THE ENCYCLOPEDIA OF
MEN’S HEALTH
Glenn S. Rothfeld, M.D., M.Ac.,
and Deborah S. Romaine
An Amaranth Book
The Encyclopedia of Men’s Health
Copyright © 2005 by Amaranth
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Rothfeld, Glenn S.
The encyclopedia of men’s health / Glenn Rothfeld and Deborah S. Romaine.
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“An Amaranth book.”
Includes bibliographical references and index.
ISBN 0-8160-5177-1 (HC : alk. paper)
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innovations that marked the latter decades of the
20th century have made it possible for us to repair
damaged hearts, cure many forms of cancer, and
even replace diseased organs. Men today can expect
to live a third as long as did their grandfathers. Yet
swirling from the core of these amazing advances is
the growing recognition among many physicians,
including me, that technology alone is not the
answer when it comes to good health. Good health
comes from good health care—not only from the
care physicians can provide, but also from caring for
one’s own health and well-being. Good health is an
integration of technology and lifestyle.
I recognized early in my medical career that for
as much as we benefit from the scope and breadth
of technology in the practice of medicine, there is
much for us to learn from the history of healing.
Medicine, as we practice it in Western cultures, is lit-
tle more than a blip on the time line of humankind.
Healers have worked to improve the human condi-
tion for thousands and thousands of years. The key
lesson that endures is that the human body has a
remarkable capacity to heal and to keep itself
healthy. The methods that are most successful over-
all are those that support this capacity.
As our clinical knowledge of preventive health
care and health maintenance expands, so, too,
does the understanding among men that we can
influence the status of our health. Only with
recent generations has this even been a considera-

healthy as well as to take care of your ills and injuries.
—Glenn S. Rothfeld, M.D., M.Ac.,
Medical Director, WholeHealth New England, Inc.
INTRODUCTION
v
class="bi x0 y8 w2 h5"
ENTRIES A–Z
class="bi x0 y8 w2 h5"
A
A-B-C-D skin examination See SKIN CANCER.
abdominal adiposity A body fat distribution pat-
tern in which excess fat collects around the waist.
Although men tend to joke about their “spare tire,”
abdominal adiposity reflects potentially serious
health issues. Abdominal adiposity often signals the
pressure of
INSULIN RESISTANCE, correlating to an
increased risk for various diseases such as
HYPERTEN-
SION (high blood pressure), CORONARY ARTERY DISEASE
(CAD), INSULIN RESISTANCE, and type 2 DIABETES. This
fat distribution pattern can show up in younger men
who are overweight or obese, although it has a ten-
dency to affect more men as they enter middle age
and beyond. Men with abdominal adiposity usually
have
BODY MASS INDEXES (BMIs) over 28, the clinical
marker for overweight, although they may not look
overweight.
One reason abdominal adiposity becomes a

bones and below the navel) have the greatest risk
for serious health problems as a consequence of
excess body fat. Health experts now consider
abdominal adiposity a more significant predictor
for heart disease than any other single factor
except cigarette smoking. Lifestyle changes that
incorporate nutritional eating habits and regular
exercise to lose excess body weight and body fat
help to improve a man’s cardiovascular and overall
health. However, predisposition toward a body fat
accumulation pattern of abdominal adiposity
remains a warning. The more body fat a man
prone to abdominal adiposity acquires, the higher
his risk for health problems, even more so than a
man with the same amount of body fat who has a
generalized body fat distribution pattern. Doctors
are likely to implement treatment strategies such
as lipid-lowering medications and antihypertensive
medications earlier and more aggressively in men
with abdominal adiposity.
See also
BODY SHAPE AND HEART DISEASE; LIFESTYLE
AND HEALTH
; NUTRITION AND DIET; OBESITY; WEIGHT
MANAGEMENT
.
accidental injury An unintended event that
results in bodily damage. Accidental injury is the
leading cause of death for men under age 25 and a
significant cause of disability and death for men of

