones) were “aggressively marketed as supplements, even though these compounds are drugs and not food,” Auchus and Brower wrote. Many “so-called dietary supplements still contain hormones, drugs, and known toxins often not listed on the label,” they wrote.
    Who is responsible for clamping down on these products?
    Although the FDA is duty-bound to take action against adulterated or misbranded dietary supplements after they reach market, the agency “does not have the resources to address all of these cases,” Auchus and Brower noted.
    The FDA recently issued warning letters to three companies for distributing products that contain SARMs. Marketed and labeled as dietary supplements, the products are actually unapproved drugs no evaluated for safety, according to the FDA.
    Lindsay Meyer, a spokeswoman for the FDA, said these letters are warning shots for every company in the industry, not just the companies that receive them.
    It’s been difficult to police this activity because “most of these are being sold in dietary supplements so they don’t require any kind of premarket review,” said Meyer. “The internet is far more vast than the FDA is. As soon as we go after one of these websites or sellers or something, another one just crops back up in their place.”
    The US Drug Enforcement Administration shares responsibility for enforcement of laws regarding the sale of SARMs. “However, the DEA is overwhelmed with the opioid epidemic, and industry-sponsored legislation last year seriously impaired efforts of the DEA to thwart complicit narcotic distributors,” the editorial authors wrote.
    The DEA did not respond to a request for comment.
    “There’s no way that the authorities can intercept them, because there’s such a huge flood across our borders from so many sources, it would just be prohibitively expensive to intercept them,” said Dr. Harrison Pope, a professor of psychiatry at Harvard Medical School-affiliated McLean Hospital who was not involved in the new study.
    He said “thousands upon thousands” of websites offer these drugs, which pour into the United States from numerous sources around the world.
    “It is an important study that I hope will further awaken the population especially people who are would be purchasers to the hazards and the unpredictability of this mushrooming internet scene,” said Pope, author of another study that looked at performance-enhancing drugs sold on the Web. “With high probability you either will not be getting what you thought you were getting, or you will be getting other drugs of unknown toxicity that were not advertised in what you were getting.
    “It’s a problem that is not gonna go away, and if anything, it’s going to increase as the years go by.”

    Letter of the law

    When asked about the misrepresentative labels found in the new study, Sam Steger, a spokeswoman for MedFit Rx Inc., a company that sells SARMs, said, “it is imperative that our labels reflect the contents of our products accurately. We are of course familiar with the ‘buzz’ in the industry, but cannot speak to the internal workings of other companies.”
    Steger said her company’s products fall within FDA regulation as sports supplements.
    “We do not market as a dietary supplement and do not sell banned substances,” she wrote in an email. “To start they are not illegal or banned substances.”
    She noted a 2014 law that includes designer drugs and “hormonal substances” under the definition of anabolic steroids, which are banned under the Controlled Substances Act. The same law states that “an herb or other botanical, a concentrate, metabolite, or extract of, or a constituent isolated directly from, an herb or other botanical” is not “a drug or hormonal substance” and would not be considered illegal.
    The new study, though, found that 91% of the 44 tested products had an unapproved drug — so just 9% were made of botanicals and not drugs.
    Bhasin admits his study was not “exhaustive” and says that with “the rapidly changing nature of such internet sites, the results of similar searches will vary.” Still, he bemoans the increasing use of SARMs.
    “We don’t have very good information, but investigators have estimated in the US alone there may be 2 to 4 million young men who have used performance-enhancing drugs sometime in their life,” he said.
    “Widespread perception amongst policy makers and the public is the problem of performance enhancing is really a problem of cheating in sports.

    See the latest news and share your comments with CNN Health on Facebook and Twitter.

    “The vast majority of people who use these appearance and performance-enhancing drugs are not elite athletes. In fact, they’re not athletes at all,” Bhasin said. Rather, they’re teens and young men, often members of the armed forces, who want to improve their appeal.
    “So we are seeing these dual epidemics of body image disorder in young men, which is also referred to as muscle dysmorphia, and the associated growing abuse of appearance- and performance-enhancing drugs,” Bhasin said. “Easy availability of these compounds over the internet without a prescription is concerning because it will fuel these epidemics.”

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    Better hearing, less constipation and other surprising benefits of exercise

    (CNN)Periodically, we see reports that scientists are closer to developing a pill that would mimic the benefits of exercise.

    The truth is that no medication or supplement even comes close to exercise for being able to do so much for so many people — or probably ever will.
    While we’ve all heard that regular exercise can improve heart health and strengthen muscles, it can also enhance the quality of your life in a number of ways. Five such benefits may surprise you.

