Is It Time to Confront Your Demons? - 2

continued...

"David."

I looked up. She was smiling: a thin, stylish woman with wavy hair and a pleasantly disarming bohemian glow. I shook her hand and followed her to an airy office at the end of a long hallway. She pointed me toward the couch (yes, there really was a couch) and sat down in a chair facing me. I'd dreaded this moment. How do you confide in a complete stranger? How do you share the thoughts you've never shared with anyone else? Yes, this woman was trained (and paid) to listen. Yes, it was supposed to be easier to talk about your life with someone outside of it. But I didn't actually buy any of that. I mean, seriously. The entire setup was so artificial. How should I play along? Where would I begin?

Well, at the beginning, if you're Freud. First memories and all that. But so far, this had nothing to do with Freud. She hadn't asked me to lie down or recount dreams. No, we just started talking. This and that. Occasionally, she asked a pointed question. Sometimes she wrote things down. On my book tour, I'd grown tired of talking about myself, so I created a kind of persona, a second, more public version of myself. It was a phenomenon I hadn't pondered or discussed with anyone because, well, that would be even more self-serving. And anyway, who in her right mind would listen?

It took me a moment to realize I was saying all of this out loud. In less than an hour, I'd delved deeper into my, what, unconscious than at any time in the past year. And this I told her, too.

"I'm not sure we've reached your unconscious yet," she said. "But we have awakened some of the bats that were sleeping."

At my next appointment, I came rushing in, frustrated by all the small aggravations of life. I slumped into a chair and took a deep breath, and the outside world began to fall away. I could no longer ignore it: I'd been looking forward to coming back. Last week's visit felt like something worth pursuing--an intriguing first date or an adulterous affair. And I was cheating on the part of me I didn't like. I just started talking: women, work, goals I should be pursuing--

"You're saying 'should' a lot," she said.

"I am?"

"Yes. As if you have a preconceived notion of yourself. Some other possible life you're battling against. Tell me, what do your parents do?"

"Is this the Freud part?"

She laughed. "Maybe, a little bit. We all have different versions of ourselves. And they're rooted in our pasts."

"They're both lawyers," I said.

"Oh, dear. This may take a while."

There is a moment in therapy--if it's going well--when you decide to tell the truth. For me it was the middle of the fourth session. And I don't mean I'd been lying until then. It's just that I hadn't come completely clean. This was, after all, a relationship of sorts. The person sitting across from me was someone I'd quickly come to value and respect. I wanted her to like me. I wanted her to be impressed. And yet I was playing that coy game we all play. When she said she was looking forward to reading my book, I told her she must have better things to do. The false modesty was pathetic. I'm sure she saw through it, even if she didn't let on.

She changed the subject. I changed it back.

"About the book," I said. "Of course I want you to read it."

"So why did you say you didn't?"

"I don't know. Why does anyone say anything?" And then I caught myself again. I did know. "Okay, I didn't want to sound self-involved."

She leaned forward slightly. "You're very hard on yourself. You should want your work to be read; otherwise, why do it? You can't just stay silent, hoping to be noticed. Not in this day and age."

I almost said that flagrant self-promotion was part of what had made "this day and age" so superficial in the first place. But this was psychotherapy, not philosophy. And I'd just made a small breakthrough of sorts, peeled away a layer of myself. She knew it, too.

Suddenly, we were off and running. She poked and prodded. I reacted and explained. For the first time, I could imagine these mini-realizations leading to a larger, life-altering discovery.

The following week I came armed with a question.

"Tell me, where does all this end?"

"What do you mean?" she asked, looking up from her notes. She smoothed the wrinkles in her skirt.

"You don't like it when I ask the questions, do you?"

"Therapists have their own therapists for that," she said.

"Oh, that makes me feel better."

"How?"

"That you have someone to vent to."

"I think you know this is about a lot more than just venting," she said. "We're on a journey. And the end is never as important as how you get there."

"But if we keep peeling off layers, there may be nothing left."

She laughed at this and was silent for a time. I thought back to that first day in the waiting room and of all those ideas and misconceptions. Psychotherapy wasn't what I had thought it would be. It was instead a reflection of who I was. It wasn't spiritual or New Age, because I'm not spiritual or New Age. But something positive was happening, so why not give it a chance? Was I going soft? Maybe a bit, or maybe I'd been hard-edged for too long.

I realized then that I was staring out the window. When I turned back, she was regarding me curiously, her brow slightly furrowed. And then, as if reaching a decision, she opened her notebook and clicked her pen.

"I think you're ready," she said. "So let's start at the beginning. What are your first memories?"

Find the Right Therapy for You

Psychotherapy works -- but only if you visit the right kind of therapist. Here are five common reasons men visit shrinks, and the recommended therapy for each problem.

1. Depression: Cognitive Behavioral Therapy (CBT)
When men believe they have no reason to be happy, they turn away from activities they enjoy. "The cognitive part helps patients identify their negative thoughts, and the behavioral aspect pushes them to stay active," says Greg Simon, M.D., a psychiatrist in Seattle.

2. Phobias: Exposure Therapy
"Contact with the feared event is critical to overcoming it," says Jeffrey S. Berman, Ph.D., a University of Memphis professor. Exposure therapy slowly desensitizes you. Say you're afraid to fly. Over a few months, you visit an airport, sit on a plane, and taxi around. Then you're cleared for takeoff.

3. Substance Abuse: 12-Step Programs
Alcoholics Anonymous and Narcotics Anonymous are still the key treatments for alcohol and drug abuse. A 2006 study in Addiction found that people who sought treatment by using a 12-step program were 44 percent more likely to be clean and sober 3 years later.

4. Anxiety: Psychodynamic Therapy
CBT is the standard treatment for anxiety. But a recent study suggests that psychodynamic therapy, which raises awareness of unconscious motivations, is a great alternative. In the study, patients had a 153 percent greater reduction in symptoms after 12 weeks than those receiving relaxation training.

5. Marital Troubles: Family Therapy
"Family therapy treats relationships, not individuals," says Jacques Barber, Ph.D., a professor of psychology at the University of Pennsylvania. The goal is not to pinpoint the cause of a problem -- i.e., place blame -- but to reveal how the couple's interactions feed it.

Is It Time to Confront Your Demons? - 1

WebMD Feature from "Men's Health" Magazine

By David Goodwillie

Everyone seems to be seeing a shrink these days. What's the perfectly sane and well-adjusted guy to do? Give it a try.

I almost turned around and walked out. It was that bad. Beige walls, ambient mood lighting, decorative bamboo shoots, and on the coffee table in front of me one of those miniature Zen rock gardens. There was also an incessant trickling. I peered into the gloom of the waiting room and saw its source: one of those plug-in waterfalls with a craggy slate cliff. There was no receptionist, so I took a seat. I picked up Mother Jones and put it down. I picked up the rock garden and started raking pebbles; then I realized what I was doing and put that down, too.

What was I doing?

Therapy, psychoanalysis, counseling . . . call it what you will. I'd always called it a sham, a cop-out, an excuse. Granted, I don't come from a touchy-feely family. When I was a teen, my parents divorced, my mother moved in with a woman, my father remarried a widowed socialite, and my brother and I were shipped away to school. Yet none of us even considered therapy. Imagine that happening today, in this era of self-help books and life-coaching seminars. What's happened to America? When did we stop solving our own problems? We've all gone soft, and I wanted to find out why. So I booked a session with a shrink.

Okay, there's more to the story--a personal side. Truth be told, I was curious. As I'd crept through my late 20s and early 30s, the number of people I knew who were in therapy had grown to the point at which I found myself in the minority. And everyone talked about it! Dates came bustling into restaurants, apologizing because their shrinks had kept them late. Married friends mentioned how counseling had helped their sex lives so much, as if I wanted to know.

And it was not just a New York phenomenon. My therapy-devoted friends were in Atlanta and Los Angeles, in Kalamazoo and Fort Lauderdale. They were bankers and housewives and salesmen. They were older and younger. And most interesting of all? There was nothing wrong with them: no severe anxiety or debilitating depression, no strange phobias or suicidal tendencies. Sure, they had their issues--who doesn't?--but they were hardly head cases. Yet they looked forward to their weekly sessions the way I look forward to poker night. Therapy was their escape.

It was Sigmund Freud who, in the late 1800s, first theorized that psychological problems are rooted in the unconscious mind. The techniques he developed to bring those problems to the surface have, over 100-plus years of refinement, become the foundation of modern psychotherapy. But none of my therapy-attending friends ever mentioned the analysis of dreams or the cataloging of Oedipal impulses. No, it seemed they just spent their time ranting about scheming bosses or annoying spouses while their shrinks sat there quietly, feigning interest, fighting sleep. If things turned worse--if the sadness or anxiety became constant--perhaps the doctor would write a prescription or call another doctor. Therapeutic solutions and chemical cures. Life without mental illness--it's a powerful idea.

Popular, too. According to the National Center for Health Statistics, the number of American adults who visited mental-health professionals jumped by more than a third between 1997 and 2005, to almost 24 million. That's just over 10 percent of us. And the patients aren't all women: 38 percent of today's therapy seekers are men, presumably emboldened by James Gandolfini's Tony Soprano and Robert De Niro's Paul Vitti.