Acetaminophen works to relieve fever through
its actions on the hypothalamus, the structure
deep within the brain that regulates body temper-
ature. Acetaminophen activates body mechanisms
that cause sweating and peripheral blood vessel
dilation, helping to cool the body by circulating
more blood near the surface of the skin. The cool-
ing effect of evaporation (sweating) further lowers
skin temperature. As a pain reliever, acetamino-
phen acts to interrupt the release of prost-
aglandins. Prostaglandins are chemicals that convey
pain signals.
Acetaminophen has few side effects when taken
as directed, and doctors generally recommend it for
pain and fever relief when there is no need for an
anti-inflammatory effect (acetaminophen does not
relieve inflammation). However, the liver is very
sensitive to acetaminophen. When taken in excess
or in combination with alcohol, or in other cir-
cumstances that impair liver function, such as
chronic alcohol or substance abuse, acetamino-
phen can accumulate to toxic levels capable of
causing serious, permanent liver damage. This can
result from a single excess or from a mild excess
over time (such as with extended use).
See also
ASPIRIN; NONSTEROIDAL ANTI-INFLAMMATORY
DRUG
.
ACL See ANTERIOR CRUCIATE LIGAMENT.

shaven reduces the opportunity for skin oils and
moisture to accumulate. Numerous skin cleansing
products are available without a doctor’s prescrip-
tion. Products containing salicylic acid, sulfur,
TEA
TREE OIL
, witch hazel, and aloe often are effective in
controlling mild to moderate acne. Products con-
taining benzoyl peroxide have a stronger astrin-
gent (drying) effect for moderate acne. It is
important to follow label directions for all prod-
ucts, as overusing them is of little value and can
cause skin irritation, redness, flaking, and peeling.
Conventional soaps tend to leave residue, which
itself can plug pores and exacerbate, rather than
relieve, acne.
Prescription medications to treat moderate
acne include antibiotics such as tetracycline,
which can be taken long term, and topical creams
containing retinol, a form of vitamin A. A derma-
tologist should evaluate and treat acne that forms
pustules and cysts that leave scars and pitting.
There are numerous prescription medications
available that can treat severe acne. A single 20-
week course of treatment with oral Accutane
(isotretinoin) permanently ends acne for most
men who take it. Accutane alters the biochem-
istry of the skin in ways that changes sebum pro-
duction; these changes generally are permanent.
However, Accutane has potentially serious side

body odor—all common symptoms.
Diagnosis and treatment are important, as
endocrine dysfunction becomes more pervasive
and causes a cascade of health problems such as
OSTEOARTHRITIS, cardiomegaly (enlarged heart),
HYPERTENSION (high blood pressure), ERECTILE DYS-
FUNCTION, intestinal POLYPS, and DIABETES. Because
early symptoms are vague and acromegaly is rela-
tively uncommon, it sometimes takes time to reach
the correct diagnosis. Laboratory tests that meas-
ure the amount of growth hormone in the blood-
stream and imaging procedures such as a
COMPUTED
TOMOGRAPHY
(CT) SCAN or MAGNETIC RESONANCE
IMAGING
(MRI) can make the diagnosis. Treatment
might include surgery or radiation, depending on
the tumor’s location, or injections of drugs
(bromocriptine, also used to treat P
ARKINSON’S DIS-
EASE, or octreocide, a hormone that suppresses
growth hormone production) to suppress growth
hormone production. Many of the symptoms go
away with treatment, although physical changes
such as enlarged feet and hands remain. Diseases
such as diabetes and hypertension often also per-
sist, requiring treatment.
Actors Richard Kiel, who played the character
Jaws in the James Bond 007 movies; Carel Struy-