      Sounder sleep

      The headline of a survey by the National Sleep Foundation said it best: “Exercise is good for sleep.” In the poll of 1,000 people, those who exercised the most vigorously reported the best sleep quality overall. And they were less likely than non-exercisers to say that in the past two weeks, they had experienced problems such as trouble falling asleep or waking during the night.
      These findings are supported by a review of 66 studies on exercise and sleep. It concluded that regular exercise is comparable to sleep medication or behavioral therapy in improving the ability to fall asleep, as well as sleep duration and quality.
      The same researcher found a similar benefit regarding age-related macular degeneration, a leading cause of vision loss also known as AMD, in a study of nearly 42,000 runners. The more people ran, the more their risk of the condition declined. A different study, which followed roughly 4,000 people for 15 years, showed that participants who were physically active were less likely to develop AMD than those who weren’t active.
      Scientists aren’t sure why exercise protects against cataracts and age-related macular degeneration. One possibility is that it reduces inflammation, which is associated with both conditions.
      Cataracts and AMD have also been linked to risk factors for cardiovascular disease, including elevated blood sugar and triglycerides, which regular exercise can improve. Further, some research suggests that people who are overweight or obese are more prone to cataracts and AMD, so physical activity may help by preventing weight gain.

      Enhanced hearing

      You heard it here first: Exercise may be good for your hearing. A study of more than 68,000 female nurses, who were followed for 20 years, found that walking at least two hours a week was associated with a lower risk of hearing loss. Other research has linked higher fitness levels with better hearing.
      Exercise may protect against hearing loss by improving blood flow to the cochlea, the snail-shaped structure in the inner ear that converts sound waves into nerve signals that are sent to the brain. What’s more, it may prevent the loss of neurotransmitters, which carry those signals between nerve cells. Exercise may also help by reducing the risk of diabetes and cardiovascular disease, both of which are linked to hearing loss.
      Of course, blasting music into your ears while you exercise could have the opposite effect and do damage to your hearing. Noise-canceling headphones are a good option because they reduce the need to turn up your music as much. But don’t use them while exercising on a busy road. By being unaware of approaching traffic, you could be subjecting yourself to a risk far more serious than loud music.

      Better bathroom habits

      The place to start, naturally, is No. 1: Though high-impact activities such as jumping or running can cause women to leak urine, research shows that moderate exercise may decrease the risk. For example, a study of middle-aged female nurses found that those who were physically active had lower rates of urinary incontinence than women who were inactive. A study of older nurses by the same team of researchers yielded similar findings.
      A urinary problem familiar to many middle-aged and older men is nocturia, the need to get up more than once a night to pee. Often, the cause is an enlarged prostate, a condition known as benign prostatic hyperplasia. Exercise can help prevent nocturia or reduce its severity.
      In a large study of men with benign prostatic hyperplasia, those who were physically active for an hour or more per week were less likely to report nocturia than those who were sedentary. Likewise, a study of sedentary older men found that after eight weeks of daily walking, they urinated less frequently during the night.

      See the latest news and share your comments with CNN Health on Facebook and Twitter.

      Another common bathroom-related problem for both men and women is constipation, which exercise can help improve as well. In a study of 62,000 women, those who reported daily physical activity were nearly half as likely to experience constipation as women who exercised less than once a week. A randomized trial involving inactive middle-aged men and women with chronic constipation found that those assigned to a 12-week exercise program were able to poop more easily.
      Exercise helps by decreasing transit time. That’s how long it takes food to move through the digestive tract — not, as it sounds, the amount of time it takes to get to work. Alas, a shorter commute is one benefit that exercise may not have — unless, of course, biking to work is faster for you than driving in heavy traffic.

      Read more:

      9 prostate cancer myths, debunked

      After skin cancer, prostate cancer is the most common type of cancer in men. In 2017, the American Cancer Society estimates about 161,360 new cases of prostate cancer will be diagnosed and about 26,730 men will die from it.

      The good news is that survival rates for prostate cancer are high, but experts say there are several myths out there about how its diagnosed and treated, and how it may affect mens health and sex lives.


      To help you tell fact from fiction, Fox News sifted through the research and talked to some of the top prostate cancer experts to unpack the most common myths about prostate cancer.

      1. Its an old mans disease.
      According to the American Cancer Society, six in 10 cases of prostate cancer are diagnosed in men ages 65 and older. Although many men think prostate cancer is something they need to start thinking about in their 60s, men as young as 40 are diagnosed with prostate cancer too.

      Whats more, screening all men between ages 45 and 49 for prostate cancer can predict almost half of all deaths several decades later, a 2013 study in the journal BMJ found.

      2. There are no symptoms.
      Its true that many men with prostate cancer may not have any symptoms, even for those who have metastatic disease.

      Many symptoms of prostate cancer can also mimic other benign conditions like prostatic hyperplasia (BPH) or an enlarged prostate, a urinary tract infection (UTI) or another type of cancer.

      Nevertheless, if you notice urinary frequency, urgency, a slow or weak flow or an obstruction of the flow, blood in your urine or ejaculate, bone pain, or unexpected weight loss, you should see your doctor to be evaluated, Dr. Chung-Han Lee, a medical oncologist at Memorial Sloan Kettering Westchester in West Harrison, New York, told Fox News.


