Men's Health: When It's Good Medicine to Do Nothing

Q: What side effects should I look for when taking drugs for erectile dysfunction (ED)? And how do I know my ED isn't a sign of a more significant problem like diabetes or heart disease?
-- Jim, Syracuse, NY

A: The major side effect of these drugs -- mainly Viagra, Cialis, and Levitra -- is that 100 people die each year while taking them . . . and that is a major side effect. Yet this happens almost exclusively in people with cardiac disease.

Unfortunately, many cases of nonperformance involve guys who are part of this group: men with arterial disease who have risk factors such as high blood pressure, chest pain, diabetes, high LDL or low HDL cholesterol counts, or high inflammation numbers, which are indicated by either a waist size larger than 40 inches or a test called high-sensitivity C-reactive protein (hs-CRP). If you are in this category, get thee to a cardiologist, tell him (most guys with this problem choose a male doctor) what you want, and get his take on it.

If you do get a prescription, remember not to use these pills with nitroglycerin. If you get chest pain after using one of these, take an aspirin with water, and get to an ED – that stands for emergency department, not erectile dysfunction -- fast. Have your partner drive you. IMMEDIATELY.

Q: Both my doctor and the urologist he sent me to told me I have benign prostatic hypertrophy (BPH), but they are not recommending surgery or medicine, just "watchful waiting." What does this mean? What will likely happen?
-- Michael, Chicago, IL

A: Watchful waiting means you and your doctor watch how you do -- and do not use any pills or surgical instruments right away. That's a good thing, in our view; it means you're running no risks from any treatments. About 30% of men with BPH have symptoms (you feel like you've gotta go right now, often two or three times in the middle of the night) that do not progress. But 35% get better without treatment, and 35% get symptoms that are so bothersome that they elect treatment. Keep in touch with your doc with a yearly or twice-yearly visit. That way, you won't suffer side effects of delaying treatment, even if you're among the 35% that wind up getting treated.

While you are watching and waiting, take a shine to avocados. A compound in the avocado -- beta sitosterol -- is reputed to decrease the size of prostate cells without side effects. Even if it doesn't turn out to do that, you've enjoyed a fruit rich in healthy omega-3 fats, and those omega-3s are good for your eyes, heart, and memory.

Q: My dad has a full head of hair, but I'm starting to lose mine, and I'm not even 30 yet. If he's not bald, how can I be headed there? And can I bring my hair back?
-- Tim, Louisville KY

A: Along with your stunning blue eyes and a fondness for broccoli rabe, you may have inherited a genetic predisposition for male pattern hair loss from your mom, not your dad. Either or both parents could have passed on this gene to you. (They were more generous than you knew). While most hair loss is genetic (sorry), your diet (too little iron) or your meds (including some cholesterol reducers and some hypertension drugs) could also be causing the exodus.

If you can't blame anything but your genes, don't start Googling "hair transplants" or "hottest bald guys in history" just yet. When applied to your scalp, minoxidil (Rogaine) inhibits the enzyme that starts the chain reaction of shrinking hair follicles and thinning hair. You can also inhibit that enzyme with finasteride, a prescription pill originally designed to counter an enlarged prostate. (Another prostate drug, dutasteride, has also had some success.) Both approaches -- potion and pill -- can have side effects that range from scalp dryness to decreased libido.

What about the LaserComb, a home laser that supposedly makes hair stay put? There's not enough evidence to know whether it works, and until more research is in, we think there are better things to do with the $545 it costs. A round of golf and a healthy life can make you look better than a few extra strands of hair will.