off, if practical, and by excising them if not. The
dermatologist can do this in his or her office. With
liquid nitrogen treatment, the dermatologist
freezes the area with a focused spray, causing the
cells to die (often scraping a few cells for laboratory
examination). Over the following 10–14 days, the
area darkens and then sloughs off. With excision,
the dermatologist numbs the area with a local
anesthetic and cuts out the lesion, pulling the
edges together with sutures if necessary. The
wound takes seven to 10 days to heal. All excised
lesions undergo pathological examination to deter-
mine whether they are precancerous or cancerous;
if they are, the dermatologist might recommend
further treatment. With both methods, discomfort
is minor, healing is quick, and typically there is no
scarring.
Removing actinic keratosis lesions is the surest
way to prevent certain forms of skin cancer. Wear-
ing sunscreen and protective clothing (including a
hat that shades the ears and face) to reduce sun
exposure helps to prevent actinic keratosis from
developing. Dermatologists usually can diagnose
actinic keratosis on visual examination because of
its characteristic appearance, and laboratory analy-
sis can provide definitive diagnosis.
See also
ACNE; ROSACEA; SEBORRHEIC KERATOSIS;
SKIN CANCER.
acupuncture The centuries-old therapy founda-

TION DEFICIT DISORDER (ADD), nausea or vomiting,
substance abuse, and health situations that fail to
respond to conventional approaches.
In 1997 the National Institutes of Health issued
its “Consensus Statement on Acupuncture.” This
statement identified conditions for which clinical
research studies have established acupuncture’s
therapeutic effects. Among them are:
• addiction
• asthma
• carpal tunnel syndrome
• dental pain
• headache
• low back pain
4 ACTH
• nausea following chemotherapy and surgery
• osteoarthritis
• stroke rehabilitation
• tennis elbow
Although acupuncture has been practiced
around the world for 3,000 years or longer, it did
not come to the attention of the Western world
until 1971, when American journalist James
Reston, in China on assignment for The New York
Times, experienced acupuncture anesthesia and
pain relief when he had emergency surgery to
remove his appendix. Today there are an estimated
15,000 licensed acupuncturists practicing in the
United States; about 25 percent of them are also
medical doctors. However, training and experience

version of stored glycogen into glucose (sugar the
body can use for its energy needs), the body’s
inflammatory response, and nutrient metabolism,
particularly in response to events that physically
stress the body, such as infection or injury. Aldos-
terone regulates the body’s electrolyte (salt) and
water balance, which controls
BLOOD PRESSURE and
blood volume. Addison’s disease also is called
hypoadrenocorticism or adrenal insufficiency.
Most cases of Addison’s disease develop when
the body’s immune system produces antibodies
that attack adrenal cortex cells, erroneously per-
ceiving them as foreign to the body. This is similar
to the autoimmune process that results in type 1
DIABETES and hypothyroidism, other more com-
mon autoimmune disorders of the
ENDOCRINE SYS-
TEM; having one such disorder increases the
likelihood of having another. Tumors, particularly
adrenal
ADENOMAS, can also cause Addison’s dis-
ease. A similar condition, secondary adrenal insuf-
ficiency, can develop when the pituitary gland fails
to produce enough
ADRENOCORTICOTROPIC HOR-
MONE (ACTH), the hormone that stimulates the
adrenal cortex to produce cortisol. In secondary
adrenal insufficiency, however, aldosterone pro-
duction remains normal.

including blood tests to measure blood electrolyte
levels.
English physician Thomas Addison first
described the condition that now bears his name in
1855, when he observed the symptoms and con-
nected them to tuberculosis affecting the adrenal
glands.
adrenocorticotropic hormone (ACTH) A HOR-
MONE the pituitary gland secretes that stimulates
the adrenal cortex to produce its hormones: corti-
sol, aldosterone, and
ANDROGENS. These hormones
have many essential functions. Cortisol regulates
the body’s response to physiological stress, includ-
ing the conversion of glycogen to glucose in the
liver, interactions with insulin in glucose regula-
tion, and inflammatory reaction (injury and ill-
ness). Aldosterone regulates the body’s electrolyte
(salt) and water balance to control blood pressure
and blood volume. Adrenal androgens contribute
to the transformations of puberty and in the adult
man play a role in bone density and strength. Cir-
culating levels of ACTH in the bloodstream trigger
the hypothalamus, a structure deep within the
brain, which in turn signals the pituitary gland to
release ACTH. The lower the circulating ACTH
level (which can be measured by blood tests), the
stronger the hypothalamic response.
Doctors sometimes administer injections of
ACTH to treat

