5 Healthy New Year's Resolutions for Men

Experts share their thoughts on the top 5 things men can do to get healthy in the new year
By Dulce Zamora
WebMD Weight Loss Clinic-Feature
Reviewed by Brunilda Nazario, MD

The new year is a time many men rethink their lives and make plans to get their health back on track. Are you one of them?

At least 40% of adults make one or more resolutions each year, and at least two-thirds of them vow to change something unhealthy about themselves, according to a small study conducted by John C. Norcross, PhD, professor of psychology at the University of Scranton in Pennsylvania. The popular resolutions concern weight gain, fitness, and smoking.

WebMD examined these common objectives and added a couple more that men might want to consider in their pursuit of good health. We then asked health experts to offer advice on how best to approach the resolutions for maximum success. Consider their suggestions, and see what works for you. Good luck!
New Year's Resolution No. 1: Get Fit

When men want to get fit, they tend to aim for weight loss in the stomach area and muscular definition in the biceps, chest, and abdominals, says Cedric Bryant, PhD, chief exercise physiologist for the American Council on Exercise.

To achieve these goals, men do little cardiovascular exercise, and a lot of resistance training -- a strategy that Bryant says is not ideal.

"Men need to participate in a balanced exercise program where they are involved in strength training that is for all the major muscle groups. They need to participate in some aerobic exercise, because that's going to help them to expend energy and burn calories," says Bryant, who also notes that good nutrition is crucial to fitness success. "You need the whole package if you want to get optimal results."

For instance, a man who performs many abdominal exercises may become frustrated because he is not able to obtain the "washboard abs" he desires. He may well have beautiful, washboard abs, but a layer of fat may be hiding them.

"Until you lose body weight and body fat overall, people aren't going to see the fruits of your labor," says Bryant. He says there's no such thing as spot reducing -- targeting certain areas of the body for fat and weight loss. When people lose weight, it usually comes off all over the body.

To get rid of the flab and pounds, Jean Bonhomme, MD, MPH, a member of the board of directors for the Men's Health Network, suggests choosing an enjoyable physical activity, even if it is not a traditional workout.

The idea is to move the body, doing anything from running, hiking, walking, or martial arts.

With any new or renewed activity, it is important to start slowly, gradually raising intensity. Starting out at a level that is too aggressive could cause pain, injury, and a sense of dejection.
New Year's Resolution No. 2: Watch What You Eat

Meat and potatoes have somehow been associated with manly men. "For some men, it's a macho thing to eat a lot of red meat," says Bonhomme. "We're supposed to be the hunters, and we bring home the deer and the elk."

There is certainly nothing wrong with a juicy piece of steak, but overindulgence can be a problem, says Bonnie Taub-Dix, RD, a spokeswoman for the American Dietetic Association. "Diets that promote large amounts of protein and fat, like the low-carb diets, are really not the way to go. Men have a tendency to do that more," she says.

Low-carbohydrate and high-protein diets limit intake of particular grains, rice, potatoes, pastas, fruits, and starchy vegetables. They sometimes encourage meat and fat consumption to promote weight loss.

Studies show low-carb diets do help people lose weight in the short term. After a year, however, researchers found no difference in weight loss between the low-carb diet and the standard low-calorie diet.

Experts are still waiting for long-term data on low-carb diets. Critics fear the diets will have negative effects on the heart, particularly since fatty foods have been shown to raise risk of heart disease. Many of the restricted foods on the low-carb diet, such as whole grains, fruits, and vegetables, have also been shown to prevent cancer, and lower risk of heart disease.

To lose weight, Taub-Dix recommends a well-balanced diet, with emphasis on whole grains, fruits and vegetables. She says three servings of low-fat dairy can also be beneficial. Besides improving bone health, some studies show calcium may make it easier to shed pounds.

Instead of a beefsteak, try tuna or salmon steaks. A turkey burger could replace a beef burger. There are also vegetarian meat substitutes.

If this does not sound appetizing, try mixing healthy items into the meals you normally eat. For instance, a beef dish could be mixed in with tofu. "So you can get some of what you want, but not enough to hurt you," says Bonhomme.

(Have you resolved to diet this year? Check out WebMD's Diet Assessment tool.)
New Year's Resolution No. 3: Go to the Doctor

Do you have a twisted ankle, back pain, blood in the urine, an enlarged mole, or unexplained sadness lasting more than a couple of weeks? These are all good reasons to see a physician. Yet plenty of men simply don't do it.

Men make 130 million fewer visits to the doctor than women do, and that's not including childbirth visits, says Armin Brott, author of Father for Life. He says men tend to discount pain and see themselves as indestructible, especially at younger ages. He says this general thinking stems from ideas promoted in childhood -- that big boys need to be tough and they don't cry. As men grow up, they are raised to think of themselves as providers and protectors.

"We're supposed to be taking care of our families, and we just don't have time to take care of ourselves," says Brott, noting a great percentage of the time men go to the doctor because their wife sent them. By the time they go, however, their condition could have progressed to more troublesome stages.

Promise yourself that if something doesn't feel right, you'll go to the doctor, Brott tells men.

Besides treating ailments, a medical practitioner can screen for potential problems, and keep a record of normal fitness levels. Health exams can give doctors a baseline for things like blood pressure, and cholesterol. If a man does not go to the doctor, it becomes harder for physicians to determine the severity of a problem.

The U.S. Preventive Services Task Force recommends the following screening tests for men:

* Cholesterol Checks. Have your cholesterol screened at least every five years, starting at age 35. Have it done at age 20 if you smoke, have diabetes, or have a family history of heart disease.
* Blood Pressure. Have it checked at least every two years.
* Colorectal Cancer Tests. Begin testing at age 50.
* Diabetes. Have a test done if you have high cholesterol or high blood pressure.
* Depression. Talk to your doctor if you've felt sad for two weeks straight, and have had little interest in normally pleasurable activities.
* Sexually Transmitted Diseases. Ask your doctor whether you should be screened.
* Prostate Cancer Screening. Talk to your doctor about the risk and benefits of performing the prostate-specific antigen test, or the digital rectal exam.

Brott says it's also a good idea for men to give themselves a regular visual exam, taking inventory of how they feel and look.
New Year's Resolution No. 4: Quit Smoking

Giving the nicotine habit the boot is one of the most popular resolutions for both men and women. It is a difficult task, and for some people, success does not come until after multiple tries.

Experts say the best way to deal with the problem is to get help. "You get no extra points for being macho," says Brott.