David Gardner, M.D., an associate clinical professor of psychology at Georgetown University hospital, traces the roots of the trend to the introduction of Prozac in 1986. "But drugs are only part of the story," he says. "Celebrities are the ones who erased the stigma attached to psychotherapy. Take Oprah. She talked openly on her show about her weight problems and history of sexual abuse, and ever since then there's been an explosion of self-revelation. It's really quite extraordinary."

Sitting in the waiting room, pondering the craziness of the "crazy" craze, I thought back to the night when this all started for me: at my 35th-birthday dinner. A group of friends began talking about how invaluable therapy had become in their lives, and when I raised a dissenting voice, I was quickly shouted down.

"How can you know what you're talking about if you've never tried it?" my friend Haley asked. The rest of the table jumped in. I was surrounded, outnumbered. And they had a point. A few days later, I called Haley to request her therapist's number and ask what the woman was like.

"She's laid back but tough," Haley said. "She doesn't just sit there and ask questions. It's more of a conversation."

"About what?"

"About you."

"But I'm fine," I insisted.

"Oh, honey, no one's fine. That's the first thing you'll learn."

Those words stuck in my head. Was I really fine? Certainly there were things that bothered me--inconvenient corners of my life that I tended to ignore or explain away, phrases that emerged in arguments with girlfriends, bad habits that never quite died. But the big picture still looked rosy. I lived in a great city, was surrounded by supportive friends, and now had something I could legitimately call a career. So why was I really sitting in this waiting room? It wasn't just because I was culturally curious. Or because of my friends. It was the birthday . . . 35. It felt like the end of something big. A graduation into adulthood.

But I wasn't an adult--not in any conventional sense. I wasn't married. I didn't have kids or a car. I owned no real estate. I didn't even have health insurance. And yet all of this seemed perfectly normal. I'd chosen a certain life and was now living it. A successful book, a film deal . . . what a great year it had been for me. So why hadn't I had fun? Why had my girlfriend and I broken up? Why did I run off to Europe for 2 months to get away from everything?

NEXT>> Is It Time to Confront Your Demons? - 2

Are You Your Own Worst Enemy?

WebMD Feature from "Men's Health" Magazine

By Gil Schwartz

7 mental roadblocks that undermine your success.

You know the guy. He could be right down the hall. Or looking back at YOU in the mirror. He's got the talent, the looks, the hair--but he's not going anywhere. He seems to streak past others and then, wham! Suddenly he's flat on his back watching all the tortoises cross the finish line ahead of him.

No, he's not stupid. Nor is he incompetent, foolish, weak on strategy, or lamer than your average dude. He's suffering from a malady that afflicts just about all of us at one point or another: He's tripping over himself. He's throwing up obstacles where none previously existed. He is, in short, his own worst enemy.

I'm going to tell you about seven bombs you can blow yourself up with. There are more. But I like lucky seven, because if you pay attention, you may be fortunate enough not to stab yourself in the eyes. So pay attention!

Procrastination

Don't get me wrong: I'm a master procrastinator myself. But you need to be smart and tightly wrapped to make it a way of life.

Begin by ascertaining exactly what "the last minute" is for a given project. The night before it's due is not the last minute for a 40-page speech to investors, or a strategic-planning document that's going to be presented to the board of directors. The last minute, in those cases, is a month prior to the night before. A big project will generate many tasks that can, of course, be done the night before, but there are even more that can't. Learn to identify each type.

The great procrastinators indulge in a pre-crastinatory phase that involves the full range of thumb-twiddling, foot-tapping, and snoozing while they decide when to put the pedal to the metal. They then enjoy the procrastinatory activity, which often includes late-stage work on other projects. In this way, they are mixing procrastination with multitasking. Very 21st century.

They treat themselves, after the successful event, to a period of post-crastination, in which they ponder how to put off things more effectively in the future.

But for most employees, procrastination is dynamite. Don't fool around with it until you've attained a certain level of proficiency.

Loose Fact-itis

This syndrome involves cooking up a "fact" to bolster one's position during an important meeting--a "fact" that can easily be disproved by saner and more mature minds, leaving the individual who generated it up the creek without a BlackBerry.

Once, I was sitting in a meeting with about 10 other guys, and the boss asks, "What are we going to say to security analysts about our plange rate?" I'm making up the issue here, since there is no such thing as a plange rate, but you get the idea.

So anyhow, Leonard, who is in charge of planges for our company, says something like, "We have the biggest plange rate in the world!" And the chairman says, "Can I use that stat?" and Leonard says, "Yes, well . . ." and begins poring over a spreadsheet--after which he admits that we had the biggest plange rate in the world for about 5 minutes last February. A bad moment for Leonard. That's the kind of thing I'm talking about.

Hardness of Listening

You have to be a really big wheel to enjoy a total lack of obligation to pay attention to other people. Men work decades to earn that right.

I knew this guy in strategic planning, Huff. He had just come from another company. About a week after he arrived, he was included in a meeting about where the corporation was headed. When it was his turn, he spoke for 20 minutes. "Blah blah blah," he said, as the chairman grew visibly restive. Finally, he was done. Then he lolled in his chair, thumbed his BlackBerry, pondered the view out the window, poured coffee from the sideboard, and gave other signs of terminal not-listening.

Everybody hated the mother so much afterward that he was never invited to a meaningless meeting again. A lot of planes have gone down because the pilot was hewing precisely to the wrong flight plan. Listen. Take it in. There's actually information out there that you're going to need.

Under-Truthfulness

I'm not talking about lying, but the far more common mistake of being afraid to tell the boss stuff he doesn't want to hear.

Berkowitz, our former head of sales, would be called upon to give a status report at the senior staff meeting every Thursday. The problem was that he was afraid to say what was really going on. He put a nice shine on things. Later, the head of finance would paint a much more realistic picture.After a while, when they reached Berkowitz, the chairman would say, "Okay, now let's get a bunch of lies from sales." It wasn't long before Berkowitz took a package.

Over-Truthfulness

I'm not saying that Berkowitz should have said, "We're having the worst quarter in our history, and nothing can pull us out." That's just stupid and crude. Better would have been something like, "We have an issue on the upside that we think we can work on with some success in the coming weeks." See? The message is conveyed without embarrassing anybody.

Senior executives deserve the truth, except when it would do neither them nor the business much good, in which case kindness is better. But truth is like chocolate: A little is a pleasure; too much can be lethal. The smart and non–self-destructive player will make the boss aware of the general outlines of the snake pit but not inundate him with enough rancid slime to wash him over the edge.

Rampant Distemper

My first boss was a woman who was fine before lunch but really crabby afterward. Betty would go into a meeting with the very powerful dudes and sit there with a grumpy expression on her face. Everybody in the room, including the chairman, was afraid of her. When she spoke, they would defer to her, because her ideas were very good and very strongly presented.

It wasn't the quality of her work that eventually got her canned. It was the fact that she was what we may define, technically, as a Big Bummer. It was impossible to have a free-flowing discussion around her because she would bite your nuts off.

I'm sure you have a lot to be angry about. But if you radiate bad vibes, the guys who wear the stripes are going to feel them and pinpoint the source. That's not smart. Lighten up. Or at least be strategic and keep your karmic bleakness to yourself.

Bad Credit/Blame Management

This is a tough one. A lot of people trip over this issue. Naturally, you want credit for the good things you do. This means working in such a way that (a) you are recognized as the author of the good thing in question, and (b) others are happy to give you the credit. Satisfying both criteria is not always easy. And you never want to be seen as a man who hogs other people's credit. As a rule of thumb, attempt to receive no more than 70 percent of the credit that's due you. Give away the rest.

Then there's the issue of blame. Real players never dodge it when it belongs to them. There's nothing a senior guy hates more than a craven, cowardly weasel who tries to lay blame on other people.

How you manage credit and blame is directly influenced by your relationship with your senior officer. If he wants the credit, give it to him. That's what you're there for. And if he's trying to escape blame, take it. The guy who decides your upcoming raise is the only one who needs to be satisfied in either regard.

Of course, if a peer tries to suck off your credit for something, cut off his legs. We're talking strategic management of this issue, not surrender.

The Fit Man’s Heart Threat - 3

continued...

In other words, Bill was collateral damage in society's effort to become healthier. I can't accept that my friend was sacrificed so the rest of us would stay motivated to exercise. And I'm sure the hundreds of thousands of Americans who have HCM would have a problem with their doctors viewing them as sacrificial lambs. If the Italians have found a way to prevent HCM deaths, why can't we?

I call the University of Padua, in Italy, and track down Gaetano Thiene, one of the doctors who conducted the Veneto study. I tell him Bill's story. "In the United States, the burden is on the athlete, and this is totally wrong," he tells me. "Life comes first."

"If your friend had lived in Italy," he says, "he would most likely still be alive today."

So the question is, how many people like Bill will we lose before we decide we've lost too many?