distinctive characteristics that help to make this
determination, although
BIOPSY with pathology
examination provides the diagnosis.
See also
CANCER; ENDOCRINE SYSTEM.
adult attention deficit disorder (ADD) A chronic
behavioral disorder of inattention and impulsive-
ness. These symptoms make focus, concentration,
and control difficult. Researchers do not know pre-
cisely what causes adult ADD; it likely is a combi-
nation of factors centered on complex biochemical
interactions in the brain that affect the brain’s
functions.
6 adrenocorticotropic hormone
NIMH-DEFINED ADD SYMPTOMS
Inattention Impulsiveness
• becomes easily distracted by irrelevant activity • blurts inappropriate comments
• forgets and loses things • answers before questions are finished
• does not follow instructions • steps in front of others when waiting in line
• makes careless mistakes • disregards rules and procedures
• leaves tasks incomplete • outbursts of anger disproportionate to the situation
Recent understandings about ADD have height-
ened sensitivity to its existence, particularly among
adults who had undiagnosed attention deficit hyper-
activity disorder (ADHD) as children. Although
many children seem to “outgrow” ADHD in adoles-
cence, the disorder often persists into adulthood.
Men with adult ADD might have trouble holding
jobs, completing education or training, and main-

terminal medical condition or situation. Advance
directives generally comprise two components:
• A living will, which states the level of medical
treatment, including life support, a man desires
at the end of life; and
• Durable power of attorney for health care, which
authorizes a specific individual to make health
care decisions on a man’s behalf when he is unable
to make such decisions himself.
Most hospitals now routinely ask people upon
admission if they have advance directives and offer
standardized forms to fill out for those who do not.
Advance directives should become part of the med-
ical record in the doctor’s office as well as in the
hospital of admission. A family member or trusted
friend should also have a copy, such as a desig-
nated proxy on the durable power of attorney for
health care. A man can change any part of his
advance directives at any time, whether or not he
is hospitalized or ill at the time. Medical staff make
every effort to honor advance directives when it is
within their legal capacity to do so.
See also
INFORMED CONSENT; QUALITY OF LIFE.
aerobic exercise See EXERCISE.
age spots Discolored, usually darkened, skin
spots of varying sizes that occur toward middle age,
most commonly in fair-skinned men. They result
from sun exposure over time and often appear
most prominently on the hands and arms. Some

aggression 7
Because men are physically larger and stronger
than women and children, their aggression has
greater potential to do harm to others. There is also
a tacit approval of mildly aggressive behavior, in
the guise of competitiveness, within the American
culture that establishes fairly wide latitude for
acceptable behavior. However, aggression is not
appropriate or acceptable when it results in damage
to objects or property, or causes harm (physical and
emotional) to other people. Men who feel their
aggression is out of control should seek therapy to
understand their aggressive tendencies and to learn
anger management skills.
See also
SEXUAL ASSAULT.
aging The physiological and emotional changes
that occur with growing older. Cells are pro-
grammed to die under certain circumstances, a
process called apoptosis. It appears that an interac-
tion between genetics and environment deter-
mines the timing and rate of apoptosis. Apoptosis
usually is gradual, resulting in a slow but progres-
sive diminishment of function. The changes that
result become apparent at about midlife (40s and
50s). Other factors shape the changes of aging as
well, such as diseases and injuries. And as the
body’s structure slowly changes, it becomes more
susceptible to both disease and injury.
Normal, observable changes associated with