There are a number of resources for support. You may visit your primary care doctor and/or join a smoking cessation program in person, online, or by phone. You may consider medication, or nicotine replacements such as patches, gums, sprays, inhalers, and lozenges. Or you may contact groups such as the American Cancer Society, the American Lung Association, and the CDC's Office on Smoking and Health for help.

Robert Stenander, corporate services clinician for the Illinois Institute for Addiction Recovery, recommends face-to-face support groups. The personal interaction, he says, can help raise accountability, and can provide vital social connections.

"You can describe and talk about what your issues are with regard to your smoking cessation, and you've got other people who may be able to give you some hints and suggestions as to what they've encountered," says Stenander.

A relapse is a real possibility, but it's important to look forward and avoid negative thinking. "Don't give up," says Stenander. "Don't get yourself in a defeatist attitude that you can't do something. Let's talk about what you can do."

If one smoking cessation method doesn't work for you, try another one. You may also consider different support groups as some may work better than others.

Don't forget that you can also enlist the support of family and friends. Many former smokers have found loved ones as a vital source of encouragement.

Promise yourself that if something doesn't feel right, you'll go to the doctor, Brott tells men.

Besides treating ailments, a medical practitioner can screen for potential problems, and keep a record of normal fitness levels. Health exams can give doctors a baseline for things like blood pressure, and cholesterol. If a man does not go to the doctor, it becomes harder for physicians to determine the severity of a problem.

The U.S. Preventive Services Task Force recommends the following screening tests for men:

* Cholesterol Checks. Have your cholesterol screened at least every five years, starting at age 35. Have it done at age 20 if you smoke, have diabetes, or have a family history of heart disease.
* Blood Pressure. Have it checked at least every two years.
* Colorectal Cancer Tests. Begin testing at age 50.
* Diabetes. Have a test done if you have high cholesterol or high blood pressure.
* Depression. Talk to your doctor if you've felt sad for two weeks straight, and have had little interest in normally pleasurable activities.
* Sexually Transmitted Diseases. Ask your doctor whether you should be screened.
* Prostate Cancer Screening. Talk to your doctor about the risk and benefits of performing the prostate-specific antigen test, or the digital rectal exam.

Brott says it's also a good idea for men to give themselves a regular visual exam, taking inventory of how they feel and look.
New Year's Resolution No. 4: Quit Smoking

Giving the nicotine habit the boot is one of the most popular resolutions for both men and women. It is a difficult task, and for some people, success does not come until after multiple tries.

Experts say the best way to deal with the problem is to get help. "You get no extra points for being macho," says Brott.

There are a number of resources for support. You may visit your primary care doctor and/or join a smoking cessation program in person, online, or by phone. You may consider medication, or nicotine replacements such as patches, gums, sprays, inhalers, and lozenges. Or you may contact groups such as the American Cancer Society, the American Lung Association, and the CDC's Office on Smoking and Health for help.

Robert Stenander, corporate services clinician for the Illinois Institute for Addiction Recovery, recommends face-to-face support groups. The personal interaction, he says, can help raise accountability, and can provide vital social connections.

"You can describe and talk about what your issues are with regard to your smoking cessation, and you've got other people who may be able to give you some hints and suggestions as to what they've encountered," says Stenander.

A relapse is a real possibility, but it's important to look forward and avoid negative thinking. "Don't give up," says Stenander. "Don't get yourself in a defeatist attitude that you can't do something. Let's talk about what you can do."

If one smoking cessation method doesn't work for you, try another one. You may also consider different support groups as some may work better than others.

Don't forget that you can also enlist the support of family and friends. Many former smokers have found loved ones as a vital source of encouragement.

New Year's Resolution No. 5: Ease Stress

Got stress? Who doesn't? Men have their lion's share partly because society hasn't given them the freedom to process pressures that well, says Bonhomme. "A lot of times men will hold things inside ... they won't talk about them."

The pent-up negative feelings can cause feelings of anger and hopelessness, promote destructive behavior, or manifest themselves in physical ailments. Research shows stress can have adverse effects on the cardiovascular, nervous, immune, and digestive systems.

Bonhomme suggests exercise as a "masculine" way of relieving tension: "If you've had a stressful day and you work out, you burn off stress hormones."

It also helps to identify what is causing the stress, and try to deal with the issue, says Brott. Sometimes, he says this may mean talking to your girlfriend, wife, or a minister.

If none of these methods work, talk with your doctor, or a psychologist.

Low Testosterone, Early Death?

Higher Death Risk in Men With Lower Testosterone Levels
By Daniel J. DeNoon
WebMD Medical News
Reviewed by Louise Chang, MD

Nov. 27, 2007 -- The lower a man's testosterone level, the higher his risk of death -- especially death from heart disease.

The finding comes from a study of British men aged 40 to 79 by University of Cambridge gerontologist Kay-Tee Khaw, MBBCh, and colleagues.

"The men with lower testosterone levels had an increased risk of dying from any cause, but most particularly of cardiovascular disease," Khaw tells WebMD. "We looked at cancer, too, and found no evidence of a link to cancer with higher testosterone levels."

Nearly 12,000 men enrolled in the long-term study from 1993 to 1997. More than 800 of the men died by 2003; Khaw compared these men's testosterone levels to those of some 1,500 living study participants.

After adjusting for factors that might affect risk of death -- including age, weight, smoking, alcohol use, high blood pressure, diabetes, physical activity, education, and social class -- the link between low testosterone and earlier death remained.

Compared to men with the lowest quartile (25%) of testosterone levels:

* Men in the second lowest quartile were 25% less likely to die.
* Men in the second highest quartile were 38% less likely to die.
* Men in the highest quartile were 41% less likely to die.

"We found that low testosterone predicts early mortality in men over the next 10 years or so," Khaw says. "But we think this finding needs to be replicated. We would like others to look at this in other populations of men and see if they get the same results."

The findings make sense to Robert Davis, MD, professor of urology at the University of Rochester, N.Y. Davis says low testosterone is common among men with metabolic syndrome -- a constellation of risk factors including abdominal fat, high blood sugar, high blood pressure, low HDL cholesterol, and high blood-fat levels.

"Certainly I'm not surprised at this finding. It's been shown that low testosterone correlates with metabolic syndrome, which is related to diseases like diabetes, heart disease, and vascular disease," Davis tells WebMD. "The need to check testosterone levels in people with metabolic syndrome is being recognized more and more among physicians."
Testosterone Therapy: Studies Needed

Low testosterone may be bad, but it is not clear that testosterone replacement therapy corrects this problem. Only clinical trials can prove whether testosterone supplementation can lower the risk of death linked to low testosterone levels. Ironically, researchers have been reluctant to test testosterone replacement in clinical trials because of worries that the treatment may increase men's risk of prostate cancer.