When I was 21, I ran the Napa Valley Marathon. At mile 20, I hit the wall and could barely move my legs for the last few miles. Afterward, I felt nauseated and couldn't stand. For the next week, I could barely climb stairs.

I hadn't thought of that experience for years--until Bill died. Nor had I ever worried about the mild chest pains I occasionally felt, until Salberg told me they're a common warning sign of HCM.

If the Napa Marathon had prescreened me, would they have found an abnormal heart? I schedule an ECG with my doctor and, a few days later, go in for the 10-minute test. A nurse tapes 12 sensors to my arms, legs, and chest. The wires running from the sensors snake into a small box, which spits out a heart-rate graph. To my alarm, the top of the graph is labeled with these words: Abnormal ECG.

ECGs sense suspicious electrical activity, but they don't provide a definitive picture. To really gauge my risk, I need an echocardiogram. So, 5 days later, I visit the Mayo Clinic in Minnesota, home to one of the country's oldest HCM centers. Since 1989, an entire team has been devoted to detecting and treating the illness. They see hundreds of patients a year.

After a nurse jams a small black probe into my ribs, the monitor to my right flutters and, suddenly, a curious image appears out of the static. An assembly line gone mad. Clouds of red hurtle across the screen, controlled by doors that frantically open and shut. The doors look overworked, as if they're constantly behind schedule. This bleak picture is my heart.

An hour later, I review the images with Steve Ommen, M.D., the fresh-faced head of the HCM Clinic. "Your right ventricle looks pretty large," he says. He uses a mouse to measure the chamber, to confirm his suspicion. "Yes, it's big."

Diagnosing athletes with HCM is complicated by the fact that hearts can grow naturally as a result of exercise. One of Dr. Ommen's patients is a basketball player whose heart is enlarged, its chamber walls thick. It's a result of either HCM or vigorous exercise--Dr. Ommen can't tell which. He asked the man to stop all forms of exercise for 3 months. If the enlargement is natural, the heart will shrink. Otherwise it's HCM, and the jock will have to give up hoops or risk dying every time he steps on a court.

Dr. Ommen's story makes me wonder what Bill would have done. Being a runner was part of who he was. If someone had advised him not to run, I think he might have said, "I'll take the risk."

"It's a difficult balance," Dr. Ommen tells me. "On the one hand, there are health risks associated with sitting around. On the other, exercising too hard can kill you. It's a tough question to answer."

It's also a controversial one. After the 2000 Olympics, the Italian swimmer and two-time gold medalist Domenico Fioravanti was diagnosed with HCM. In keeping with Italian regulations, Fioravanti was barred from further competitions. Fioravanti argued that competing should be his choice.

Dr. Ommen leans toward the monitor displaying my heart. If he tells me I have HCM, how will my life change? Will I stop running, and start thinking twice about rushing to catch a bus? Or will I choose, as some HCM patients do, to have a defibrillator installed in my chest, and then go about my daily life until, one day, my heart spasms and the defibrillator engages? "They say it feels like being struck by lightning and punched in the chest at the same time," Dr. Ommen says. When you recover your wits, you realize you should have died just then.

There are other treatment options as well. Drugs can improve bloodflow within the heart, but studies show they're effective in only two-thirds of patients. Surgeons can also try to cut out the thickened sections of heart muscle. It's a major surgery, fraught with risk, and it doesn't always work. But in one study, 70 percent of patients reported major improvements in their quality of life afterward.

Still, the best defense is knowledge. Athletes are the most-visible victims, but many more nonathletes die of HCM each year. Every member of a family that has experienced a perplexing heart-related death should be tested. For those who have HCM, altering their lifestyles is critical. Will that be me?

Dr. Ommen pulls up a different image of my heart and measures the thickness of the walls separating my left and right ventricles. "You're fine," he says.

At Bill's unofficial wake a few days after he died, I got drunk on Fernet, his favorite drink. I ended up in a parking garage in downtown San Francisco, hurling traffic cones off the third level. "He shouldn't have died," I shouted.

Now, a year later, I know I was right.

The Fit Man’s Heart Threat - 2

continued...

And then another whopper: You know you have HCM if you die unexpectedly. That's often the first symptom. About 15 people in this country drop dead from the condition each day. It's the most common heart-related killer of men younger than 30.

"It steals people away in the prime of life who have no outward signs of illness," says Salberg. "They often just collapse without warning." At least 600,000 Americans, in other words, are walking around with a potentially deadly condition they're probably unaware of. Their chances of dying from HCM in any given year is about 1 percent, but the risk rises as they age. If you suffer from HCM, chances are it'll eventually kill you.

Salberg has HCM, as do her father and daughter. She formed the Hypertrophic Cardiomyopathy Association after her sister died of the disease in 1995. But without that kind of tragedy in a family, the disease can be hard to pinpoint. It sometimes produces heart palpitations, but these are often misdiagnosed as anxiety or panic attacks.

Salberg points me to medical journals like the Journal of the American College of Cardiology and the European Heart Journal. I stay up late reading research papers, and at around 3 a.m. it hits me. All the answers are here, hidden in plain view beneath such phrases as "morphologic protocol" and "phenotypic profile." Many athletes who died on the court or field--Hank Gathers, the Loyola Marymount basketball star; Thomas Herrion of the San Francisco 49ers; Reggie Lewis of the Boston Celtics--had HCM and probably didn't know it. That list now includes my friend Bill.

I can't help but wonder, Could these deaths have been prevented?

On February 18, 1982, the Italian Ministry of Health issued a decree. Henceforth, every athlete wishing to participate in a competitive sport would have to undergo cardiac screening. The testing would begin with a simple electrocardiogram, known as an ECG (or EKG), which would measure the electrical activity of the heart. If this test found abnormalities, doctors would order an echocardiogram, an ultrasound of the heart.

The athletes would pay for the annual test, but the government subsidized prices. The decree spawned a new industry for doctors, who pored over millions of cardiograms searching for HCM-afflicted hearts. If they found one, the athlete was prohibited from participating in vigorous competitive sports. His or her athletic options were abruptly reduced to golf and bocce.

Over the next 22 years, researchers scrutinized the data streaming in from the Italian screenings. The most comprehensive study focused on the region surrounding Venice, where sudden cardiovascular deaths in athletes between the ages of 12 and 35 plummeted by nearly 90 percent. Extrapolating those results, the researchers estimate that over the past 25 years, thousands of lives have been saved across Italy.

The Veneto report, published in 2006, has triggered a debate in the Western world. On one side are Italian cardiologists, who say that because comprehensive testing works in Italy, it could work elsewhere. On the other are American and British specialists, who are mostly dismissive.

"It would be impossible to accurately screen tens of thousands of runners for one of the big British or American marathons," says cardiologist Dan Tunstall Pedoe, FRCP, who was the medical director of the London Marathon for 26 years. "We don't have enough cardiologists to read all those ECGs and echocardiograms." Three times as many athletes compete in the New York and London marathons than in the Rome marathon, and though not every athlete would necessarily need to be screened before each race, many would likely schedule their yearly screening around such an event.

Equally challenging would be annual checkups for the millions of Americans who play locally just for kicks, including the 7.2 million young adults competing on high- school teams. Italy, by contrast, has only 2.9 million young adults of high-school age. "We just don't have the manpower to create a national program," says Barry Maron, M.D., director of the Hypertrophic Cardiomyopathy Center at the Minneapolis Heart Institute Foundation.

Pedoe points out another issue: ECGs often indicate a problem when there isn't one. Euan Ashley, MRCP, director of Stanford's Hypertrophic Cardiomyopathy Center, estimates that, because of their intense training, more than half of all athletes have abnormal ECGs. The result: A large number of athletes without HCM would be sent for an expensive echocardiogram. Italy's national health-care system helps defray costs there, but athletes in the United States would have to pony up thousands of dollars. Some kids wouldn't be able to afford to pay--or play.

The AHA, while acknowledging that exercise can kill, issued two statements in the spring reiterating its decade-old recommendation that U.S. health-care professionals screen for HCM using a good old stethoscope, along with a questionnaire that asks athletes to report any family history of heart trouble. But a stethoscope can identify only certain forms of HCM, the types in which the heart muscle is so thick that it produces an audible murmur. More often than not, there is no murmur. And the questionnaire is only as effective as the respondent wants it to be. Kids trying to make a team are unlikely to disqualify themselves.

"Medical history and physical-exam screening in the United States can certainly be improved," admits Dr. Maron, who served as chairman of the AHA scientific committee that issued the recommendation.

Pedoe worries that because testing would add cost and hassle, people might be dissuaded altogether from participating in sports. "For the vast majority of people, running a marathon is beneficial," he says. "For every person who dies, thousands of others are postponing or preventing their heart disease by exercising. Labeling a generally safe activity as more dangerous than it really is could do more harm than good."

NEXT>>> The Fit Man’s Heart Threat - 3

The Fit Man’s Heart Threat - 1

WebMD Feature from "Men's Health" Magazine

By Joshua Davis

Bill Goggins was in the best shape of his life. So why did he collapse and die during the San Francisco Marathon? The answer: a genetic flaw that afflicts a shockingly large number of men. Are you at risk?