recover before developing a second erection.
• Illness and injury. The likelihood of health
problems increases with age, as the body
becomes more susceptible to, or begins to show
the consequences of, damage. Some damage is
internal and cellular, such as heart disease. An
older man’s body also is more vulnerable to
damage from external sources, such as muscle
strains and broken bones.
There are many social implications related to
aging. Contemporary culture seems to favor youth,
and some men find it difficult to be “old,” however
it is that they define it. Nutritious eating habits,
regular physical exercise (aerobic and resistance),
moderation, and not smoking are all ways to main-
tain the body’s health and vigor.
See also
EXERCISE; PLASTIC SURGERY.
alcohol and health Alcohol use among adults is
a common and acceptable practice in modern
Western culture. There are positive and negative
consequences of this, personally and societally.
There is some evidence that moderate alcohol con-
sumption has a protective effect on the cardiovas-
cular system; alcohol is a mild anticoagulant and
contains flavonoids (antioxidants).
But alcohol abuse causes heart disease as well as
numerous other health problems. Alcohol intoxi-
cation accounts for more than a third of fatal motor
vehicle accidents and is a contributing factor in as

therapeutic and destructive is a thin one and varies
among individuals. This makes it difficult to iden-
tify a “safe” level of alcohol consumption for any
purpose. Many health experts feel that the only
“safe” amount of alcohol is no alcohol at all,
regardless of whether alcohol dependency exists
(and certainly when it does).
Heart health Some studies suggest that drink-
ing modest amounts of alcohol—one to two drinks
daily—reduces the risk of
HEART DISEASE and STROKE.
However, these findings are not conclusive and the
precise reasons for such an effect continues to
elude researchers. People with drinking problems
or health conditions exacerbated by alcohol con-
sumption should not drink, regardless of the possi-
ble benefit for the cardiovascular system.
Extended abuse of alcohol causes a condition
doctors refer to as “alcoholic heart failure.” Over
time alcohol damages cells throughout the body,
including those of the heart and blood vessels. This
reduces the heart’s pumping strength and effi-
ciency, causing it to become enlarged as it struggles
to maintain adequate circulation. Heart failure that
results from alcohol abuse tends to be less respon-
sive to medical treatment. Men who drink exces-
sively are more prone to other forms of heart
disease as well, a combined consequence of alcohol
toxicity and lifestyle factors such as poor nutrition,
lack of exercise, and cigarette smoking.

body systems feel the effects of inadequate nutri-
tion and exercise, as well as of alcohol’s cumulative
toxicity. In particular, deficiencies of nutrients such
as vitamin B1 cause many of alcohol’s toxic neuro-
logical effects. Binge drinking can result in poten-
tially fatal alcohol poisoning. The brain and
nervous system are particularly vulnerable, with
cognitive loss as well as motor function loss possi-
ble. Alcohol intoxication interferes with judgment;
alcohol consumption is a contributing factor in
about a third of all fatal motor vehicle accidents
and up to half of motor vehicle accidents overall.
Binge drinking can cause seizures.
Treatment Treatment for alcohol abuse and
dependency generally combines medical interven-
tion with supportive measures and therapy. Men
with alcohol dependency experience withdrawal
symptoms when stopping alcohol, which can
require hospitalization and supportive medical
care. Continued support might include medica-
tions such as disulfiram (Antabuse) or calcium car-
bimide (Temposil) that interfere with the body’s
ability to metabolize alcohol, and intensive sub-
stance abuse therapy or participation with a pro-
gram such as A
LCOHOLICS ANONYMOUS (AA).
A
CUPUNCTURE, particularly aural or ear acupunc-
ture, is effective in reducing alcohol cravings in
many men. Herbs such as milk thistle help to restore

based on the 12-step program approach that helps
people remain in recovery for alcohol abuse. It is
the largest such structure for support groups, with
chapters in thousands of locations throughout the
United States. The structure’s key principles are:
• Anonymity; members identify themselves by
first name only.
• Acceptance; members may not speak or behave
in judgmental ways toward one another or
themselves.
• Honesty; members must be truthful about any
lapses.
• Encouragement; members support each other in
their challenges to remain sober.
• Self-understanding and knowledge; AA meet-
ings often feature guest speakers who provide
information about alcohol and substance abuse
and their underlying causes.
Most AA chapters meet weekly and are open to
anyone who agrees to abide by AA guidelines.
Local telephone directories provide listings for AA
chapters. Hospitals, medical clinics, health depart-
ments, and community centers generally have
contact information for area AA chapters as well.
See also
ALCOHOL AND HEALTH; LIVER DISEASE;
HEART DISEASE.
allergies Abnormal, hypersensitive reactions
the body’s
IMMUNE SYSTEM generates in response