"Our study may provide some reassurance of those planning trials of testosterone supplementation," Khaw says. "The irony is that while a lot of men believe testosterone supplements may be good for their health, those trials have not been done because of ethical concerns of testosterone causing prostate cancer."

Davis worries that doctors are too wary of prescribing testosterone supplements for men with too-low testosterone levels.

"It is a very underdiagnosed and undertreated problem," he says. "One of the myths is that androgen supplementation will cause a cancer. We know that prostate cancer often regresses when androgen is removed, but there is very little evidence that supplementing to normal levels increases risk of cancer, and some evidence it may lower it."

Khaw and colleagues report their findings in the Dec. 4 issue of the journal Circulation.

The Carnivore's Guide to Vegetables

WebMD Feature from "Men's Health" Magazine

By Mark Bittman

30 recipes that will help you live longer and leaner (and eat better) without giving up burgers and breasts

You might call me an accidental semivegetarian. Five years ago, I thought nothing of following up a cheeseburger lunch with a rib-eye dinner. But when I began working on a book called How to Cook Everything Vegetarian, it was clear I needed to find a way to squeeze more plants onto my plate.

Over the next year, I gained a new appreciation for lettuce, zucchini, and whole grains. (Try black rice if you doubt me.) I was whipping up explosively flavorful dishes in no time, and I dropped 20 pounds.

I bet you could use a few more fruits and vegetables in your diet. According to the Centers for Disease Control and Prevention, 87 percent of American men don't consume the USDA's recommended five or more servings a day. And yet a huge body of evidence connects vegetable consumption to lower rates of cancer, obesity, and heart disease.

Vegetarians can teach us a thing or two about coercing big flavors and textures out of otherwise bland ingredients, as these recipes prove. Give them a shot. They're not just fantastic vegetarian dishes. They're fantastic dishes, period.

PASTA WITH BROCCOLI, CAULIFLOWER, OR BROCCOLI RABE

Use Your Noodles: This recipe is the foundation of dozens of pasta dishes.

Makes 4 servings
Time: 40 minutes

A rich Bolognese sauce can be super-satisfying, but it has three times the ingredients of this recipe and can be cooked only a few different ways. This simple pasta dish is made with a terrific, explosive vegetable sauce that takes well to other flavors.

1 Tbsp salt
1 lb broccoli, cauliflower, or broccoli rabe, trimmed and cut into pieces
1/4 cup extra-virgin olive oil, or more as needed
1 Tbsp chopped garlic, or more to taste
1 lb penne, ziti, or other cut pasta
Freshly ground black pepper

1. Bring a large pot of water to boiling and add salt. Boil the vegetables until they're fairly tender, 5 to 10 minutes, depending on what you use (broccoli rabe is fastest, cauliflower slowest) and the size of the chunks. Meanwhile, heat the oil in a large skillet over medium-low; add the garlic and cook until it begins to sizzle. Scoop the vegetables out of the pot with a slotted spoon or strainer.
2. Drop the vegetables in the skillet and turn the heat to medium-high. Cook, stirring and mashing, until they're hot and soft.
3. Cook the pasta according to the package directions. When it's almost (but not quite) done, drain it, reserving about a cup of the water. Add the pasta to the skillet with the vegetables and 2 tablespoons of the reserved water. Toss it all with a large spoon until well combined. Sprinkle with salt and pepper, along with more of the pasta water to keep the mixture from drying out. Serve immediately.

Pump up this pasta
8 simple ways to add complex flavor

1. Cook 3 or 4 dried chilies along with the garlic, or toss some red-pepper flakes into the pasta.
2. Add a teaspoon of minced garlic to the mashed vegetable 30 seconds before you turn off the heat.
3. Cook several threads of saffron in the oil along with the garlic.
4. Toss 1/2 cup of pesto into the cooked pasta.
5. When you combine the pasta and vegetable, stir in a small can of tomato paste or a cup of chopped tomatoes.
6. Add a couple of tablespoons of olive tapenade when you toss the pasta.
7. Add 1 cup of sliced mushrooms to the oil once the garlic sizzles.
8. Toss in a cup of peas, chopped spinach, or arugula during the last minute of cooking.

BEER-GLAZED BLACK BEANS

Makes 4 servings
Time: 2 hours soaking, plus 30 minutes cooking

Beans often intimidate beginners, so many people buy the markedly inferior canned stuff and then don't like it. But dried beans actually take very little effort: Just soak, simmer, and eat.

1/2 lb dried black beans, rinsed, with any pebbles picked out
Salt and freshly ground black pepper
2 Tbsp extra-virgin olive oil
1 onion, chopped
1 Tbsp minced garlic
1 cup beer (stout or porter is best)
1 Tbsp chili powder, or to taste
1 Tbsp honey

1. Put the beans in a large pot and add enough cold water to cover the beans by 2 to 3 inches. Turn on the heat and let the beans boil, uncovered, for 2 minutes. Put the lid on, turn off the heat, and let the beans soak for at least 2 hours.
2. Return the water to boiling, and reduce the heat so that the beans bubble gently. Cover partially and cook, stirring occasionally. Check the beans for doneness after 10 or 15 minutes and add a little more water if necessary. When the beans are tender, stop cooking and drain any excess liquid. Season with salt and pepper.
3. Heat the oil in a skillet over medium heat. Add the onion and cook, stirring occasionally, until soft. Add the garlic, cook for a minute, and then add the remaining ingredients (including the beans) and another good shake of salt and pepper.
4. Bring to a steady bubble and cook until the liquid is slightly reduced and thickened, about 15 minutes. Taste, and adjust the seasoning if necessary. Serve hot or store, covered, in the refrigerator for up to 3 days.

Enliven these legumes

3 ways to give beer-glazed beans an edge

1. Sweeten the dish by adding 1 cup of chopped ripe tomato or 1 to 2 tablespoons of tomato paste in Step 1, and then proceed with the recipe.
2. For extra tang, stir in 2 teaspoons of balsamic or sherry vinegar during Step 1. Proceed with the recipe.
3. Add an Asian flair with a tablespoon of peeled, minced fresh ginger and 2 tablespoons of fermented black beans when you add the garlic in Step 3. Swap out the salt for a bit of soy sauce.