On a crisp, sunny July morning in San Francisco, my good friend and jogging buddy Bill Goggins began his push to post a 3-hour marathon. I'd decided not to join him; Bill always ran too fast for me. On any given jog, he'd invariably say, "How about we pick it up a bit?" It took me a year to develop the mental fortitude to resist.

The day before the race, I met Bill for lunch. He looked great, and he was clearly happy. The next morning, he got off to a good start. For the first 71/2 miles, he averaged a little over 7 minutes a mile. Runners generally slow as they tire. Not Bill. At the halfway mark, he sped up. And then, at the marathon's 24th mile, Bill smiled for the cameras and, mid-stride, dropped dead.

It was inconceivable. Bill was 43 years old and, by all accounts, in the best shape of his life. For as long as I'd known him, he'd stay out late drinking Fernet Branca, a bitter Italian liquor, and still meet me at 7 the next morning looking fresh and indomitable. He'd run a step ahead of me, glancing over his shoulder to tell me stories about the people he'd laughed with through the night. And though I had surely been asleep while he was having these grand adventures, I still couldn't keep up.

During the 6 months after Bill's death, I felt numb. But slowly, my denial morphed into a series of questions. Today I'm left with just one: Why?

In December 2005, 8 months before Bill died, he and I went for an early-morning run along the Embarcadero, the walk way beside San Francisco Bay. The air smelled of salt water and creosote from the wharf pilings. Sixty years ago, the area would have been crowded with longshoremen and ships from around the world. Today it's dotted with joggers in fleece jackets and leggings.

Back in 1951, an enterprising University of California at Berkeley doctor initiated a study of the men working these wharves. The researcher, Ralph S. Paffenbarger Jr., M.D., wanted to know whether cargo handlers, who performed strenuous physical labor all day, had different rates of heart disease than men with more-sedentary jobs had. He did an initial exam and then, 18 years later, checked them all again. He discovered that the less-active workers had a 27 percent higher death rate than the cargo handlers did. In a seminal 1986 report that laid the groundwork for the exercise boom that followed, Dr. Paffenbarger concluded that physical exercise prolongs life.

This year, that assertion quietly received an asterisk. In April, the American Heart Association released a scientific statement noting that although regular physical exercise is now widely advocated by the medical community, studies show it can increase your risk of early death. A study published in the Journal of the American Medical Association found that joggers in Rhode Island were 7.6 times more likely to die early than people who didn't run. In another study, published in the New England Journal of Medicine, researchers reported that the incidence of cardiac arrest during exercise was 25 times higher than during light activity or while resting. The AHA statement concluded that exercise "acutely" increases the risk of sudden death in "susceptible persons." For these people, "the health risks of vigorous physical activity almost certainly exceed the benefits."

Susceptible persons . . . was Bill one of them? Did he suffer from something he had no knowledge of? The only way to find out was to dig up his autopsy report, so, with consent from Bill's family, I called the San Francisco medical examiner's office and requested a copy of their findings. The following Tuesday, a little after 9 in the morning, a man with a skull tattooed on his fore-- arm slid me a white envelope marked with both my name and Bill's, as if our collective fate was sealed within.

I returned to my car and began reading. The case history was concise: "The subject, Mr. William Goggins, a 43-year-old male, collapsed while running in the San Francisco Marathon and was transported to [San Francisco General Hospital], where he expired." The autopsy findings came a couple of pages later: "Cause of Death Due To: Hypertrophic Cardiomyopathy."

Hypertrophic cardio-what?

"If your friend hadn't run that marathon, there's a good chance he could have lived a long life," says Lisa Salberg, president of the Hypertrophic Cardiomyopathy Association. I've called her looking for answers. She asks me to read Bill's autopsy findings to her, and when I reach the section about the thickness of the wall separating the chambers of his heart--1.7 centimeters--she stops me.

"Anything more than 1.5 centimeters is definitive," says Salberg. She explains that HCM is characterized by the thickening of heart muscle. As the muscle wall separating the right and left ventricles bulges, it obstructs the flow of oxygenated blood leaving the heart through the aorta, making it more difficult for the heart to function, particularly during exercise. It's caused by a genetic flaw that can be passed down from either parent. So far, researchers have pinpointed 14 genes associated with the condition. Those who carry any one of these genes generally develop HCM during adolescence or early adulthood.

Then she drops a whopper: One in 500 people has HCM. It's more prevalent in the United States than is HIV and Parkinson's.

NEXT>>> The Fit Man’s Heart Threat - 2

Are You MH Fit?

WebMD Feature from "Men's Health" Magazine

By Beth Bischoff

Take our hard-body challenge. We've identified five performance standards and set the bar high. See how you measure up.

1. The 1-Mile Challenge

Why it matters: The mile is an iconic distance that has served as a solid measuring stick for fitness since grade school. It requires power, stamina, and determination. And although a 4-minute mile no longer impresses the world-class field of sprinters, a 6-minute mile remains the mark of a fit man.

How to do it: Go to a track or path that you know to be a mile. Set your timer and take off.

Out of Shape: 10 minutes
Average: <8>

2. The Single-leg Squat Test

Why it matters: Strength is one thing; to have control of it is quite another. "The single-leg squat requires tremendous core control," says Micheal Clark, D.P.T., National Academy of Sports Medicine president.

How to do it: Stand on a bench. Hold your arms in front of you and flex your left ankle so your toes point up. Keeping your torso as upright as possible, bend your right knee and slowly lower your body until your left heel touches the floor. Pause 1 second, then push yourself up. That's one repetition.

Out of Shape: 0 reps
Average: 1 rep
Fit: 3 reps
MH Fit: >5 reps

3. The Vertical Jump Test

Why it matters: The vertical jump demonstrates your power and athletic ability, says Craig Ballantyne, M.Sc., C.S.C.S., a personal trainer in Toronto.

How to do it: Against a wall, extend your arm and mark your reach with chalk. Then jump as high as you can and make another mark. The space between marks is your vertical jump.

Out of shape: <16>24 inches

4. The Chinup Challenge

Why it matters: Most workouts are "front" focused, but your back drives you in sports and protects you from injury, says Mike Boyle, M.A., A.T.C., a strength coach.

How to do it: Start from a full hang, hands shoulder-width apart, palms toward you. Pull your chin over the bar, and then lower your body back down.

Out of shape: 0 reps
Average: 4 reps
Fit: 8 reps
MH Fit: >9 reps

5. The Pushup Test

Why it matters: The tug-of-war between a man and his weight is the best way to calculate his strength. Pushups gauge the amount of force you're able to generate with your chest, triceps, and shoulders while staying strong throughout your body's core.

How to do it: Assume the classic pushup position: legs straight, hands beneath your shoulders. Brace your abs. Keeping your body rigid, lower yourself until your chest touches the floor. Then push back up until your arms are extended.

Out of shape: <20>49 reps

What the World’s Healthiest Guys Know - 2

(continued)

Health

Where Men are the Healthiest

1. Australia
2. Netherlands
3. Spain
4. Canada
5. United States

Unhealthiest

20. Ukraine

What went into the scores: We considered death rates for heart disease, cancer, and stroke; the prevalence of diabetes and smoking; and data on life expectancy, cholesterol, blood pressure, sleep, and alcohol.

United States: Extinguish Your Addiction

Here's an area where the United States kicked butt: Only 19 percent of American men smoke, as opposed to more than half the men in South Africa, China, and Ukraine. And 70 percent of U.S. workers are covered by smoke-free rules.

What you can learn from your brothers: Still one of the 19 percent puffing? Set a quit date and rally support. A study published in Tobacco Control reports that people who received daily text messages encouraging them to quit were twice as likely to stop smoking 6 weeks later, compared with those who went textless. Go to backpackit.com to send text messages to yourself on preset days and times.

Australia: Put a Steak Through Hypertension

Go Down Under if you want to duck heart disease, cancer, and stroke. "Men here strive to be stereotypical muscular Aussies playing volleyball in Speedos, and their health improves as a result," says Christopher Semsarian, Ph.D., a professor of medicine at the University of Sydney.

What you can learn from Australia: Hypertension rates are low among Aussies. Exercise will do that for you -- as will eating more steak. In an Australian study, people who traded a daily serving of starch for red meat reduced systolic blood pressure by 4 points in 8 weeks.

Sex and Relationships

Where the Sex is Spectacular

1. United Kingdom
2. Poland
3. Netherlands
4. Romania
5. Philippines

Worst Sex Lives

20. Italy

What went into the scores: We analyzed marriage rates, divorced population, sex partners and frequency, masturbation habits, number of friends, sexual satisfaction, and affairs.

Poland: Charm Her Pants Off

Men in number two Poland are monogamous and happy with their sex lives. "The Polish way of approaching women is still chivalrous," says Beata Dzugaj, an editor at Men's Health Poland. This fosters more committed relationships than casual hookups in the long run. And commitment equals more sex.

