MEN’S HEALTH


recommending this treatment to a patient. However, the ability for this medication to be recommended and sold from within the pharmacy is hopefully the start of a government- backed culture of making it easier for men to take charge of their health.


ERECTILE DYSFUNCTION Erectile dysfuntion (ED), or impotence, is a common condition that affects many men in Scotland, and the rest of the UK. It is a condition that sees a higher prevalence with increasing age, and in Britain is estimated to affect 55% of men between 40 and 70 years of age5


. Like many male health


conditions, it carries a social stigma which can make it much more difficult for men to speak to a professional about their problem, and this problem is made all the more serious when it is considered that impotence can be an indicator for more serious conditions such as diabetes, hypertension or hypercholesterolaemia, in around 90% of patients who suffer from ED5


. As a


result, health professionals, including pharmacists, should strive to make this condition less of a taboo subject, and assure patients that they should seek advice if they have problems either obtaining or maintaining an erection during sexual intercourse.


and be able to reassure their patients accordingly. With respect to Prostatitis, treatments centre around antibiotics such as ciprofloxacin, ofloxacin or trimethoprim, as these agents are able to effectively penetrate the prostatic tissue. In all cases, these treatments are recommended to be used for a duration of 28 days in order to bring about full resolution. The treatment of Prostate Cancer is obviously much more complex and usually involves the use of hormonal treatments, which bring about the reduction of androgen concentrations, and an associated reduction in prostate size. Such medications include buserelin (Suprefact®


), goserelin (Zoladex® )


histerelin (Vantas®) and Lurproelin (Prostap®


), and can be administrated normally via depot injection, implant or intranasal routes. Pharmacists should again be aware of these particular products and be confident when providing information to patients about these treatments and how they are used.


BPH treatment is slightly different to the treatment of prostatitis or prostate cancer, in that it can be managed


19 - SCOTTISH PHARMACIST


within the pharmacy, if this is deemed to be suitable. However, in most cases, this condition will be managed with prescription medications such as dutasteride and finasteride (5-alpha reductase inhibitors) or alpha1


alpha blockers such as alfuzosin, doxazosin, indoramin, and prazosin. All of these medications function to reduce the effect of testosterone on the prostate, reducing its size, and reducing the hindrance of urine flow. In 2009, tamsulosin 400mcg capsules were deregulated from POM to P status by the UK Government (Flomax®


Relief), which allowed


pharmacists to manage BPH entirely within the pharmacy, if it was deemed appropriate. However, the sale of this particular medication is somewhat complicated, and also requires that patients visit their GP within six weeks of starting treatment to assess their condition, and if they are allowed to continue self-treatment, the patient must visit their GP for a review on an annual basis. Pharmacists should be aware of the full detail of how this medication should be used within the community setting, and also factor in issues such as cost before


-selective


When it comes to the treatment of ED, in many cases, this can be brought about via treatment of the underlying condition. However in some cases, pharmacological intervention will be required with commonplace medications such as Viagra® Cialis® or Levitra®


, , which are all


phosphodiasterase type-5 inhibitors, and improve bloodflow to the penis in order to assist with the maintenance of an erection. In all cases, the use of these medications carry a number of associated risks, particularly if the patient has one of more underlying conditions, and as such, pharmacists should offer this information to men


REFERENCES


1 BBC News. Women ‘more likely to report ill health than men’. 2010; Available at: http://news.bbc.co.uk/1/hi/health/8588686.stm. Accessed 05/12, 2015.


2 Prostate Scotland. Prostate Cancer. 2014; Available at: http://www.prostatescotland. org.uk/diseases-of-the-prostate/prostate-cancer.html. Accessed 05/12, 2015.


3 Prostate Scotland. Benign Prostatic Hyperplasia (BPH). 2014; Available at: http://www. prostatescotland.org.uk/diseases-of-the-prostate/benign-prostatic-hyperplasia.html. Accessed 05/12, 2015.


4 Prostate Scotland. Diseases of the Prostate. 2014; Available at: http://www. prostatescotland.org.uk/diseases-of-the-prostate.html. Accessed 05/12, 2015.


5 British Association of Urological Surgeons. Erectile dysfunction (impotence). 2014; Available at: http://www.baus.org.uk/patients/symptoms/impotence. Accessed 05/12, 2015.


who receive these medications on prescription, whilst being as discreet as possible.


In addition to the use of drug treatments, ED can be alleviated by a number of lifestyle changes, which pharmacists should make their patients aware of. For example, reduction in stress, cessation of smoking, alcohol and illicit drugs, loss of weight and increasing exercise can all assist with the improvement of this condition. Moreover, pharmacists should also be aware of concomitant medications which can lead to sexual dysfunction as a side effect, and work together with the patient and prescriber to find a suitable alternative to the causative treatment if this is possible.


IT’S A MAN’S WORLD?


In addition to those mentioned above, there are many conditions which men struggle to seek advice about, which pharmacists can assist with. These include the diagnosis and treatment of sexually transmitted infections, and other non-“genital” conditions which affect men significantly, such as depression, vascular disease and obesity. It is necessary that the discussion about these conditions becomes more open, commonplace, and less taboo, and pharmacists are the ideal professionals who can facilitate this step change towards a better future. We should ensure that we take every step possible to promote better use of health services to men, and ensure that we can make it as easy as possible for men to access these resources. In addition, pharmacists should make full use of the treatments that they can provide to patients when appropriate. This can have the dual purpose of significantly improving men’s health, whilst also improving their faith and confidence in the profession of pharmacy. •


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