87% of men don't eat enough vegetables.

ASPARAGUS AU GRATIN

Create a crust A handful of cheese and bread crumbs lends crunch and flavor to asparagus.

Makes 4 servings
Time: 15 minutes

Gratin is just a scary word for a baked dish with a crumb crust. It can be made gooey and cheesy or, as it is here, light and crunchy. This recipe calls for asparagus, but I can't think of a vegetable that wouldn't work well.

1 1/2 to 2 lb asparagus
1 Tbsp butter or extra-virgin olive oil
Salt and freshly ground black pepper
1/2 cup grated Gruyère or Swiss cheese
1/2 cup freshly grated Parmesan
1/4 cup fresh bread crumbs
1/4 cup chopped fresh parsley, for garnish

1. Break off and discard the woody bottom ends of the asparagus spears (they'll naturally snap off where they're supposed to), and peel the top parts if they're thick. Steam or microwave, covered, just until tender--5 minutes max.
2. Preheat the broiler and make sure the rack is about 4 inches from the heat source.
3. Use the butter or oil to grease a medium, shallow baking dish.
4. Sprinkle the spears with salt and pepper and place them in the dish. Cover with the cheese and sprinkle the bread crumbs on top. Broil for 3 to 5 minutes, until the cheese is melted and golden. Add the parsley and a few more grinds of pepper (and some paprika if you'd like). Serve.

Build a grander gratin

5 vegetable and cheese variations worth checking out

1. Substitute 5 cups of cooked mushrooms for the asparagus, and crumbled Roquefort for all or part of the Gruyère or Swiss.
2. Substitute 5 cups of roasted, baked, or boiled potatoes for the asparagus, and Manchego cheese for the Gruyère or Swiss. For garnish, sprinkle with smoked paprika.
3. Substitute 5 cups of chopped, cooked broccoli or cauliflower for the asparagus, and more Parmesan for the Gruyère or Swiss. Add a cup of pesto and omit the parsley. In Step 2, toss the broccoli or cauliflower with the pesto, sprinkle with Parmesan, and proceed.
4. Substitute 5 cups of lightly sautéed onions for the asparagus.
5. Substitute 5 cups of sliced, roasted beets for the asparagus, crumbled goat cheese for the Gruyère or Swiss, and thyme leaves for the parsley. Sprinkle the beets with the thyme leaves and the goat cheese, and proceed with the recipe.

CHOPPED SALAD

Makes 6 servings
Time: 15 minutes

The most popular nonrecipe in the world doesn't have to be a bowl of nonflavor. You just have to know how to dress it for success.

2 celery stalks (preferably from near the heart), trimmed and chopped
2 carrots, peeled and chopped
1 small red onion, minced
1 cucumber, peeled and chopped
1 red or yellow bell pepper, cored, seeded, and chopped
4 cups chopped romaine lettuce
Salt and freshly ground black pepper
1 Tbsp vinegar or lemon juice, or to taste
1 tsp Dijon mustard, or to taste
1/2 tsp minced garlic
3 Tbsp extra-virgin olive oil

1. Combine the vegetables and lettuce in a bowl; sprinkle lightly with salt and pepper and toss. Combine the vinegar or lemon juice, mustard, and garlic in a bowl. Slowly drizzle in the oil, whisking until combined.
2. Drizzle the dressing on the salad, taste, adjust seasoning to your liking, and serve immediately.

Strengthen this salad

Simply add one of the following ingredients. Better yet, mix and match.

1. Fennel, 1/2 bulb, trimmed and chopped
2. Avocado, peeled, pitted, and chopped
3. Cabbage, 1 cup, chopped or shredded
4. Haricots verts or other green beans, 1 cup, briefly boiled or steamed
5. Fresh peas, snow peas, or snap peas, 1 cup, very lightly cooked
6. Cheese, such as Parmesan, blue, or feta--1/2 cup grated or crumbled
7. Radishes, 1/2 cup chopped
8. New potatoes, steamed and cut into small chunks--about 1 cup
9. Canned chickpeas, 1/2 cup (or more), lightly rinsed
10. Nuts, such as almonds, pistachios, or peanuts, 1/2 cup, chopped into large pieces

You'll eat well, lose weight, save money, and lower your risk of disease.

The 5-Second Strength Booster

WebMD Feature from "Men's Health" Magazine

By Dan John

The best way to transform your body is simple: Pick up a heavy weight and put it down

In the late 1800s, a simple exercise called the health lift--the original lift--was believed to provide the only physical fitness a man needed.

The health lift was a very simple exercise. Pile heavy objects onto a machine, and then lift it. Workout completed, fitness and health improved--instantly.

Today we have another name for that exercise: the deadlift. And it's still king for developing total-body strength and muscle. But most 21st-century men avoid deadlifts because we've been told, rightly so, not to lift with our backs.

Sure, you can lift without your back, much like you can speak without your tongue. But it's not very efficient or effective.

The deadlift works wonders on your physique for the exact reason the move's opponents avoid it: It requires a team effort from hundreds of muscles, including those in your lower back.

As a result, you become more proficient at a basic human movement. Need to pick your kids off the floor? Deadlift. Taking out the trash? Deadlift.

Make the original lift for optimal health and longevity a staple in your workout. Use our safe and effective plan to master this simple and time-proven move.

DO THE POTATO-SACK SQUAT

There's a subtle difference between deadlifts and squats when you're learning how to do them. Typically, when you hold the weight down in front of your body, the move is a deadlift. When you hold it across your shoulders, it's a squat.

An exercise called the potato-sack squat is a sort of hybrid, and it helps you get comfortable using your back to lift weights. You can do this move with a dumbbell, luggage, or, yes, a bag of potatoes.

Stand holding a dumbbell--use a 20- or 30-pounder to start--with both hands under the top of the weight and your arms hanging straight down in front of your body. Keep your chin and chest up and your shoulders back. Next, lower your body until the weight touches the floor. Then stand back up.

It takes longer to explain than it does to master. You should get the hang of it within three or four repetitions.

SIT BACK AND RELAX

Once you've done a set of potato-sack squats, try another set, but this time slide two 10-pound weight plates under your toes so the balls of your feet are on the plates and your heels are on the floor.

Doing the exercise this way stretches your hamstrings and calves, and, more important, trains your body to stay upright. Men have a tendency to let their weight creep forward over their toes, and that's when back injuries often occur. By keeping your weight on your heels and pressing into the floor every time you do the deadlift, you'll reduce your risk of injury.