What you can learn from Poland: Date the way your parents did. "Make the first call, and invite her out for a real date," Dzugaj says. "Bring flowers, kiss her hand, open the door for her." These gestures make her feel like a potential partner rather than a conquest.

United Kingdom: Speak Up in the Sack

There's a good reason why English men were the most sexually satisfied men in our survey: They know how to use their mouths. "British men aren't scared to ask for what they want in bed," says Emily Dubberley, a British sex expert.

What you can learn from the U.K.: If you're eager to try something new, ask on a night when she's feeling confident and you've complimented her endlessly. Pleasing her in return will also help your case, says Yvonne K. Fulbright, Ph.D., author of Touch Me There! "Anything you do -- whether kissing, licking, or touching -- do it in circles."

World Leaders

Where men are happiest: Mexico
How men rate their happiness, on a scale of 1 to 10: 7.61
Runners-up: Netherlands 6.97 Brazil, Ukraine 6.94
Where life's a vacation: Germany
Number of weeks per year the average guy takes off: 6.12
Runners-up: Poland, Romania 5.25 Spain 4.97
Where friendship is sacred: Philippines
Number of close friends the average guy says he has: 3.23
Runners-up: China 2.89 Portugal 2.87

World Losers

Where cancer is killing men: Poland
Cancer deaths per 100,000 men: 250
Runners-up: Netherlands 203 Ukraine 198
Where men are lighting up: Romania
Percentage of the male population that smokes: 62.87
Runners-up: Ukraine 62.54 Philippines 58.21
Where hearts are breaking: Ukraine
Heart-disease deaths per 100,000 men: 543
Runners-up: India 268 Romania 232
Where men eat the most junk: China
Number of take-out or fast-food meals consumed per week: 5.51
Runners-up: Malaysia 3.53 India 3.47

What the World’s Healthiest Guys Know - 1

WebMD Feature from "Men's Health" Magazine

By Laura Ongaro

We collected reams of research to find the fittest, healthiest, and happiest men in the world. Steal their strategies and you'll outlive them all.

We collected reams of research to find the fittest, healthiest, and happiest men in the world. Steal their strategies and you'll outlive them all. Our first ranking of "The World's Best Countries for Men" turned out a lot like the World Cup. Though there were no international head-butting incidents and all our scoring was done with stats instead of soccer balls, a few countries dominated the field while the United States stood on the sidelines -- just like in the Cup. The upside? We don't have to wait 4 years to turn our team around.

In order to arrive at our rankings, we began by conducting a worldwide survey of more than 20,000 men. Then we delved deep into data from such sources as the World Health Organization, Euromonitor International, the United Nation's International Labour Organization, and the Durex Global Sex Survey. After days of mind-numbing number crunching, we had our winners in five categories. Start transforming yourself today with the secrets we've gleaned from the countries where men have the most muscle, the least stress, the best sex, the healthiest bodies, and the smartest diets. And yep, you can use your hands.

Nutrition

Where Men are Well-Fed

1. Portugal
2. Spain
3. Canada
4. Italy
5. Greece

Worst Diets

20. Ukraine

What went into the scores: We looked at each country's per capita consumption of fish, vegetables, fruit, breakfast, tea, sweets, and take-out and fast food.

Greece: Make Vegetables a Main Event

Greek Orthodox men eat their greens religiously: Some go meatless half the year. "So they create tasty vegetarian dishes," says Elena Paravantes, R.D., of the Hellenic Dietetic Association. Since these dishes are popular, so is produce.

What you can learn from Greece: "Stop trying to eat all your vegetables as sides," says Paravantes. To that end, try this Greek stew, called ladera. Boil a pound of frozen green beans for 3 minutes, and then drain. Sauté a chopped onion in olive oil, and add a can of crushed tomatoes, a pinch of sugar, and some parsley. Cook for 10 minutes, add the beans and simmer for 20 minutes. Top with feta and serve with whole-grain bread. For more recipes, go to MensHealth.com, keyword world.

Portugal: Keep a Stash of Seafood

Thanks to their country's endless coastline, Portuguese men eat a serving of fish a day. That's enough omega-3 fatty acid to reduce their risk of heart disease and possibly prostate cancer.

What you can learn from Portugal: The hardest part of eating more seafood is the forethought needed to buy and prepare it. Supplement the times when you cook or order fish with a cache of ready-to-eat tuna in your desk drawer. We like Bumble Bee's Easy Peel Sensations in Lemon and Pepper and Spicy Thai Chili.

Fitness

Where They Work up a Sweat

1. Netherlands
2. Canada
3. Poland
4. Ukraine
5. United Kingdom

Most Sedentary

20. Romania

What went into the scores: We crunched obesity rates, strength (from situps and pushups), time spent exercising each week, and six-pack prevalence.

Canada: Adopt a Reason to Exercise

Most of Canada's biggest cities are 50 percent green space, which may be why men there exercise an average of 5.2 hours a week. Living near a park makes you twice as likely to exercise, says the American Journal of Health Promotion. "It's easy to be motivated when you see activity around you," says Craig Ballantyne, C.S.C.S., a personal trainer in Toronto.

What you can learn from Canada: Don't live near a park? Tap into canine inspiration. A Canadian study found that dog owners exercise more -- 5 hours per week -- than their poochless peers. Labrador retrievers and German shorthaired pointers both make good running buddies.

Netherlands: Cycle to a Six-Pack

One in five Dutch men can see their abs, and that's nearly the number who ride a bike to work. "Cycling is great for core strength. Everything is done on a bike here," says Asker Jeukendrup, Ph.D., Men's Health Netherlands' fitness advisor.

What you can learn from the Netherlands: If your commute is impossible to pedal, do like the Dutch and run errands on two wheels. Trips shorter than 3 miles can be biked in 15 to 20 minutes. If you're sans cycle, consider the 3-speed Kona AfricaBike ($325); it's rugged enough for urban errands.

Work/Stress

Where Relaxation Reigns

1. Spain
2. Canada
3. Australia
4. United States
5. Romania

Most Stressed-Out

20. India

What went into the scores: We surveyed workweek hours, vacation time, happiness, commutes, spending on leisure, and whether men check work e-mail at home.

Spain: Take Meetings Outside

Afternoon siestas aren't the only reason a scant 19 percent of Spaniards consider their jobs "too stressful." "Spanish men build in breaks and social interaction throughout the workday," says Patricia Ramirez, Ph.D., a clinical psychologist in Andalusia, Spain. "They also have the habit of leaving the office a few times during the day. Instead of drinking the company coffee, they'll go out with a colleague and brainstorm over espresso."

What you can learn from Spain: Skipping out to Starbucks at 3 o'clock will help, but you also need a longer break, a.k.a. a bona fide vacation. In Spain they take off the entire month of August. In the United States, you should shoot for two 1-week vacations a year. If you can't swing two, at least try for three consecutive long weekends, says Ramirez. "That's enough to feel like a break without requiring a lot of time off." And if you think your R & R makes the boss unhappy, consider this: In a survey of executives, over half said employees were more productive after a vacation.

NEXT>> What the World’s Healthiest Guys Know - 2

Installing a Moral Compass

WebMD Feature from "Men's Health" Magazine

By Daniel Amen, M.D.

Kids have one eye on Dad and Mom, another on Kobe and Britney. Whose example will they follow?

Morality is a kind of navigation software kids download from the adults in their lives. They make their own adjustments, sure, but it's a v2.0, not a whole new operating system. So make sure the kids in your sphere are receiving virus-free code. The best way to do this: Teach and nurture a sense of right and wrong, empathy, decency, and equality. Here are six ways to accomplish that goal:

1. BUILD THE BOND

If you want your children to share your values, listen to them, spend time with them, and encourage them. In the Journal of the American Medical Association, psychologist Michael Resnick reported that teenagers who felt loved and connected to their parents had a significantly lower incidence of emotional distress, drug use, violence, and suicide.

2. SHOW 'EM HOW IT'S DONE

Children do what you do, not what you tell them to do. If you want your children to act with a sense of integrity, you must set an example. So if you tell them not to steal but you have a pirated satellite box, the commandment has less impact. If you tell them to be kind to others but you are frequently rude to your wife, the odds are they will be rude to others.

3. TEACH, DON'T PUNISH

When your kid messes up, your anger won't erase the event; it'll just pile another negative on top of it. After you cool down, go over the incident to see what the child can learn from it. Also, when moral teaching opportunities arise, such as during a television show or when they tell you about the events of their day, use the time to talk about sensitive issues.

4. WRITE SOME COMMANDMENTS

It's often helpful for parents to have written rules posted at home, such as "Tell the truth" or "Treat each other with respect." First, follow the rules yourself. Second, when children follow the rules, notice it and show appreciation. When they break rules, discipline them with love, not guilt or anger.

5. EDIT THE GUEST LIST

New research indicates that children become like the kids they hang out with. If her friends shoplift or cut classes, she's more likely to do so. Use parent-teacher conferences to inquire about your kids' friends, and act accordingly. After school, steer kids toward groups that are properly supervised. Also, arrange events where you'll get to know your child's friends, so you can weed out the bad and encourage the good.