      3. Blood PSA levels are only one way to make a diagnosis.
      High blood prostate-specific antigen (PSA) levels usually indicate prostate cancer, but the only definitive way to diagnose it is with a prostate biopsy, Lee said.

      4. You must start treatment right away.
      If youre diagnosed with prostate cancer, your doctor will first determine the stage and your risk group low, intermediate or high-risk before deciding on a treatment plan. Hell also take into account other conditions you may have, like obesity, heart disease and type 2 diabetes, as well as your smoking history, before deciding on the course of treatment.

      If you have other medical problems but a low-grade prostate cancer, for example, your doctor may hold off on treatment. Yet if youre otherwise healthy and have an aggressive form of prostate cancer, treatment may be done earlier.


      5. Natural remedies can help.
      Selenium, alkaline water, high-dose vitamin C, and even a combination of maple syrup and baking soda have been cited as ways to prevent and treat prostate cancer. 

      The thinking behind them is, If you alkalize your blood then cancer has a hard time surviving because cancer cells love an acidic environment, Dr. Geo Espinosa, a naturopathic and functional medicine doctor in New York City, and author of, Thrive, Dont Only Survive, told Fox News. Yet experts agree theres no evidence any of these can help.

      6. Surgery will end your sex life.
      Surgery will likely cause impotence at least initially, but most men will regain the ability to become erect with treatments such as Kegel exercises.

      How the surgery will impact your sex life depends on whether or not your doctor has to remove the nerve bundles that run on either side of the prostate. If they can save at least one of them, then they can still have erections, sometimes with assistance, Lee said. Medications like Viagra or injections, or a a penile implant or pump can help. 


      7. Diet and lifestyle dont matter.
      You might think theres no way to reduce your risk for prostate cancer, but diet and lifestyle actually play a significant role.

      Diets low in carbohydrates and sugar like the Mediterranean diet, and moderate to vigorous exercise three to four hours a week have been shown to help prevent the disease.

      Its also a good idea to get 15 to 30 minutes of sun exposure sans sunscreen on 40 percent of your body, or talk to your doctor about a supplement, as low levels of vitamin D may predict aggressive prostate cancer, a 2016 study out of Northwestern Medicine found.

      Also, herbs like curcumin and boswellia lower inflammation and reduce biological markers that contribute to cancer, Espinosa said.


      8. Treatment is a cure.
      Within 10 years of prostate cancer treatment, 40 percent of the time PSA levels will start to rise again, Espinosa said. Its also not uncommon to be diagnosed and treated for low-grade prostate cancer and years later be diagnosed again with metastatic prostate cancer.

      If youve have prostate cancer, its important to be monitored roughly every three to six months within the first one to two years of treatment, After two years, you should get checked out every six to 12 months. If the PSA is undetectable after five years, you should be monitored every 12 months.

      9. Its fatal.
      The risk that prostate cancer will be fatal depends on how aggressive it is and the other medical conditions you may have.

      The good news is that for all stages of prostate cancer, the survival rates are high: The five-year survival rate is nearly 100 percent; the 10-year survival rate is 98 percent; and the 15-year survival rate is 95 percent.

      Julie Revelant is a health journalist and a consultant who provides content marketing and copywriting services for the healthcare industry. She’s also a mom of two. Learn more about Julie at

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      What The Provember Project can teach you about the prostate

      This article contains sexually explicit material.

      Twenty-nine-year-old sex educator and performer Lucas Brooks is passionate about prostates.

      In 2014, he launchedThe Provember Projectas a playful and educational online resource to encourage men to get in touch with their prostatesliterally. The Provember Project is inspired by The Movember Foundations Movember campaign(though the two are unaffiliated) thatasks supporters to grow mustaches to raise awareness and funds for men’s health causes. By contrast, The Provember Project focuses specifically on prostate health and pleasurea decidedly less-PG take than growing facial hair.

      Brooks wanted educating men about the prostate to be a little more intimate because, well, it is intimate. The prostate is a gland in the male reproductive system that helps produce semen. Stimulation of the prostate, sometimes called “the male G-spot,” can bring sexual pleasure. Plus, according to the authors of The Ultimate Guide to Prostate Pleasure, prostate massage may increase blood flow, clear blockages and help lessen the symptoms of an enlarged prostate.

      But the prostate isn’t just important for sex. Prostate canceris the second most common cancer in American men, according to And asMadeleine Castellanos, M.D., wrote for the blog Good In Bed, other prostate health issues include frequent urination, difficulty ejaculating, benign prostate hyperplasia (BPH) and prostatitis, an infection of the prostate.