PREPARE FOR BIGGER MUSCLE

This next move can help you attain all the hip and hamstring flexibility you'll ever need. You're going to do the potato-sack squat once more, this time on an elevated surface. Stand with each foot on a box that is about 6 inches high, or on a pair of 45-pound plates. An aerobics step will work, too.

Now perform the potato-sack squat. When you touch the dumbbell to the floor, your hips will drop deeper than they did before, so you'll expand your range of motion and your muscle-building potential.

BUILD STRENGTH IN SECONDS

Now you're ready for the deadlift. Place two 45-pound plates on a barbell and do what comes naturally: Pick it up and put it down. Then see the workout plan at right to increase the amount of weight you can lift fast. Keep these cues in mind.

Keep your arms straight, elbows locked
Drive your chin toward the ceiling as you lift the weight
Press down on your heels
Elevate your chest

Experiment by holding the barbell with an overhand grip (palms facing you) or an alternating grip (one palm forward, one palm facing you), with your hands placed at shoulder width or out toward the ends of the bar. Variations help you improve faster.

Tips for a Successful Doctor Visit

At your next doctor's appointment, get in, get the information you came for, and get out without wasting anyone's time -- including your own.
By Tom Valeo
WebMD Feature
Reviewed by Louise Chang, MD

“Help me ... help you. Help me, help you.”

That famous line from the film Jerry Maguire may be the best advice a doctor could give his or her patient.

“Some patients have the attitude, 'I’m putting myself in the hands of a professional,'” says Stephen Permut, MD, chairman of family and community medicine at Temple University School of Medicine in Philadelphia. “They want you to make all their decisions for them.”

Permut prefers to have patients get involved in their own care and engage the doctor in a cooperative effort to determine the best course of action.

So if you want to help your doctor help you, you need to help your doctor. Here’s how.

1. Prepare for your doctor visit in advance.

A recent review of 33 studies showed that patients who filled out a detailed checklist before an office visit, or received in-office coaching that focused on their health status, asked more questions during their doctor visit and got more satisfaction from the visit.

“Keep a symptom diary,” advises Terrie Wurzbacher, MD, a Navy physician for more than three decades and author of a book titled Your Doctor Said What? Exposing the Communication Gap.

“You may think you can remember everything,” says Wurzbacher, “but by the time you get to see the doctor you will have forgotten the majority of what you wanted to tell the doctor, and it’s important for the doctor to know the progression of the problem. Be specific. Explain that it all began with belly pain, and then you developed diarrhea, and so on.”

Write down all of your medical problems, and also the names and the dosages of the medications you’re taking. Once you’ve written it all down, make a copy and give it to the nurse when you arrive for your doctor visit. She’ll add it to your medical records.

“You know the doctor is going to look at that before seeing you,” says Wurzbacher.

2. Explain how you’re feeling.

You know better than anyone else how you feel, and that information is vital to your doctor. That’s why Permut prefers to take a patient’s medical history himself.

Has your appetite increased or decreased? Are you having trouble sleeping? Do you have any pains? How’s your mood? Your sex drive? Are you feeling unusually tired?

“I prefer to see the reaction on their face when I ask the questions,” he says. “A bunch of studies show that 85 to 95 percent of diagnoses can be made by the medical history alone. Listening is what being a physician is all about. It’s amazing what you can accomplish in 10 to 15 minutes.”

Are you taking any prescription drugs? If so, make sure you know the name of each drug, the dosage you’re taking, and the number of times a day you take it. “That includes herbal remedies and over-the-counter drugs, too – even multivitamins,” says Permut.

Also let the doctor know about medications you have tried that caused side effects or didn’t work.

“The patients who frustrate me the most are the ones who talk to me about their little white pill, or the triangular pill,” Wurzbacher says. “They don’t know what their medications are or what they’re for.”

4. Be honest, and don’t leave out details.

“I want to know everything medical that has happened to a patient,” says Permut. That includes the removal of any organs. That may not seem like something a patient could forget, but outpatient surgery makes some procedures so simple that patients do forget.

“Gallbladder surgery, for example, used to be a big deal that required a lengthy hospital stay and left you with large scars,” Permut says. “Now you wind up with three or four half-inch scars and go home from the hospital the same day. You might forget to tell doctor you had your gallbladder out.”

Also tell the doctor everything that you’re doing that could affect your health. Are you taking laxatives? Are you on a diet? How much exercise do you get? Are you using a sleep aid? How much alcohol do you drink? “If you’re using illegal drugs, I need to know that also. A visit to the physician is totally confidential,” emphasizes Permut.

Are you under stress? Have you ever endured extraordinary stress?

“I want to know about any emotional stresses that may have changed people’s lives -- the loss of a child or a spouse, job setbacks,” Permut says. “I want to know about anything that might have had a powerful effect on the patient.”

5. Don’t be embarrassed -- your doctor has heard it all.

If you’re planning to discuss a personal topic, one way to avoid nerves is to practice what you plan to say in advance.

“It’s like public speaking, once you get it out of your mouth it’s easier to say,” says Wurzbacher.

“Once you’ve said it to your mirror a few times, it’s easier to say, ‘I’ve had this vaginal bleeding.’ Rest assured,” says Wurzbacher, “the doctor probably has heard everything you’re going to say at least 10 times before.”

6. Keep an open mind.

The patients Permut finds most troubling are those who come in with a fixed idea about the treatment they should receive.

“They’ll say, ‘I’m having headaches, and I want an MRI,’ and they won’t be happy unless you arrange that for them,” Permut says. “But if you take the medical history and conclude that they’re almost certainly tension headaches, an MRI would be a waste of resources. One of my colleagues used to say that it takes 5 seconds to say yes and 15 minutes to say no, but I think you have to take the time to educate patients about what the issue is and what your plans are for ordering tests down the line.”

7. Write it down.

Once you’re with the doctor, take notes in case you want to look something up, or bring someone with you to provide a second set of ears. Write down the names of any medications the doctor prescribes. And don’t hesitate to ask questions.

Most Steroid Users Are Not Athletes

Survey Shows Typical User Isn't Motivated by Sports Performance
By Jennifer Warner
WebMD Medical News
Reviewed by Louise Chang, MD

Oct. 12, 2007 -- Contrary to popular belief, the typical anabolic steroid user is more like an "Average Joe" than a professional athlete or competitive teenager.