6. MAINTAIN THE BRAIN

Brain health determines how we think and act. Brain illnesses, such as bipolar disorder and autism, are often associated with difficult behavior, and physical trauma can cause problems with judgment. Protect your children from brain injuries (no soccer headers), educate them about drug and alcohol abuse, and get them help for mood and behavior problems.

--Daniel Amen is a psychiatrist, a Men's Health columnist, and the author of Change Your Brain, Change Your Life.

Testosterone Under Attack - 3

continued...

Phthalates are also everywhere, almost certainly including your own body. Manufacturers use them in colognes and cosmetics and as softeners in plastics. Baby bottles now come "phthalate-free," but hospital intravenous bags generally don't. And yet some phthalates seem to have all of carbaryl's unpleasant associations with reproductive health. And not just in men: Last year Greenpeace issued a warning against the danger of phthalates in your girlfriend's sex toys. Then the Danish Environmental Protection Agency came riding to the rescue, declaring such toys safe--as long as she keeps it to an hour or less a day.

Scientists can't say that any of the suspect chemicals actually cause the reproductive effects that are occurring. They can only point out troubling associations. But these associations seem to be proliferating. About 50 new chemicals come onto the market weekly, says Dr. Harman, and while testing for carcinogenicity is required, "there's no systematized testing for subtle endocrine effects."

We're not likely to have good answers anytime soon. The reproductive problems of human males will remain understudied, says Dr. Harman, in part because federal research dollars are being diverted to issues like biological warfare and terrorism. "We might just wind up disappearing from the planet quietly," he says, "because we were too busy fighting wars to figure out that our reproductive systems were going south."

All this could Make testosterone therapy a more likely part of your life as you age. Demand is already booming. Last year, according to IMS, a pharmaceutical information company, U.S. doctors wrote more than 2.5 million testosterone prescriptions, and the market was worth more than $500 million to pharmaceutical companies. That's double what it was 5 years ago. If the decline in testosterone levels turns out to be real, the market could easily double again, with 6 to 12 percent of men in some age groups likely to qualify as "hypogonadal," to use the medical profession's distinctly depressing term. (Loosely translated, it means "tiny testicles.")

Misuse of testosterone-based steroids to build muscle is booming. It's already twice as common as heroin abuse among U.S. 12th graders. Baby boomers have also latched onto testosterone therapy as an anti-aging remedy, despite a dearth of supporting evidence.

At the same time, Australian andrologist David Handelsman, Ph.D., worries that doctors are failing to diagnose cases of genuine testosterone deficiency, resulting in "lifelong consequences" for younger men. As a result, testosterone therapy "suffers simultaneously from both overuse and underuse." And yet evidence about whether such therapy is safe or effective is "shockingly weak," says the Mayo Clinic's Victor M. Montori, M.D. "There is no way for physicians to be certain when prescribing testosterone that, on average, it's doing more good than harm."

So is it safe to use testosterone therapy, even under a doctor's care? Does it cause prostate cancer, as some suggest? Here's where the debate stands now: First, the fear isn't that testosterone will cause prostate cancer. It's a natural product of the human body, and no evidence anywhere has ever shown it to be a carcinogen. Scientists worry instead that adding testosterone may fuel the growth of small cancers that already exist, undetected and harmless, in the prostates of many older men.

The only reliable way to gather scientific evidence on the prostate-cancer question would be the sort of large-scale, long-term study endocrinologists have tried and failed to get the government to undertake since 1999. That's roughly the same period in which testosterone use doubled in this country. So men are, in effect, undertaking the same experiment themselves, on their own bodies--haphazardly, and with no way to track the results.

The debate over testosterone levels was kind of a parlor game for me when I started researching this article. I'm married, a father of three, and neither overweight nor a smoker. I lift weights, and I row crew 6 miles a day in season. My appetites and my outlook on life have always seemed healthy. It never occurred to me that my testosterone levels might be low. Using testosterone therapy to prolong the illusion of youth made about as much sense to me as hair plugs.

Then I had a blood test, and my total-testosterone level came back way low. It looked like the batting average of an okay hitter in a bad month near the end of his career. Suddenly, I listened a little more sympathetically when Abraham Morgentaler, M.D., an associate clinical professor of urology at Harvard, started making the case for test-osterone-replacement therapy. "What's amazing to me is the passion this testosterone issue generates in people," he was saying. "There are a couple of issues that come up. 'Why can't we just age normally? Why do we have to have 70-year-old men chasing their wives like they did when they were 25? Why can't they just be 70?' And I think it's the most ridiculous argument. Bad vision is age related, as are bad hearing, bad joints, bad hearts, bad blood vessels. Even cancer is age related. We treat all these things so we can live longer or happier. And the change in hormonal levels? If it's treatable and the therapy is safe, reasonably speaking, why would we want to withhold treatment from somebody?"

The case for considering testosterone therapy became even more compelling this past summer, when researchers at the University of California at San Diego released results from their long-term study of men over 50. Participants whose testosterone levels tested low in the early 1980s but who were otherwise healthy had a 33 percent higher risk of death over the following 2 decades. Another study, from the University of Washington, looked at men over 40 who already had health problems, and found that low testosterone dramatically increased their risk of death.

But I didn't immediately try to alter my T levels. (See "Become Mr. T" for natural ways to do it.) The standard medical guidelines for treatment are strict. I qualified on the first count: "unequivocally low serum testosterone levels." But I didn't have "consistent symptoms and signs" of low testosterone.

For doctors who take the conservative approach, the symptoms that matter most are physical changes, such as shrinking of the testicles, development of breasts, a decrease in spontaneous erections, or a loss of muscle bulk and strength. Doctors who take a looser approach often recommend therapy to men with the sort of complaints almost everyone experiences at some point: "Do you tire more easily? Is it more difficult to get and stay in shape? Is there less desire to exercise? Have you lost some of the zest for life?" I didn't fit either set of symptoms.

Given the nuances involved, anybody thinking about testosterone therapy needs to consult a specialist. My doctor, an endocrinologist, pointed out that, despite the low total testosterone, my free testosterone was normal. He also discovered a slight thyroid hormone deficiency, a potential cause of low testosterone. So while he wasn't ruling anything out, it didn't look like T-time just yet.

Those are the kind of judgments a lot more men will be making over the coming years, as the population ages and further evidence comes in on health and reproductive issues. For some men, both young and old, testosterone therapy will seem like a miracle, a second chance at life as a man. But the effects can also vary dramatically from one person to the next. So for other men, it won't make much difference at all. "I'll be 64 in April," says one endocrinologist, whose total testosterone is "sky high" at 640, "and I don't feel the same as I did when I was 44. There's more to aging than hormones."

So which are you? And what should you do? A good doctor is the place to start, but even doctors have no certain answers, and your government has guaranteed doctors won't get answers for decades to come. So when it comes to doing the right thing about testosterone, the truth is that you're pretty much on your own.

The question remains: Are you man enough right now? Will you be, 10 years from now?

Testosterone Under Attack - 2

But none of this diminishes the mystery: Why would testosterone levels in the United States today be substantially lower than they were 15 years ago? When they saw their results, the Massachusetts researchers thought they'd made a mistake. "We'd used the same lab, the same assay, and the same analyst to gather the data over time," says Travison. "But even so, subtle changes in the way the assay was manufactured could have had some impact."

Then in the summer of 2006, Travison attended an Endocrine Society meeting where another researcher, Antti Perheentupa M.D., Ph.D., from the University of Turku, in Finland, presented evidence of a similar decline. The Finnish results suggested the change was happening among younger men, too. A man born in 1970 had about 20 percent less testosterone at age 35 than a man of his father's generation at the same age. "When I saw another group reproducing our results," says Travison, "that was convincing to me that we were seeing a true biological change over time, as opposed to just some measurement error."

One possible explanation for the decline is obvious: Men are fatter now. In the Massachusetts study, the average 60-year-old man in 1988 was already well past overweight (a body mass index, or BMI, of 25). But his 2003 counterpart was pushing obese (a BMI of 30). And obesity, says Travison, is "a very powerful predictor of low testosterone." Gain 10 percent in your BMI and you can expect your testosterone to drop by about the same amount. As a result, fat men typically have up to 25 percent less total testosterone than their trim counterparts do. (Fair warning: This doesn't make them girly men. SHBG--the stuff that locks up half your testosterone--also decreases with obesity. That means even a fat man with low total testosterone may have enough of the bioavailable stuff to crush you between his manboobs.)

Taking multiple medicines also tends to decrease testosterone, and a quarter of the Massachusetts test participants were practicing "polypharmacy"--taking six or more medicines at the same time. This was partly because the test group had aged. But in tandem with the obesity epidemic, participants also seemed to be experiencing an Rx epidemic. In 1988, 38 percent of the men were not taking regular medications. By 2003, not one man could make that claim.

Still, obesity and polypharmacy together weren't enough to explain the loss of testosterone. Nor was the dramatic decline in smoking among participants, though quitting can sometimes cause a decrease in testosterone. To filter out these effects, Travison's group looked at a subsample of 500 nonsmokers who were neither obese nor taking a large number of drugs. And even these apparently healthy men displayed the same exaggerated decrease in testosterone.