      The Provember Project deals more with the fun side of prostate exploration because simply talking about prostates is a step in the right direction for a lot of guys. As Dr. Castellanos has written, “Most men don’t think about their prostate unless there is a problem with it and would prefer if they never had to think about it.” That is exactly the attitude that Brooks wants to change. “I like to think of Provember as an ‘expansion pack’ of sorts,” he told the Daily Dot. “If you’re participating in Movember, you’re doing something nice for others. With Provember, you’re doing something nice for yourself.”

      Brooks is no stranger to talking about sex, online or offline. A blogger forThe Intellectual Homosexual,he is on staff at New York sex toy store The Pleasure Chest and has taught workshops such as “Playthings for People with Penises” and “Playing with Prostates.” In the same vein as his sex shop workshops, Brooks has makesvlogsabout putting on gloves before prostate exploration, among other topics, and evenlaunched a “p-spot shop“online featuring sex toys focused on the prostate.

      The Daily Dot interviewed Lucas Brooks over email to find out why prostates are so important for health and pleasure and what you can do to help yours stay healthy.

      Where did the idea for The Provember Project come from and why is the topic of prostate health so important to you?

      Lucas Brooks: About four years ago I first became familiar with the Movember campaign and the resources that I found included very little education about prostate healthjust “awareness.” There are plenty of Movember resources now that do talk a bit about health and plenty that are raising money to battle health issues that affect male-bodied folks. But there are also a lot of people who are just growing mustaches because they think it’s cool.

      Is there still stigma attached to talking about prostate health?

      I think the stigma is more focused on men enjoying anal pleasure in general. Many people still see anal penetration as “a gay thing,” causing men to repress their curiosities about exploring it. I do find that prostate play paves a path that many folks find more acceptable, so it’s becoming a little less taboo. Still, we have a lot of work to do to reduce the shame attached to “butt stuff.”

      How is prostate play for pleasure linked to prostate health?

      It’s a sort of “if you don’t use it, you lose it situation.” Regular massage and frequent orgasms are essential in keeping your prostate happy and healthy. If you neglect it, it’s just going to sit there with all this unused fluid building up. I think of my prostate like a puppy: If I don’t take it for a walk on a regular basis, it’s really going to start to hate me. Please note: I do not have any medical training of any kind. This is just the language I use to give people perspective on their relationships with their bodies.

      The Provember Project blog recommends various different sex toys to explore the prostate. Are toys really necessary?

      Toys are not required, by any means. Most of us are born with some of the best prostate massagers attached to our hands! But there are plenty of benefits to having a toy handy. Sometimes your fingers and wrists get tired from the rhythmic movements; for this, I recommend any of Aneros products. Sometimes you want vibration (Naughty-Boy or Protouch are excellent options). Sometimes you want heavier pressure than your hands can provide (NJoy Pure Wand all the way!).

      What can other men gain from exploring prostate play?

      Besides lots and lots of incredible orgasms? A better relationship with their bodies and in my experience, a significant reduction in stress.

      Is it easier to reach people on the subject of prostate health and sexual exploration online than in-person, like at the sex shop where you work?

      I think the masses are always going to be more comfortable talking about sex with more anonymity, given the option. That said, I’ve had a lot of experiences in the store where people come to me, nervously admitting that they want something they can put in their butt, and when I respond enthusiastically, and without judgment, they gradually get more and more excited about the conversation we’re having. I really hope those conversations continue once they leave the store!

      Illustration by Max Fleishman

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      Philip K. Dick’s alt-history science-fiction novel of the same name comes to life on Amazon.

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      Pastor Lights Up Like a Christmas Tree With CancerThen He Sees This Bracelet on a Curb

      He was headed to lunch with his wife after one of his treatments, and there it was …

      As the pastor of the Federated Church of Bondurant in Iowa, Jeff Sanderson is known as a great man of God, but it wasn’t until death was staring him in the face that his faith was really put to the test.

      He started to experience excruciating pain in his lower back, and as the stinging persisted, he decided he should get it checked out. His doctor told him that he had an enlarged prostate and abnormal PSA levels. Jeff was then sent to a urologist who initiallyfound nothing wrong, but after the biopsy results came back, the pastor got chilling news that was enough to make even a man of faith shudder: He had “The Big C.”

      “I have some bad news,” the urologist said hesitantly. “You have prostate cancer and it’s the most aggressive form.”

      Realizing he only had 12 to 14 months to live, the pastor was thrown into a whirlwind of emotion. At the time, he didn’t even think to ask for healing. His only request ofGod was to keep him looking healthy during his time left so that his kids and wife wouldn’t have to worry about him.

      He was sent to the Mayo Clinic for further evaluation, and that’s when he saw the deadly diagnosis come to life before his very eyes.

      “My body was lit up like a Christmas tree,” he told God Updates. “I was absolutely filled with cancer, from my knees to the top of my shoulder blades.”

      The doctors tried to break the news softly, but Jeff and his family could clearly see that the scan meant his days left on this earth were few. He had tumors on his femur bones, hip bones, ribs, tail bone, abdomen, vertebra and more. The cancer had literally infected his whole body.