A new survey suggests that the typical anabolic-androgenic steroid (AAS) user is a well-educated 30-year-old male who wants to build muscles and strength and increase his physical attractiveness. Researchers say the results show the notion of the typical steroid user as a "cheating" athlete is inaccurate.

"These findings question commonly held views of typical AAS users and their underlying motivations," Rick Collins of Collins, McDonald & Gann, PC, in Carle Place, N.Y., says in a news release.

"The vast majority of AAS users are not athletes and hence, are not likely to view themselves as cheaters. The targeting of athletes through drug testing and other adolescent or sports-based interventions has no bearing on non-competitive adult users."
Typical Anabolic Steroid User Is Atypical

In the study, published in the Journal of the International Society of Sports Nutrition, researchers surveyed nearly 2,000 men about anabolic steroid use via the Internet. Researchers say they used the Internet in order to encourage men to participate by allowing them to remain anonymous.

The results showed that the average male anabolic steroid user is:

* About 30 years old
* Well-educated
* Earns an above-average income in a white-collar job

In addition, the survey shows that most did not start using steroids in adolescence, nor are they motivated by athletic competition or sports performance.

Instead, the typical anabolic steroid user wants to increase muscle mass, strength, and physical attractiveness. Other motivating factors for taking anabolic steroids were increasing confidence, decreasing body fat, improving mood, and attracting a sexual partner.

Researchers found that men in this survey followed carefully planned drug regimens along with a healthy diet and exercise practices designed to maximize benefits and minimize harm.

"The users we surveyed consider that they are using directed drug technology as one part of a strategy for physical self-improvement within a health-centered lifestyle," says Collins. "Effective public policy should begin by accurately identifying who's using steroids and why."

Drop 5

WebMD Feature from "Men's Fitness" Magazine

Lindsay Brown

Our regular five-pack for taking off­ five pounds in the next 30 days

START STROKING

Just because a chill is in the air doesn’t mean you have to retire your swim trunks. Swim laps twice a week at an indoor pool. An hour will burn 572 calories.

Calories burned: 4,576

SAY OM

Find your inner Mr. Miyagi this month and start taking a weekly karate class. One intense class will torch 1,347 calories. While you’re at it, sign up for more Eastern exercise classes, like tai chi and yoga, to truly connect your mind and body.

Calories burned: 5,388

HAVE A HEALTHY HALLOWEEN

For once, really stick to your promise not to overindulge in Halloween candy. Every bite-size candy bar you inhale is packed with almost 100 calories. And that “harmless” candy corn? Try 150 sugar-packed calories per serving.

Calories saved: 3,750

LEARN SELF-CONTROL

Shave 100 calories from your diet each day this month. By simply substituting mustard for mayo on your sandwich, leaving a few bites on your dinner plate, eating two fewer cookies, or omitting the cheese on your burger, you can effortlessly save calories.

Calories saved: 3,100

CLEAN THE GUTTERS

Pick up a rake and tidy up your yard once a week. An hour of raking, bagging leaves, and doing other household chores can burn more than 400 calories.

Calories burned: 1,632

Total savings for one month: 18,446 calories (or just over five pounds of fat)

Rehab Clinic

WebMD Feature from "Men's Fitness" Magazine

You’re a young guy, but your joints creak like rusty hinges. Should you be worried? It depends. We’re here to translate the popping in your knees, crunching in your elbows, and clicking in your shoulders—and tell you how to silence all that noise.

POP!

In most cases, popping occurs when a joint dislocates and then pops back into place. The danger is that one day it may not go back where it belongs, and the very movement may also irritate tissue around the joint (an especially common problem in the shoulder socket). Rule out exercises that may be causing damage, such as behind-the-neck pulldowns and shoulder presses. Strengthen the rotator cuffs with exercises such as external rotations, but also see a physical therapist for treatment.

SNAP!

This sound is the result of friction between two structures (such as tendons) gliding past each other. If the snapping body part (usually the hip, ankle, or shoulder blade) doesn’t hurt, don’t worry about it. But if the area also feels stiff or tight, the tendons are constricted and could benefit from regular stretching.

CRACK!

Most cracking sounds are the result of a vacuum being created between two joint surfaces and then releasing (like the noise a wet glass makes when you lift it off a table). Contrary to popular lore, cracking your joints has not been proved to cause damage. In fact, it actually relaxes the muscles surrounding the joint, improving joint movement and reducing pain. Just don’t do it too often, or you’ll overstretch the joints, making them unstable and injury prone.

GRIND!

Over time, the cartilage in your body can wear down, removing the padding between irregular joint surfaces and allowing those surfaces to rub together. Normally, any sort of grinding noise is harmless. The exception is your knee. There, grinding can be a sign of improper kneecap alignment, which can cause painful and damaging effects to the joint, such as “runner’s knee.” The solution: Stretch the connective tissue on the outer sides of the thighs and strengthen your quads.

Male Breast Enlargement May Be Common

Condition Known as Gynecomastia May Occur in Nearly Half of Men

By Kathleen Doheny
WebMD Medical News

Reviewed by Louise Chang, MD

Sept. 19, 2007 -- Gynecomastia, the enlargement of breast tissue in men, can be an embarrassing condition, but it is surprisingly common and usually benign.

Overall, nearly half of men may experience the condition at some time in their lives, says Glenn D. Braunstein, MD, chairman of the department of medicine at Cedars-Sinai Medical Center in Los Angeles and the author of an article on the topic in the Sept. 20 issue of The New England Journal of Medicine.

Later in life, in middle age and older adulthood, the condition can also appear or reappear, says Braunstein, who wrote the article to inform doctors about how to diagnose and treat the condition.

During puberty, the condition is even more common, he tells WebMD. "Up to two-thirds of boys will develop gynecomastia during puberty," he says, although some cases will be so mild they go unnoticed.

The good news: Gynecomastia during puberty generally disappears on its own. Later in life, the problem can often be traced to medications or treatments for prostate cancer. Treatment options, including medication and surgery, are very effective.

What Causes Gynecomastia?

Underlying the condition is an imbalance of estrogen and testosterone. When estrogen levels get too high, the breasts can begin to grow. Some breast tissue is more sensitive to estrogen than others, Braunstein tells WebMD.

As the body mass index, a measure of height to weight, increases, so does the chance of gynecomastia, he says. So the heavier the teen or man, the more likely he may get the condition. But "gynecomastia occurs even in normal-weight kids," he says.

Gynecomastia in Puberty

When gynecomastia occurs during puberty, it usually appears at about age 13 or 14, Braunstein says.