in which a small amount of the substance is
injected just under the skin to see whether it
evokes a response. Treatment for type 1 allergy
responses combines immediate treatment to
relieve the histamine response (antihistamine
medications) and long-term immunotherapy, or
“allergy shots.” This involves injecting very small
amounts of the antigen, usually weekly, to gradu-
ally desensitize the immune system. Immunother-
apy generally extends over several years and may
not be a permanent solution. The only certain
remedy is to avoid the allergen. Men who know
they have severe allergic reactions should carry an
anaphylaxis kit that includes diphenhydramine
tablets (an effective oral antihistamine) and a pre-
filled syringe of epinephrine for injection.
Type 2 In type 2 the allergen-antibody inter-
action activates a different component of the
immune system, the T-cells, and instigates a full-
blown immune system response.
Type 3 These allergen-antibody reactions acti-
vate immune complex, which leaves deposits at
the point of activation. These can cause localized
swelling and scarring, such as with vaccinations
like smallpox, or disease conditions involving spe-
cific organs such as allergic alveolitis (extrinsic
fibrosing alveolitis), which affects the lungs of peo-
ple who breathe allergens such as bird dander (bird
breeders). Type 3 hypersensitivity responses can
take up to several days to manifest and often

as those resulting from illness,
CHEMOTHERAPY or
RADIATION THERAPY, and as side effects from med-
ications. Other forms of alopecia, notably androge-
netic alopecia (male pattern baldness), result in
permanent hair loss. There are treatments to
encourage more rapid hair regrowth, delay hair
loss, and replace lost hair. More accurately, alope-
cia identifies circumstances in which new hair fails
to grow rather than an increase in loss of hair.
alopecia 11
Alopecia Areata
Alopecia areata is an
AUTOIMMUNE DISORDER in
which the body’s immune system attacks clusters
of hair follicles, halting hair growth and causing
round patches of baldness that vary in size and can
extend to cover the entire scalp or the whole body.
The hair follicles remain alive, and hair growth
typically returns to normal once the immune
response subsides. The length of an immune
response varies from months to years. Alopecia
areata affects men and women equally and can
appear at any age (even in childhood). About
2.5 million American men have alopecia areata.
There appears to be a strong genetic component to
the condition, as 20 percent of those who have it
also have other affected family members. Alopecia
areata is more common in those who have other
autoimmune disorders such as type 1

that naturally occur with
AGING. There do not
appear to be any health consequences associated
with androgenetic alopecia, although researchers
are exploring potential correlations to a higher
rate of
HEART ATTACK and BENIGN PROSTATIC HYPER-
TROPHY (BPH) among men who have male pattern
baldness.
A man can inherit the genes for androgenetic
alopecia from either parent. It appears that these
genes affect the way hair follicles respond to
androgen hormones, especially
TESTOSTERONE and
its derivative that signals hair follicles to diminish
hair production, dihydrotestosterone (DHT).
Genetic programming regulates the hair follicle’s
sensitivity to testosterone and DHT. The amounts
of testosterone, DHT, and other androgens circulat-
ing in the bloodstream also begin decline slightly
and gradually, starting when a man is in his mid-
20s, so less of these hormones is in circulation.
However, a man with androgenic alopecia has no
less testosterone than a man whose hair remains
full; it is the way the hair follicles respond to the
testosterone that causes changes in hair growth.
Dermatologists assess the extent of androgenetic
alopecia using the Norwood-Hamilton classification
scale, which assigns numeric values of one through
seven according to the severity of hair loss, with