      Jeff hesitantly shared the information with his congregation, feeling like it was the right move to makebut little did he know, his news would ignite a chain of prayer warriors to petition the Lord on his behalf. He started to get calls from total strangers saying they were praying for a miraculous healing.

      One afternoon after one of his tumor check-ups, Jeff and his wife Kathy decided to get lunch at a local eatery. As they walked into therestaurant, something by the curb captured Jeff’s attention. It was a bracelet that read “FAITH Rx.”

      “In that very moment, we knew that God was reminding us to put our faith in Him. And as I put the bracelet on my wrist, I knew that however things went, the Lord would make a way for my family and I to get through the storm,” Jeff told God Updates.

      The next time he went in for his scans, Jeff could hardly believe his eyes! They were dreading the inevitable progression of his cancer, but when he looked at the screen, he was utterly SPEECHLESS.

      “Where’s my cancer?” he asked.

      The doctor replied, “You don’t have any!”

      Jeff was knocked to his knees at the unbelievable sound of those four words. The cancer that once consumed every inch of his body had been unexplainably eradicated. The doctors were dumbfounded! They had never seen somebody walk in with Stage 4 cancer and walk out a perfectly healthy man.

      What’s even more mind-blowing is that at his next weigh-in two days later, he was 12 pounds lighter. He even had to go out and buy new pants that same day. “The Lord had removed 12 pounds of cancer from my body!” Jeff told God Updates.

      Almost a year after the divine healing, Jeff is doing better than ever, and more importantly, his relationship with the Lord has grown even deeper. Sometimes even pastors need a reminder that the only prescription you need is faith.

      “One day we will stand before the Lord and He will scan our lives,” he shared. “While we are fully aware of the cancer of sin within us, the Lord will choose, by His grace and forgiveness, to declare all who put their faith and trust in Him to be CANCER FREE! Now that will be the greatest miracle of all!”

      Read more:

      Hows Your Walnut, Mate? Why Men Dont Like To Talk About Their Enlarged Prostate

      This is part of our series on hidden or stigmatised health conditions in men. Read the other articles in the series here.

      Conversation about how often you have to get up at night for a piddle is probably not the most scintillating discourse. But theres a much bigger reason men dont like to talk about prostate conditions.

      My experience as a practising urologist suggests most men dont like talking about their enlarged prostate because they actually have no idea what their prostate even is or does, let alone how it can cause problems when it gets bigger with age. Theyve heard of it of course, they know its somewhere down there and that it can get cancer in it, but mostly I suspect thats about the extent of it.

      So, lets get back to basics and explain to these guys (you?) what the prostate is, what it does, and what can happen when it enlarges due to benign prostate hyperplasia (enlargement).

      What Is The Prostate?

      The prostate is a gland made of solid tissue that sits right under a mans bladder and surrounds its outlet. The prostates job is to make semen so sperm that are shot up from the testes at ejaculation have got transport and food for their journey to the promised land of the female fallopian tube.

      The prostate is normally about the size of a walnut, but once men hit their 50s and beyond its very common for their prostate to grow. This is not cancer and appears to have nothing to do with cancer. We dont know exactly why the prostate decides to grow at this point, but it appears to be due to some interplay between hormones.

      Because the prostate surrounds the bladder outlet, when it enlarges it sometimes constricts the outlet, causing a weak flow of urine and incomplete bladder emptying. This can lead to other symptoms such as urgency and frequency of urination, commonly at night (nocturia). All together, we call these lower urinary tract symptoms.

      The worst-case scenario in benign prostate hyperplasia is when the bladder blocks off altogether (acute retention). This is excruciatingly painful and requires urgent insertion of a catheter, which externally drains the urine.

      Benign prostate hyperplasia from


      The classic presentation is a middle-aged or older man complaining of these lower urinary tract symptoms. A doctors rectal examination, where the back of the prostate can be felt, or an ultrasound will usually then reveal an enlarged prostate. Incidentally, prostate cancer rarely causes lower urinary tract symptoms, but is common in exactly the same age group, complicating its diagnosis.

      Symptoms raising a red flag that plain old benign prostate hyperplasia may not be the underlying cause of lower urinary tract symptoms are painful urination (dysuria) and blood in the urine (haematuria). Either of these may indicate cancer or infection of the urinary tract and always require further tests to rule them out. If symptoms are just standard lower urinary tract symptoms such as urgency and frequency of urination, no further tests are required.


      The most important thing to know is if the symptoms dont particularly bother you, you dont need any treatment at all. Your symptoms might get worse over time, but they can be effectively dealt with if and when they do cause a sufficient impact on quality of life.

      Medicines are the most common treatment for bothersome urinary tract symptoms due to prostate enlargement. Many of these can be given as a single daily tablet.

      Alpha1-blockers appear to work by relaxing the muscle fibres in the prostate, reducing its constriction of the bladder outlet. These typically provide relief of symptoms within just days of starting them.