And if the enlarged breasts are noticeable, already self-conscious preteens can become embarrassed. "The kids are often socially conscious," he says. "They don't want to take their shirts off. They fear they are becoming like girls."

Depending on how enlarged the breasts are, there can also be tenderness. "[The breasts] can hurt when they are physically active," Braunstein says.

A pediatrician should do a thorough physical exam, Braunstein tells WebMD, making sure there are no tumors, thyroid problems, or other medical conditions that might explain the breast growth.

Recently, doctors have found that use of products containing lavender oil or tea tree oil may trigger breast growth in preteen boys, says Braunstein, citing a study published earlier in 2007. The boys who developed the breast growth had been using a lavender oil skin balm, a hair gel with lavender and tea tree oils, or lavender-scented soap and skin lotions. When they stopped using the products, their breasts returned to normal within a few months.

After ruling out other conditions, a pediatrician typically suggests waiting to see if the gynecomastia disappears, Braunstein says, typically telling the patient to return in three months.

"About 95% of the time, this [condition during puberty] will disappear within three to six months," he says.

Another expert, Yong Bao, MD, assistant professor of pediatric endocrinology at the University of Miami Leonard M. Miller School of Medicine, agrees that "tincture of time" often works. The smaller the growth, the more likely it will go away, Bao says. "After the peak of puberty, it usually goes away," he says.

"Most teens do not need any therapy," Braunstein says. But if the breasts are very tender and the patient is bothered by a large degree of growth, doctors may suggest taking tamoxifen, used in breast cancer treatment, Braunstein says. It works by interfering with the activity of estrogen on the breast cells, thus stopping the growth. While tamoxifen is not officially approved for this purpose, it's used "off-label," which is legal. A course of three months of the drug is typical, he says.

About 60% of teens and adults who take tamoxifen have complete regression of the growth, Braunstein says, citing published studies, and about 80% have at least partial regression.

If tamoxifen does not work, male breast reduction or liposuction can be done.

Gynecomastia Later in Life

In older men, an imbalance of hormones is also at the root of gynecomastia, Braunstein says. "In older men, testosterone is down, estrogen is up. There is often an increase in body fat [which makes the condition more likely]."

A doctor should rule out tumors, breast cancer, and other problems, just as in preteens and teens, he says. Certain drugs used for the treatment of prostate cancer, as well as other medications, can lead to excess breast growth in men.

If possible, doctors should switch the medication associated with the breast growth, Braunstein says.

Other options are tamoxifen or surgery such as breast reduction or liposuction to remove the excess tissue.

Treatment May Not Be Needed

"Gynecomastia is a very common problem," Braunstein says. "It's been around a long time." If the teen or man isn't bothered by the problem? There's no reason to treat it, he says, if other problems have been ruled out.

Even if a teen is bothered by the condition, immediate treatment isn't warranted, Bao says. "We always recommend to wait."

Braunstein reports getting consultation fees from companies including Abbott Diagnostics, Esoterix, M&P Pharma, and Novartis -- and research funds from Procter & Gamble and BioSante.

Male Enhancement: Is It Worth a Try?

Nonpresciption methods of male enhancement and male enlargement range from the possibly effective to the downright dangerous.
By Richard Sine
WebMD Feature
Reviewed by Louise Chang, MD

Our email inboxes fill up every day with advertisements for pills, ointments, supplements, and contraptions aimed at enhancing penis size, sexual stamina, or libido. It’s a testimony to men’s abiding insecurities about sexual performance. The question is, do any of these “male enhancement” techniques really work?

Richard, a mechanic from upstate New York, is a muscular, athletic guy. He has a loving wife who has always enjoyed their sex life. But ever since he was a young boy, Richard couldn’t get over the feeling that his penis was too small. In public bathrooms, he’d use the handicapped stall. He felt embarrassed in gym locker rooms and when standing naked before his wife. “I didn’t feel manly enough,” he tells WebMD.

Then, in the back of a weightlifting magazine, he saw an ad for the FastSize Extender, a device that claims to make the penis longer and fatter through traction. Richard began wearing the device almost eight hours a day, every day. He was shocked to notice a difference within a few days. After four months of wearing the device, he says his flaccid penis has stretched from 3 inches to over 5 inches; erect, he has gone from less than 6 inches to over 7 inches. The device cost $298, but Richard says the effect on his self-confidence has been priceless: “It made a world of difference to me.”

The FastSize Extender, though not extensively tested, has received some validation from mainstream medical sources. But that makes it a true rarity among the nonprescription methods of male enhancement. Most are a waste of money, and some are downright dangerous, doctors say.

Instead of furtively turning to untested methods, men with persistent concerns should consider opening up about them with their doctors. That’s because performance problems sometimes act as an early warning signal for serious health problems. Your doctor might be able to prescribe something that can really help, or least provide a valuable dose of perspective about what constitutes “normal” sexual performance.
Links Between Sexual and Overall Health

Sexual performance declines naturally as men age, doctors say. But a rapid or severe decrease in performance or libido can be a red flag. Most importantly, erectile dysfunction may be an early predictor of heart disease.

Atherosclerosis, a condition in which fatty deposits build up inside arteries, may restrict blood flow to the penis and cause erection difficulties. “The small blood vessels that go to the penis can become diseased much earlier than the [larger] vessels that go to the heart,” Karen Boyle, MD, a urologist at Johns Hopkins School of Medicine, tells WebMD. “In younger or younger middle-aged men, ED is often the first sign of atherosclerosis.”

For men with ED who are at risk of heart disease, prescribing Viagra or its cousins isn’t enough, Boyle says. These men should be also be controlling their weight and cholesterol level, limiting their alcohol intake, and quitting smoking. Evidence shows that these changes in themselves can have a positive effect on sexual function, Boyle says.

Sometimes men with erection problems or a diminished libido have low levels of testosterone, Boyle says. Testosterone deficiencies can also affect mood and energy levels. Boyle tests for testosterone levels and prescribes it as a topical gel, though she warns it is only safe when prescribed and monitored by a physician. Nonprescription testosterone, such as the kind used by some bodybuilders, is dangerous, she warns.