Scientists have been arguing for years about whether they are seeing a worrisome pattern in male reproductive-health problems around the world--and also about whether environmental factors are to blame. Fertility, which moves in tandem with testosterone, has dropped not only in industrialized nations like Sweden, but also in Sri Lanka, without any apparent change in contraception or abortion rates. Increasing numbers of boys are being born with genital abnormalities, including undescended testicles, and urethras that exit in odd places along the penis. In Denmark, 40 percent of young men have a subnormal sperm count, and the rate of testicular cancer is among the highest in the world. In the United States testicular cancer has recently become the most common malignancy among Caucasian men ages 15 to 35. Some researchers have grouped these developments together as "testicular dysgenesis syndrome," or TDS, with "dysgenesis" meaning abnormal development of the male organ.

There are plenty of experts who question the evidence of such a syndrome. But Mitch Harman M.D., Ph.D., an endocrinologist at the University of Arizona college of medicine and the director of the Kronos Longevity Research Institute, sees the shadow of Silent Spring. Back in 1962, when Rachel Carson published her environmental classic, estrogen-like substances in the insecticide DDT were making eggshells so thin that they were crushed by nesting parents; populations of eagles and other large birds plummeted. And today? Dr. Harman says, "I'm concerned that we're just pouring chemicals out into our environment that are endocrine-suppressing, estrogen-like compounds," possibly causing similar disruptions in human reproduction. The authors of a recent article in the Medical Journal of Australia likewise suggest that from early fetal life onward, male hormonal and reproductive functions are under "xenobiotic attack," meaning chemicals not naturally found in the body appear to be disrupting normal biological development.

For instance, 90 percent of American men have evidence of chlorpyrifos in their urine. This shouldn't be surprising, since up to 19 million pounds of the stuff was distributed across the United States in 1999 alone, much of it in household products like tick-and-flea powder for pets, lawn treatments, and common insecticides. Though residential use is now restricted, chlorpyrifos is still common in agriculture, as well as in some professional applications; for most people, diet is now the main source of exposure. In a recent Harvard study, men with the highest chlorpyrifos exposure typically had 20 percent less testosterone than those with the lowest exposure.

Carbaryl is another possible culprit. Detectable levels turn up in 75 percent of American men, and having it in your urine appears to be associated with reduced sperm count and liveliness, or motility, as well as increased DNA damage. And yet we still apply carbaryl to lawns and gardens at a rate of up to 4 million pounds a year, mostly by way of an insecticide known as Sevin. There should be a bumper sticker: Honey, the lawn shrunk my testicles.

NEXT>>> Testosterone Under Attack - 3

Testosterone Under Attack - 1

WebMD Feature from "Men's Health" Magazine

By Richard Conniff

Cross your legs, men. A phenomenon called xenobiotic attack is meddling with your manhood, and your family jewels may never hang the same way again.

In 2003 Professional golfer Shaun Micheel took his game to a new level. He won the PGA Championship on the 72nd hole with his 21st birdie of the tournament. Then everything seemed to fall apart.

"I lost my drive. I didn't enjoy practicing anymore. If I made a couple of bogeys, I just wanted to go home," he said at the time. It was more than a slump. He barely even showed up on the professional circuit the following year. At first he thought it was depression. "I seemed to be tired all the time, and irritable. I wasn't myself."

But in April 2005, a blood test showed that, at the age of 36, Micheel had the testosterone level of a 70-year-old. His doctor had him rub a hormone-replacement gel onto his biceps each morning. By September his testosterone level was back to normal.

It wasn't a miracle cure. He still hasn't won another major tournament, though he did manage a second place finish last year. But Micheel is working his way back up the list of money winners. More important, both he and his wife say testosterone has given him back his old, upbeat personality.

Good news for him, but what about the rest of us? Some scientists now wonder if a lot of other "walking, talking, normalish guys," as one urologist put it, are also experiencing a fading of the hormonal basis of masculinity, leaving them feeling less like the men they used to be, less than their fathers were in their time.

Most men can expect their testosterone levels to drop by about 1 percent a year beginning in their 50s. So a man in his 70s might have only half the testosterone he had when he was 25. But researchers behind the Massachusetts Male Aging Study--which has been tracking behavioral and physiological traits for 1,709 men born between 1916 and 1945--noticed something strange. Men born more recently had T levels that were surprisingly low. The 60-year-old in 2003 had about 15 percent less testosterone than the 60-year-old in 1988, according to Thomas G. Travison, Ph.D., lead author of the testosterone study. Sixty was looking like the new 70. Had something happened? Could we be in the middle of some broad biological or environmental change affecting all men simultaneously?

No one was suggesting that men rush out to get their testosterone levels checked (though, okay, I did), much less consider testosterone therapy (and, yes, I am considering it). As one endocrinologist put it, "You need to see more than one study from more than one laboratory before you start waving your arms and shouting alarm."

boomers with delusions of eternal youth. It's something the average aging male will need to think about, starting with a few testosterone basics.

Testosterone is literally what makes us men. Delivery of the right amount at the critical moment shifts development of a fetus away from the basic human blueprint, which is female, and onto the path to masculinity. A surge in testosterone (from the testes---hence the name) in adolescence boosts us into manhood. And for the rest of our lives, testosterone, or the lack of it, seems to play a key role in muscle strength, lean body mass, bone density, mental sharpness, and sex drive--the things that often make us feel best about who we are.

Despite testosterone's explosive reputation, there's no solid evidence that it causes aggression or violence. On the contrary, heightened testosterone is often associated with self-confidence and social success. Testosterone levels typically increase to ready us for a challenge, whether it's a football game or a chess match. Testosterone also rises after a victory, causing an increase in confidence that often leads to even more victories, the so-called winner effect. Who would want less of a hormone like that?

And yet the quantity of the stuff, even in healthy young men, is astoundingly small. Most doctors measure total testosterone as the starting point, and for American men under the age of 40, the normal range is 300 to 1,000 nanograms per deciliter of blood. (That's what "ng/dl" means on your medical laboratory report.) A nanogram is a billionth of a gram, and a deciliter is a 10th of a liter. Or, to put it in layman's terms, not bloody much. If you somehow managed to collect all the testosterone from your entire body, it would barely fog the bottom of a shot glass.

But it gets more complicated. Testosterone occurs in the blood in three forms.

About 40 percent of total testosterone is tightly bound to sex hormone–binding globulin, or SHBG, meaning it's not readily available for use by the body. In fact, nobody knows for sure what function SHBG-bound testosterone performs.

"Free testosterone" isn't bound to other molecules. But it constitutes just 2 percent of total testosterone.

Fortunately, the balance of total testosterone is bound to albumin and other proteins, and those links are easily broken. So together with free testosterone, this "bioavailable" testosterone is there when the body needs it.

You could look at it this way: Your manhood is based on half of almost nothing. And there's less of it with each passing year.

Measuring testosterone is complicated, because the tests themselves aren't always reliable, and results can differ from one lab to the next. "Normal" levels can also vary dramatically from one man to the next. And they can vary from minute to minute in the same man; testicles seem to do everything in spurts. That's because testosterone levels fluctuate with the little wins and losses of daily life. So if a test suggests that you have a testosterone problem, do not despair: There's a one-in-three chance you'll be back to normal on a follow-up.

NEXT>> Testosterone Under Attack - 2

Stress Management - Topic Overview

What happens when you are stressed?

Stress is what you feel when you have to handle more than you are used to. When you are stressed, your body responds as though you are in danger. It makes hormones that speed up your heart, make you breathe faster, and give you a burst of energy. This is called the fight-or-flight stress response.

Some stress is normal and even useful. It can help if you need to work hard or react quickly. For example, it can help you win a race or finish an important job on time.

But if stress happens too often or lasts too long, it can have bad effects. It can be linked to headaches, an upset stomach, back pain, or trouble sleeping. It can weaken your immune system, making it harder to fight off disease. If you already have a health problem, stress may make it worse. It can make you moody, tense, or depressed. Your relationships may suffer, and you may not do well at work or school.
What can you do about stress?

The good news is that you can learn ways to manage stress. To get stress under control:

* Find out what is causing stress in your life.
* Look for ways to reduce the amount of stress in your life.
* Learn healthy ways to relieve stress.

How do you figure out your stress level?

Sometimes it is clear where stress is coming from. You can count on stress during a major life change such as the death of a loved one, getting married, or having a baby. But other times it may not be so clear why you feel stressed.

It may help to keep a stress journal. Get a notebook and write down when something makes you feel stressed. Then write how you reacted and what you did to deal with the stress. Keeping a stress journal can help you find out what is causing your stress and how much stress you feel. Then you can take steps to reduce the stress or handle it better.

To find out how stressed you are right now, use this Interactive Tool: What Is Your Stress Level?
How can you reduce your stress?

Stress is a fact of life for most people. You may not be able to get rid of stress, but you can look for ways to lower it.