      Interestingly, one of the drugs usually used to treat erectile dysfunction (tadalafil) works in a similar fashion. Its low-dose form is also approved for use in treating these urinary symptoms.

      5-alpha-reductase inhibitors (5-ARIs) are a totally different kind of drug, which shrink the glandular tissue of the prostate, reducing its bulk to eventually reduce constriction by the prostate as well. But these take much longer to work, so their effect typically isnt noticed for several months. Also, these drugs can sometimes cause erectile dysfunction and reduced libido. One available drug combines both alpha1-blocker and 5-ARI in the one tablet.

      Alpha1 blockers and 5-ARIs both act on the prostate, but sometimes it may not be the prostate itself that is causing these symptoms, but overactivity of the bladder instead. So if urgency and frequency of urination are the main symptoms, a drug that works directly on relaxing the bladder muscle (detrusor) might be a better option. A variety of these are now available.

      Although some people swear by the natural medicine saw palmetto, the most rigorous examination of the evidence tells us it is no better than placebo.

      Surgical options, although highly effective, tend to be reserved for more severe symptoms, or when inadequate bladder emptying has led to the relatively rare consequences of bladder stones, recurring urine infection or kidney failure.

      So now youre up to date with your prostate and benign prostate hyperplasia, you dont have to be afraid to ask your mates about their walnuts.

      Further reading:

      Men more reluctant to go to the doctor and its putting them at risk

      Dads get postnatal depression too

      Breast cancer campaigns might be pink, but men get it too

      Jeremy Grummet, Urologist, Adjunct Clinical Associate Professor, Department of Surgery, Monash University

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      Hypospadias: The Cause Of Penis Malformation Is Still A Matter Of Debate

      This is part of our series on hidden or stigmatised health conditions in men. Read the other articles in the series here.

      Hypospadias is a malformation of the penis that is present from birth. In hypospadias, the opening of the urethra (the tube that drains urine from the bladder) is misplaced somewhere along the underside of the penis instead of being at the tip.

      The degrees of severity vary, depending on the position of the opening. It can sit within the glans (the tip of the penis), on the shaft of the penis itself, or even within the scrotum, between the two testes.

      Although the incidence varies among regions, hypospadias affects approximately one in 250 male children. Of these, 70% comprise less severe forms, where the opening is relatively close to the tip of the penis, while 30% are affected by more severe forms.


      Most cases are diagnosed at birth or during childhood, when parents or doctors find the penis is abnormal during a physical examination. However, it is not uncommon in adult urology departments to see older patients with mild forms of hypospadias.

      Symptoms can include abnormal spraying of urine or having to sit down to urinate. In addition, hypospadias patients may also have other features such as a downward curve in the penis (called chordee) or an incomplete foreskin. In these latter cases the foreskin is absent on the underside of the penis so that it resembles a hood on the upperside and as a consequence is known as a hooded foreskin.

      In most cases, hypospadias is not associated with any other problems or disorders, and the condition is referred to as isolated hypospadias. Sometimes, it can be associated with other genital anomalies, such as cryptorchidism (a condition where the testes are not properly descended into the scrotum) or micropenis (a condition where the penis is shorter than expected for age).

      It can also be part of the wide spectrum of disorders of sex development, a large number of conditions where the development of the genitals is atypical. Hypospadias can occasionally be found in association with multiple syndromes, where it may be one of many malformations.


      The underlying cause of hypospadias is still a matter of debate. Around 10% of hypospadias cases run in the family. Current thinking is that hypospadias may be caused by both genetic and environmental factors.

      Changes in genes required for normal development of the testes or penis have been shown to contribute to hypospadias in around 30% of cases. However, these kinds of genetic changes do not explain all cases of hypospadias.

      It is believed the environment also plays a role. Some substances found in our daily environment, such as hormonal medications or chemicals found in industry or agriculture, can modify the way our genetic information is expressed (epigenetics). These chemicals can disrupt the regulation of genes associated with normal penis development by causing them to be turned down or off.


      The aim of any medical treatment is to give the patient the best quality of life possible. Most cases will require surgical intervention to correct the curvature and bring the opening as close as possible to the tip of the penis. The aim is to improve both urination and sexual activity.

      In some minor cases, however, the surgery will be only cosmetic, to correct the hooded foreskin. In these cases, choice is usually left to the patients or their parents.

      Depending on the severity of the hypospadias, the consequences of having surgery/treatment or not will vary. Minor cases usually require a single surgical procedure and will have good outcomes, meaning the patient can have normal urination and sexual function.

      In more severe cases, surgery is more complex and has a higher complication rate, especially in terms of urinary function. For sexual and psychological outcomes, however, long-term studies report good results in all forms of hypospadias.

