P. Masson

The men's health center: Disparities in gender specific health services among the top 50 "best hospitals" in America

Objective Gender-specific integrated health services have long existed in the arena of womens health care, but mens health centers (MHCs) have only recently emerged as a novel practice model. Here, we seek to evaluate the prevalence and format of MHCs found in the leading academic medical centers in the United States. Methods The US News & World Reports Top 50 Ranked Hospitals for Urology was used as our cohort. Data were gathered on the presence of MHCs and types of providers and conditions treated. An equivalent search was performed for womens health centers (WHCs). Results Sixteen of 50 (32%) promoted some type of MHC, compared to 49 of 50 (98%) offering a WHC. Eight of the top 15 ranked institutions (53%) had an MHC compared to eight of 35 (23%) remaining programs. Six of 16 MHCs incorporated providers from a variety of medical disciplines, including urologists, internists, endocrinologists, cardiologists, and psychologists, while another six of 16 MHCs were staffed solely by urologists. Eight of 16 provided services for exclusively urologic issues, four of 16 offered additional services in treatment of other medical conditions, and four of 16 did not specify. Conclusion A considerable disparity exists between the prevalence of gender-specific health services, with WHCs being much more numerous than MHCs. All but one leading institution had WHCs compared to less than one-third having MHCs. Our findings also highlight the heterogeneous nature of mens health programs, as they exhibit great variability in program type and focus, yet are all being marketed under the “Mens Health” banner.

Hormonal Evaluation and Therapy of Erectile Dysfunction

Significant controversy currently exists regarding the evaluation and treatment of hypogonadism, especially in the setting of erectile dysfunction. Testosterone replacement therapy improves libido, but research supporting its role for improving erectile function is less clear. Despite the controversy and limitations in the literature, there is a role for hormonal evaluation in patients with sexual dysfunction and hormone replacement in selected patients with hypogonadism. Most recommendations support screening men with erectile dysfunction for hypogonadism, particularly among those men presenting with any additional hypogonadal symptoms. Men with very low testosterone or younger men may be initially treated with testosterone replacement therapy to improve erectile function. Eugonadal men with erectile dysfunction should not be treated with testosterone.