PLASTIC SURGERY.
alpha antagonist (blocker) medications Medica-
tions taken to treat moderate
HYPERTENSION (high
blood pressure) that block the action of epinephrine
on the heart and smooth muscle tissues of the arter-
ies, often simply called alpha blockers. Epinephrine
is a hormone the body releases to raise blood pres-
sure and heart rate; alpha blockers prevent this
action. Commonly prescribed alpha blockers include
prazosin (Minipres), doxazosin (Cardura), clonidine
(Catapres), guanabenz (Wytensin), terazosin (Hytrin),
and methyldopa (Aldomet).
Alpha blockers also affect smooth muscle func-
tion elsewhere in the body, most noticeably in the
genitourinary tract. For this reason doctors some-
times prescribe them to treat
BENIGN PROSTATIC
HYPERTROPHY
(BPH), or enlarged prostate. Relaxing
the muscles of the urethra helps to improve the
flow of urine. Consequently, however, alpha
blockers can cause urinary
INCONTINENCE and EREC-
TILE DYSFUNCTION as undesired side effects. Other
common side effects include
HEADACHE and
drowsiness, which usually go away after taking the
alpha blocker for a few weeks. It is important not
to stop taking an alpha blocker abruptly, as doing

base. This nearly immediately relaxes the smooth
muscle tissue of the penis and the arteries supply-
ing the penis with blood, allowing the penis to
become engorged and producing an erection
within about 10 minutes. Some men don’t like the
idea of injecting their penises, however, and the
injections can be uncomfortable. As well, the injec-
tions only can be administered three times a week
and no more frequently than once in 24 hours.
Other side effects include
PRIAPISM (an erection
that lasts longer than four hours and becomes
painful) and fibrous tissue formations at injection
sites.
Transurethral alprostadil A man inserts a
suppository about the size of a grain of rice into its
single-use applicator, then inserts the applicator
into the urethra opening at the tip of his penis. As
the suppository dissolves, the alprostadil diffuses
into the surrounding tissues and has a similar effect
as when injected. A burning sensation while the
suppository is dissolving is common and can be
somewhat mitigated by walking around to
enhance blood circulation. An erection usually
occurs within 10 minutes. Erections tend to be less
firm with transurethral alprostadil. Priapism is less
common than with injectable aprostadil. Other
side effects include continued burning and irrita-
tion of the urethra.
With both forms of alprostadil administration,

ing the nerve signals they send and receive. At the
same time, the amount of the neurotransmitter
acetylcholine, which facilitates communication
between neurons related to cognitive functions
such as logical thinking and memory, dramatically
declines. Researchers do not yet know why these
changes take place, but as they progress, they
cause continued deterioration of cognitive, and
eventually motor, functions. A number of genetic
mutations appear in some, but not all, people who
have Alzheimer’s disease. It seems clear that there
is a genetic component, but its precise nature con-
tinues to elude scientists.
It is likely that environmental factors also play a
role in whether and how Alzheimer’s disease
develops. For a period of time researchers focused
on exposure to metals such as aluminum and other
environmental substances. So far, however, clinical
research studies have not been able to definitively
link them with Alzheimer’s disease. The risk for
developing Alzheimer’s disease increases with age.
Some researchers believe that nearly everyone
over age 85 has at least a mild form of it.
Diagnosis
Confirmed diagnosis of Alzheimer’s is not possible
until autopsy after death. There are no blood tests
or diagnostic procedures that can determine the
presence (or absence) of Alzheimer’s while a per-
son is living, although imaging technologies such
as a