Try some of these ideas:

* Learn better ways to manage your time. You may get more done with less stress if you make a schedule. Think about which things are most important, and do those first.
* Find better ways to cope. Look at how you have been dealing with stress. Be honest about what works and what does not. Think about other things that might work better.
* Take good care of yourself. Get plenty of rest. Eat well. Do not smoke. Limit how much alcohol you drink.
* Try out new ways of thinking. When you find yourself starting to worry, try to stop the thoughts. Work on letting go of things you cannot change. Learn to say "no."
* Ask for help. People who have a strong network of family and friends manage stress better.

Sometimes stress is just too much to handle alone. It can help to talk to a friend or family member, but you may also want to see a counselor.
How can you relieve stress?

You will feel better if you can find ways to get stress out of your system. The best ways to relieve stress are different for each person. Try some of these ideas to see which ones work for you:

* Exercise. Regular exercise is one of the best ways to manage stress. Walking is a great way to get started.
* Write. It can help to write about the things that are bothering you.
* Let your feelings out. Talk, laugh, cry, and express anger when you need to.
* Do something you enjoy. A hobby can help you relax. Volunteer work or work that helps others can be a great stress reliever.
* Learn ways to relax your body. This can include breathing exercises, muscle relaxation exercises, massage, aromatherapy, yoga, or relaxing exercises like tai chi and qi gong.
* Focus on the present. Try meditation, imagery exercises, or self-hypnosis. Listen to relaxing music. Try to look for the humor in life. Laughter really can be the best medicine.

Workplace Stress and Your Health

Experts explain the dangers of work-related stress and provide solutions.
By Elizabeth Heubeck
WebMD Feature
Reviewed by Louise Chang, MD, MD

If you have a cruel boss or rotten co-workers, beware. It may not be just your job that's on the line.

Clearly, a work environment that includes insults, back stabbing and belittling can erode an employee's morale. What's less understood is that such a toxic work atmosphere can also lead to deteriorating health. At WebMD, we talked to the experts to find out what it is about negative work relationships that can cause so much stress, how our bodies react to chronic workplace stress, and what it takes to find relief.

How many times have you watched someone get a promotion when your hard work goes unnoticed, or attempted to offer your insight to management, only to have it fall on deaf ears? Working in an unjust environment can make you sick -- really sick.
A Need to Be Heard

Feeling trapped in a workplace that isn't fair can actually increase your risk for coronary heart disease (CHD), a leading cause of death in the U.S. In a two-part landmark Finnish study conducted between 1985 and 1990, researchers surveyed more than 6,000 male British civil servants -- without presence of CHD -- regarding how fair, or unfair, they perceived their employers. Subjects who reported a high level of justice at work were 30% less likely to develop CHD than workers who consistently experienced injustice at work.

Just how did study participants define "justice" in the workplace? Those who felt their bosses considered their viewpoints, treated them truthfully, and included them in decision-making processes said they worked in "just" workplaces.

The results of the study show what many experts say: Feeling like you haven't been heard ranks as the most stressful aspect of interpersonal work relationships. "It's a helplessness that comes when employees feel like they've expressed themselves and been discounted, or someone hasn't taken the time to listen to them," says psychologist Carol Kauffman, PhD, an assistant professor at Harvard Medical School's department of psychiatry.

Others agree. "The workplace needs to feel meaningful. If you feel like you're not respected, that your opinion isn't meaningful, you're at an increased risk of heart disease," says Bruce Rabin, MD, PhD, a professor of pathology and psychiatry at University of Pittsburgh Medical Center. On the flip side, Rabin tells WebMD, "Feeling a part of the workplace is a meaningful buffer to the health effects of stress.
Reacting to Co-Workers

How workers react to negative interpersonal relationships in the workplace, be it passive-aggressive co-workers or disgruntled bosses, also has a dramatic impact on subsequent stress levels.

"Some people are more prone to stress reactions. They're likely to be people who have difficulty managing on a day-to-day basis. They may not have effective problem-solving skills, or be predisposed to high levels of anxiety and uncertainty," says social worker Len Tuzman, DSW, an expert on stress management. This is particularly true for employees that Tuzman calls "catastrophizers" -- those who blow a situation out of proportion until it becomes a major calamity.

Just how great a toll does workplace stress take on employees' health? While it's impossible to tease out every illness and adverse health effect that began as a reaction to stress, Minnesota-based health management company StayWell compared the costs of stress with 10 other common health risk factors -- among more than 46,000 employees of both private- and public-sector companies. The risk factors included tobacco and alcohol use, overweight, high blood pressure, and high cholesterol. Cumulatively, these 11 modifiable health risk factors were found to comprise 25% of companies' total health care expenditures. The most costly risk factor? Stress.

How Stress Affects Your Health

Why does stress make you sick?

"When your brain perceives stress, you get reactions from the stress-reactive area, and an elevation of stress hormones -- cortisol and norepinephrine -- increase in concentration in the blood," Rabin tells WebMD.

What happens next? "We believe that each person has different organ vulnerabilities. One person will respond with panic attacks, another with headaches," says John Garrison, PhD, director of the stress management program at Lahey Clinic in Burlington, Mass.

While the impact of workplace stress varies from one person to the next, mounting evidence shows that stress can cause some very specific adverse health effects.

For instance, stress may make it harder to control diabetesby raising blood glucose levels. This is related to the "fight or flight" response, which prompts your body to raise blood sugar levels to help boost energy in response to the stress.
Stress and Cholesterol Levels

Stress may even raise cholesterol levels, immediately and long term. British researchers evaluating the stress reactions of 199 healthy adult men and women found that participants who reacted more strongly to emotional situations also demonstrated immediate and significant increases in cholesterol levels. Three years later, these same study participants who initially responded more dramatically to stressful situations experienced a more significant elevation in cholesterol levels than other study participants. How significant? Those who had initial stress responses in the top third of the group were, three years later, more likely to have readings above the recommended levels for cholesterol than participants whose initial stress responses fell in the bottom third.

So, what's the stress-cholesterol connection? While researchers aren't certain, one theory is that stress might increase the body's inflammatory processes, in turn increasing lipid production.

Stress-induced health reactions aren't strictly physiological.

Stress also influences our behavior, which can in turn affect our health. "Chronic stress gets in the way of putting information that we know about health behaviors into action. When you're under stress, M&Ms are for lunch," says Joe Piscatella, president of Institute for Fitness and Health and author of The Road to a Healthy Heart Runs Through the Kitchen.

You can't simply will away the people with whom you find difficult to work. But it may help to learn a different way of interacting with them.
How to Respond to Stressful Situations

Feeling like you haven't been heard? "When in doubt, check it out," Kauffman suggests. "Say directly to the person, 'I'm not sure you understood me.' It could be that the person is under too much stress, and didn't have time to absorb [your suggestion or request]."

Trying to cope with a boss you feel is making unreasonable requests?

"Describe the situation objectively," Kauffman says. For example, tell your boss how many projects you have on your plate. She may not realize it.

Next, she suggests, "Express your opinion about the situation. You can say, 'I don't think it's possible for me to work at a faster capacity.'" And, when you explain yourself? Leave the histrionics behind.

Don't end it there. "Ask for what you need," Kauffman tells WebMD. Be specific, in terms of resources, time, or whatever it is that will help you do your job.

Finally, urges Kauffman, "Reinforce the relationship." Show appreciation for the support you get from your boss.

Just can't seem to get along with someone at work? You're not going to click easily with everyone, but you can learn to make a relationship work. "If you don't have a natural rapport with someone, you've got to create it," says Karen Leland, president of Sterling Consulting Group and author of Watercooler Wisdom: How Smart People Prosper in the Face of Conflict, Pressure, and Change. Here's how. Learn to understand and evaluate a co-worker's style," Leland tells WebMD. Then, you can be "in step" with just about everyone you work with, whether they have a quiet and analytical working style or an expressive working style.

Ready to walk away from your job altogether? "Take some opportunity to step back from the situation and really assess what's going on. Most decisions that people think they need to make immediately, they don't. Look at some alternatives. Talk to people you trust before making a decision," Tuzman offers.
Behaviors That Promote Stress Relief

Even if you don't suffer a severe illness from work-related stress, it can leave you feeling fatigued and run-down, or anxiety-ridden. To combat these unhealthy, unbalanced feelings, try activities that are considered both "invigorators" and "soothers," encourages Scott Meit, PsyD, vice chairman for psychology with The Cleveland Clinic's department of psychiatry and psychology.

To get invigorated, exercise. "Exercise is very important for your emotional balance," Meit tells WebMD. What about those busy executives pressed for time? "Schedule exercise. If you treat it like a board meeting, it gets done," Meit says. Simply too tired? "The research is very clear that exercise, within your capacity, gives back energy," Meit says.

Soothe with relaxation. Garrison, who teaches stress management programs, says that of all the stress-relieving techniques he suggests, his students report the most relief from relaxation techniques.

"From traditional techniques, such as progressive muscle relaxation to tai chi and meditation, these seem to be the No. 1 way for people to find balance," Garrison tells WebMD.

"Once you start to engage in these activities, it starts to provide a solution," Meit says.