For men with performance issues who are physically healthy, Boyle often prescribes counseling, such as marriage counseling for men with relationship issues or psychiatric help for men who are preoccupied with a problem in penile appearance. For young men with sexual performance problems and no signs of physical problems, Boyle may prescribe counseling and a low dose of Viagra as they work out issues of insecurity. “They need reassurance from a physician that everything is OK,” she says.
The Quest for a Bigger Penis

The FastSize Extender device promises results, but it’s far from quick and easy. Just ask Bob, a retail manager from New Jersey. He says he’s gained over 2 inches of erect length. All it took was 25 months and over 2,600 hours wearing the device, typically five hours a day, seven days a week. “I was afraid my girlfriend would think I was a freak, but she was supportive because she felt a difference in her satisfaction and I felt more confident in myself,” Bob tells WebMD.

Richard, the mechanic from New York, got results faster than Bob, but still wore the device under his clothes for about eight hours a day. Richard’s wife has also been supportive. “I see a more confident man in front of me from using this product,” she says. She also says the lengthening has enhanced their sex life, though she had no complaints before.

Chicago urologist Laurence A. Levine, MD, director of the male fertility program at Rush University Medical Center, tested the FastSize Extender on 10 men afflicted with Peyronie’s disease, which can cause bending and shrinkage of the penis. At the end of the six-month study, which was funded by the maker of the FastSize Extender, Levine found increased penile length and reduced curvature in every man and increased girth in seven of the men. Calling the results “remarkable,” Levine now prescribes the device to many of his Peyronie’s patients and reports no significant complications. (Levine has also worked as a paid consultant to FastSize Extender.)

Could FastSize work on men of normal penile length? Levine says it might. “If a woman can have a breast enlargement and it makes them psychologically feel better,” he reasons, “then perhaps we should have the same thing for men.”

Penis-lengthening surgery is also an option for men, but it is a highly controversial procedure. The American Urological Association says a common form of lengthening surgery (involving cutting the suspensory ligament of the penis) has not been shown to be safe or effective. The group also refuses to endorse surgeries that inject fat cells in the penis with the goal of increasing penile girth.

Many doctors question whether the benefits of lengthening surgery outweigh the risks. A 2006 study found that only 35% of men were satisfied with the outcome of surgery, which added only half an inch, on average, to length. Men who are overly preoccupied with penis length tend to have unrealistic expectations of surgery and should seek counseling instead, the authors wrote.

Herbs and Male Enhancement

Thousands of years before Viagra, men were consuming everything from horny goat weed to powdered rhino horn in hopes of boosting sexual performance. The remedies persist for men who can’t get their hands on prescription drugs like Viagra or who prefer “natural” cures.

But many doctors are wary of traditional medicines. When Boyle’s patients come to her with bottles of herbal supplements, she tells them she cannot vouch for their safety or effectiveness unless the FDA has reviewed the claims on the label.

No herbal remedy can restore erections like Viagra and its prescription counterparts, says Steven Lamm, MD, an assistant professor of medicine at New York University and author of The Hardness Factor. But Lamm says these remedies may be appropriate for men who have experienced a decline in sexual performance but do not suffer from a diagnosable sexual problem. Lamm has endorsed an herbal remedy, marketed under the Roaring Tiger label, that combines horny goat weed and other herbal extracts with the amino acid L-arginine. (The supplements are made by the same company that makes the FastSize Extender.)
The Way to Happiness in Bed

The Internet is rife with scammers who seek to prey on men’s insecurities, Levine says. “All the pills, topical creams, and gels are worthless. Many men would clearly rather spend $20, $50, $100 on the Internet than go to the doctor and get real information.”

In some cases, men are harming themselves in the pursuit of a bigger penis. Levine cites “jelqing,” a technique involving hours and hours of intense stroking. He says he has patients who have developed Peyronie’s disease due to violent stretching of the penis through jelqing.

It’s ironic that the male preoccupation with enhancement seems to be independent of the needs of women, the supposed benefactors of improved sexual performance. A recent study found that 85% of women are pleased with their partner’s penis proportions, but 45% of men say they want a larger penis. Given that the vast majority of men fall within a certain penis size -- about 5.5 to 6.2 inches long when erect -- most men fall within the normal range.

And there’s plenty of debate on whether size matters at all. The most sensitive nerves in the vagina are found close to the surface, Lamm notes, and the clitoris is found on the vagina’s outside. So there should be plenty of ways to satisfy your partner that have nothing to do with pills, creams, surgery, or devices.

9 Ways to Safeguard Your Manhood

WebMD Feature from "Men's Health" Magazine

By Jason Stevenson

Here's how to safeguard your manhood.

Toxins like PCBs and dioxins not only slam the environment, they also hit you below the belt by reducing your sperm count and lowering your testosterone. Here's how to safeguard your manhood.

1. Wear a dust mask
Old stone or cement walls--especially caulking from the 1960s and '70s--can release dangerous levels of PCBs when pulverized. As you breathe in, your testes can deflate.

2. Eat saltwater fish
PCBs and dioxins accumulate faster in bluefish, striped bass and farmed salmon, because the fatty tissues absorb more toxins. Put wild salmon, skipjack tuna, or black sea bass on the menu instead.

3. Avoid sex toys and fishing lures
Gelled rubber--which makes fake worms and vibrators squishy--contains phthalates that can enter the body, decreasing semen quality in men. To be safe, swap in real worms in fishing; fingers and tongue during sex.

4. Support clean-water laws
Environmental groups like Robert F. Kennedy Jr.'s Waterkeeper (waterkeeper.org) have the balls to protect yours. His group helped force General Electric to spend millions to clean up PCB contamination along 40 miles of New York's Hudson River.

5. Toss old lawn treatments
In 2002, the EPA banned sale of residential products with chlorpyrifos, an organophosphate proved to reduce testosterone in men. Time to dispose of (properly) the old weed killer. Industrial use is still okay; pay heed if the sign says "Keep off the Grass."

6. Protect the pregnant
Women exposed to endocrine disruptors like PCBs, dioxins, and phthalates give birth to male babies with higher rates of birth defects like cryptorchidism (undescended testicles), hypospadias (malformation of the penis), and testicular cancer.

7. Buy a new bike seat
Narrow seats pressure your perineum, causing erectile dysfunction. Buy a seat that transfers pressure onto your hip bones during practice rides, and save the narrow saddle for race day.

8. Shop at the organic market
Pesticides are like debt: a little a day, over time, can develop into a big problem. Sidestep these testosterone killers by buying organic produce or growing your own testicle-friendly garden.

9. Read the ingredient list
A small study has shown a connection between lavender and tea-tree oils in cosmetics and the development of breast tissue in boys. Avoidance may be the best policy for now.

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

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."

But the Massachusetts results marked a turning point: Testosterone is no longer just a hot topic for misguided weight lifters or baby 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.

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.

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?

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.