longer knows how to do things that were once sec-
ond nature, such as returning home after a walk.
In Alzheimer’s later stages, care is usually best pro-
vided in a facility that offers a secure environment
and staff specially trained in caring for people with
Alzheimer’s.
Outlook
Doctors are getting better at diagnosing Alzheimer’s
earlier, which gives the opportunity to use medica-
tions and other approaches to maintain cognitive
function. Many people live for a number of years
showing few symptoms, and with a strong support
network among loved ones, they can enjoy good
quality of life for a long time. Alzheimer’s is not
itself usually the cause of death, although it can be
the instigating factor in the cascade of events lead-
ing to death.
14 Alzheimer’s disease
Men as Caregivers
As life expectancy for both men and women
increases, men are nearly as likely as women to
find themselves in caregiver roles for a spouse with
Alzheimer’s disease. Caregiving is a challenging
role and changes the dynamics of relationships.
Although many men who are older today are
accustomed to being the family support, caring for
a spouse with Alzheimer’s thrusts them into very
different functions. It is difficult to experience a
loved one’s changes as Alzheimer’s disease pro-
gresses, especially for men who might not have a

produce red blood cells; this is one of the thera-
peutically legitimate uses for them. Although this
improves the blood’s ability to carry oxygen, over-
all anabolic steroids do little to improve overall aer-
obic capacity and can cause reduced endurance
over time because of their effects on the
CARDIO-
VASCULAR SYSTEM. Nonetheless, anabolic steroid use
is rampant among athletes from high school to
professional despite random blood testing to detect
it. Anabolic steroids, and anabolic supplements
that the body converts to anabolic steroid forms
after ingestion, can cause numerous and serious
adverse health effects that result in permanent
damage to the cardiovascular system, liver, and
MUSCULOSKELETAL SYSTEM.
Researchers developed anabolic steroids in the
1930s as synthetic hormones to treat male hypog-
onadism (underproduction of androgens) and
delayed puberty. During clinical testing, researchers
discovered the side effect of increased muscle
bulk. Of significant concern today is the number of
young people—high school age and younger—who
use illegal anabolic steroids or steroid precursors
(anabolic supplements) to build bigger muscles,
particularly in the upper body. Anabolic steroids
hold particular appeal for young men who desire a
muscular physique, especially those who are not
athletes.
There are two common approaches to using

tions such as hepatitis and HIV/AIDS.
Anabolic steroids have behavioral effects as
well, most notably irritability, volatility, and rage
that lead to inappropriately aggressive actions
(including sexual
AGGRESSION). The National Insti-
tute on Drug Abuse, a component of the National
Institutes of Health, considers anabolic steroids to
be addictive drugs, pointing to the number of men
who continue using them even when physical
problems are apparent or interfere with everyday
life. Men who abruptly stop taking anabolic
steroids experience withdrawal symptoms includ-
ing muscle and joint pain, severe headache, mood
swings, depression, and suicidal tendencies. There
are few medical treatments to ease anabolic steroid
withdrawal; the most effective approach seems to
be a strong support network until the physical
symptoms abate.
See also
BODY IMAGE.
anaerobic exercise See EXERCISE.
anal fissure A break in the skin around or inside
the anus that can be very painful, especially with
bowel movements, and may bleed. Anal fissures
are common and have numerous causes, including
HEMORRHOIDS and straining to pass stools (a conse-
quence of
CONSTIPATION). Most anal fissures heal on
their own within 10–14 days. Warm baths or sitz

SPIRIN became commercially available
as an analgesic and antipyretic (fever reducer)
medication in 1899 and today remains the most
widely used drug in the world. Aspirin relieves
mild to moderate pain. Its major drawback is
that it causes gastrointestinal irritation and
decreased blood clotting, resulting in bleeding.
16 anaerobic exercise
COMMON ANABOLIC STEROID PRODUCTS
Oral Forms Injectable Forms Anabolic Supplements
methandrostenolone boldenone undecyclenate androstenedione (“Andro”)
(Dianabol, D-Bol) (Equipoise) creatine
oxymetholone (Anadrol) nandrolone decanoate dehydroepiandrosterone
(Deca-Durabolin) (DHEA)
oxandrolone (Oxandrin) nandrolone phenpropianate human chorionic
(Durabolin) gonadatropin (HCG)
stanozolol (Winstrol) testosterone cypionate
(Depo-Testosterone)