      Further reading:

      Dads get postnatal depression too

      Men more reluctant to go to the doctor – and its putting them at risk

      Breast cancer campaigns might be pink, but men get it too

      Hows your walnut, mate? Why men dont like to talk about their enlarged prostate

      Klinefelters syndrome: being unable to produce testosterone has serious implications for men

      Andrew Sinclair, Deputy Director of the Murdoch Childrens Research Institute, Murdoch Childrens Research Institute; Aurore Bouty, Paediatric surgeon, Genetics Master student , Murdoch Childrens Research Institute, and Katie Ayers, Postdoctoral Fellow, Molecular Development Group and Honorary Fellow, Department of Paediatrics, Murdoch Childrens Research Institute

      Read more:

      Klinefelters Syndrome: Being Unable To Produce Testosterone Has Serious Implications For Men

      This is part of our series on hidden or stigmatised health conditions in men. Read the other articles in the series here.

      Klinefelters syndrome is a genetic disorder that affects approximately one in 450 males. Each cell in the human body has 23 pairs of chromosomes. The sex chromosomes in a female are XX, and XY in men. Typically, men have 46 chromosomes with an arrangement of 46XY, while those with Klinefelters syndrome have a 47XXY arrangement.

      The chromosomal arrangement in someone with Klinefelters. from

      Klinefelters syndrome is not commonly diagnosed, with only four in 10 men diagnosed after birth and 10% diagnosed pre-puberty. Klinefelters syndrome is not typically diagnosed at birth, although physical characteristics may include a small penis and undescended testicles.

      Klinefelters syndrome is the most common form of hypogonadism, where men are unable to produce sperm or sufficient levels of the male sex hormone, testosterone. The low levels of testosterone result in the underdevelopment of typical male characteristics.

      Symptoms of Klinefelters syndrome vary between individuals, but typically include small testicles, lack of facial, pubic and underarm hair, gynaecomastia (breast tissue enlargement), poor muscle development, disproportionately long arms and legs (compared to the body), and potential learning and language difficulties.

      As adults, men with Klinefelters syndrome are infertile, as the extra X chromosome affects the ability to produce sperm, known as azoospermia. Men with this condition may also experience a low libido, depression and are at risk of osteoporosis.


      While Klinefelters syndrome is a genetic disorder, it is not one that is inherited, as brothers of men with Klinefelters syndrome typically have the 46XY pattern.

      The addition of the extra X chromosome is believed to occur as a random event during the formation of the reproductive cells, either within the fertilised egg or during cell division as the baby develops.


      Klinefelters syndrome can be diagnosed through a variety of tests. Physical examination of the genitals will confirm the size of the testes, with the size typically less than four millilitres (the size of a sultana grape).

      Klinefelters syndrome can be confirmed using a blood test, which involves chromosomal analysis. Further blood tests can also examine the levels of testosterone (and other sex hormones), as well as semen examination for levels of sperm. Klinefelters syndrome may also be diagnosed prenatally, through maternal blood testing.


      Men diagnosed with Klinefelters syndrome cannot be cured; rather treatment aims to overcome some aspects of the symptoms. Hormone therapy, specifically testosterone replacement, is a lifelong therapy that increases physical strength, body tone and general wellbeing in men.

      Testosterone therapy is available in various formats including gels, injections, lotions, creams and patches. If diagnosis occurs during the teenage years, testosterone therapy is initiated at a low dose and increased through the adult years.

      In some men with Klinefelters syndrome, sperm may be found in the testicular tissue. For such men, assisted reproductive therapies such as intracytoplasmic sperm injection (ICSI) may be used to achieve pregnancy with their partners. ICSI is a form of in vitro fertilisation (IVF) whereby a single sperm is injected into each egg during the IVF procedure.

      Donor insemination and adoption are alternatives in cases where assisted reproductive therapies are not an option.

      Cosmetic surgery may be performed to remove the enlarged breast tissue. Counselling, physical and speech therapy may also be performed to assist men with the psychosocial aspects of the diagnosis.

      Why Is It Hidden?

      Lack of knowledge, awareness and psychosocial impact are all reasons Klinefelters syndrome is typically underdiagnosed. Men typically use health services less frequently than women. Even when men do see a doctor, a reproductive health examination is not routinely performed.

      Few men have ever heard of Klinefelters syndrome, and similarly would be unaware of the symptoms. For example, many men would not know what the typical size of the testes is, and so may be unaware they have small testes.

      In teenagers, symptoms of Klinefelters syndrome may be clouded by learning problems and the onset of puberty, with Klinefelters syndrome not primary in the thoughts of many health professionals. Embarrassment, stoicism and fear of the unknown are common psychosocial issues perceived by men that prevent them from seeing their doctor about reproductive health issues.

      Treatment and management strategies for Klinefelters syndrome can ensure men diagnosed with the condition have good health outcomes. Further engagement with Klinefelters syndrome support groups can provide men with peer support and assist in overcoming any perceived psychosocial barriers associated with its diagnosis.

