Book Review

Textbook of Men's Health

N Engl J Med 2003; 348:267-268January 16, 2003

Article

Textbook of Men's Health
Edited by Bruno Lunenfeld and Louis Gooren. 594 pp., illustrated. New York, Parthenon, 2002. $119.95. ISBN: 1-84214-011-6

This book is the latest initiative of the International Society for the Study of the Aging Male to increase awareness of and research into the particular health needs of aging men. The editors begin the book by stating, “Whilst women's health care has been a specific focus of scientific and clinical attention for at least two centuries, comparatively little attention has been given to the gender-specific needs of men.” Many scientists and women's advocates would disagree, but it is true that little attention has been paid to the sex-based differences in aging that may make men susceptible to particular deficits in health and well-being. Textbook of Men's Health attempts to close this gap by providing guidance on the medical care of aging men and by summarizing the current evidence that endocrinologic changes in aging men affect their health. For this reason, a more accurate title for the book would have been “Textbook of Health in Aging Men.”

Much of the book concerns age-related declines in the circulating levels of sex steroids and growth hormone. Summaries of the evidence of these declines and of their effects on health and well-being are presented throughout the book. Specific chapters focus on evidence that these hormonal declines affect sexual function, the sense of well-being, sleep, the risk of prostate disease, bone mineral density, body composition, cognition, and cardiovascular and respiratory function. Although the authors of these chapters believe that declines in sex steroids and growth hormone are relevant to the health of aging men and make a case for their view with theory and current research, they also acknowledge that the evidence is not convincing enough to support pharmacologic intervention. Each author who discusses the potential benefits of hormone replacement in aging men points to the need for more research on how these hormonal declines affect health and on the efficacy and safety of long-term hormone replacement.

The only case in which the evidence supports hormone replacement is that of testosterone replacement in men with symptoms of testosterone deficiency. Clear and practical guidelines regarding when and how to replace testosterone in these men are presented in several chapters. The authors caution, however, that the long-term safety of testosterone replacement has yet to be established and that questions have been raised about the potential complications of the increased red-cell count and prostate stimulation that can result from such therapy. The release of this book coincided with the publication of new and convincing studies suggesting that hormone replacement in women is probably more detrimental than beneficial. As a result, a planned large clinical trial of testosterone replacement in elderly men was recently scuttled because of safety issues with a treatment whose benefit is unknown. This means that many important questions raised in this book will not be answered in the near future, and clinicians will be left wondering whether and how they should address potential hormone deficiencies in their elderly male patients who do not have clear symptoms of hormone deficiency.

The book also includes chapters on diabetes, nutrition, and disorders of the genitourinary system, the central nervous system and psyche, the musculoskeletal system, the sensory organs, and the skin and hair in aging men. These chapters almost seem to be an afterthought, as if the editors felt that they should include some clinical information in a book entitled Textbook of Men's Health. For the most part, the chapters are well written and informative, although most do not contribute much male-specific knowledge, and the information they present can be found in any general textbook. The section on the genitourinary system, which addresses erectile dysfunction and disorders of the prostate and testes, is the exception.

These chapters often do not provide substantial practical guidance on how to diagnose and treat clinical disorders in elderly men. It would be hard to use this book to develop a comprehensive diagnostic and treatment plan for a patient. It is also surprising that the book does not include chapters on other clinical issues important to the health of aging men, such as the impact of the loss of a spouse on health, life expectancy, and well-being; socioeconomic and racial disparities in morbidity, mortality, and access to health care; and the best ways to communicate with elderly male patients and to motivate behavioral change.

Overall, Textbook of Men's Health is a well-written and clear review of the theory of hormonal decline and evidence of its importance in the health of aging men. It does not succeed as well in providing comprehensive clinical information that may be of use to practicing physicians. It will most likely be of interest to geriatricians, urologists, and endocrinologists seeking an in-depth understanding of age-related declines in sex steroids and growth hormones, the potential effect of these declines on health, and the prospect of treating elderly men with long-term hormone replacement. This book raises more questions than it can answer. For those interested in those questions, it provides an excellent overview. Those looking for answers are going to have to wait.

Elizabeth A. Jacobs, M.D., M.P.P.
Eric E. Whitaker, M.D., M.P.H.
Cook County Hospital, Chicago, IL 60612
ejacobs@rush.edu