      Further reading:

      Dads get postnatal depression too

      Men more reluctant to go to the doctor – and its putting them at risk

      Breast cancer campaigns might be pink, but men get it too

      Hows your walnut, mate? Why men dont like to talk about their enlarged prostate

      Correction: the chromosomal arrangement has been corrected to say 47XXY

      Dragan Ilic, Associate Professor, Department of Epidemiology and Preventive Medicine, Monash University

      Read more:

      Prostate laser therapy recommended to NHS – BBC News

      Image copyright fotojog/thinkstock

      Some 13,000 men in England could benefit from a laser treatment to manage symptoms from an enlarged prostate, the NHS is being advised.

      Most men over the age of 60 have non-cancerous growth of the prostate gland.

      The National Institute for Health and Care Excellence says many of these, if they are having symptoms, could have the new therapy rather than conventional surgery.

      The treatment delivers a beam of green light to vaporise overgrown tissue.

      The standard care currently is to cut away the tissue using a thin, hot loop of wire during a procedure known as TURP.

      While TURP is effective, experts say the new laser treatment could be more convenient for patients.

      Image copyright Science Photo Library

      Unlike TURP, it can be done as a day treatment, meaning the patient does not have to stay in hospital overnight.

      This should save the NHS money too – up to an estimated 3m, says the NICE.

      For the laser treatment, a thin length of laser fibre is passed up the urethra (the tube in the penis that carries urine out of the body) until it reaches the target – the prostate gland that sits just below the bladder and enwraps the urethra.

      The laser is then turned on to blast the tissue.

      This should reverse any blockages and alleviate the patient’s symptoms.

      Prof Carole Longson, from the NICE, said: “Whilst benign enlarged prostates may not be life-threatening, the condition can impact on men’s lives significantly.

      “A procedure to reduce the amount of excess prostate tissue can improve the quality of life for men.”

      Higher risk men with very large prostates (bigger than 100ml) or severe symptoms, however, should still be treated routinely with a different type of laser.

      The prostate

      The prostate gland is part of a man’s reproductive system, and its job is to make the fluid to carry and nurture sperm.

      An enlarged prostate – known as BPH (benign prostatic hyperplasia) – is very common, particularly as men get older, and will not always need treating.

      Left untreated, it can get in the way of emptying the bladder, meaning you have to go to the toilet more often or need to strain to pass urine.

      In the long term, this could potentially cause other problems such as urine infections or damage to the bladder or kidneys.

      BPH can sometimes be managed with medication, but a procedure, such as TURP or a laser treatment, may be recommended.

      Read more:

      If You Eat Garlic and Honey On an Empty Stomach For 7 Days, This Is What Happens To Your Body

      As far as a food that provides major health benefits, garlic definitely ranks up there as one of the best! While included in many dishes for its strong flavoring ability, it also serves as a treatment for various health ailments. Raw garlic is best to receive all the benefits that garlic can provide.

      Its said to be able to prevent and treat a large number of different diseases such as the prevention of atherosclerosis, heart attacks, coronary heart disease, and it can lower cholesterol and blood pressure levels. It can treat and heal ailments such as bug bites, common cold, flu, hay fever, fungal infections, and travelers diarrhea.

      It can also control symptoms related to the following:

      Diabetes, enlarged prostate, and osteoarthritis. On top of all this, it can eliminate toxins, while strengthening the immune system. This is actually one of its most important benefits. It can also serve as a detox agent when combined with ginger and onion, and can be used after chemotherapy takes place. Garlic in raw form is best, as heat can decentralize the active ingredient in garlic. Crush up and chop the cloves then leave for 15 minutes, then add to food, or take them straight up! Crushing it improves bioavailability, and its best to take on an empty stomach, before drinking or eating anything.

      Consume a mix of honey and garlic to really jack your immunity up and improve health to optimal levels. Check this out:

      Honey and raw garlic

      Go with 2-3 garlic cloves and give them a fine chop, while adding a tablespoon of honey. Take this every day and your energy will skyrocket! Heres a garlic flu tonic that will prevent symptoms, but also treat them as well as soothe a sore throat. Youll see how potent it is once you make it.

      Garlic flu tonic-recipe


      5 garlic cloves, coarsely chopped
      1 tablespoon ginger, chopped
      Raw and unfiltered apple cider vinegar
      1 lemon, juiced
      2 red chili peppers, coarsely chopped

      How to make:

      Use gloves to prepare this if your skin is sensitive. The natural garlic oils may cause rashes or burns. Take a 350-500ml Mason jar, then add in chopped onion for one layer, chopped garlic for the next layer, then hot peppers with the seed. Add the ginger next. Pour lemon juice in the jar. Then add the organic apple cider vinegar.

      Seal it up tight, but leave about 1cm of free space from the rim, and keep the jar in your pantry for regular use to prevent the ailments from occurring, or to have your current symptoms go away.

      Read more: