Men’s Health 101

In plain words

On the outside are the penis and the scrotum. The penis has a shaft and a rounded, very sensitive tip called the glans. In men who haven’t been circumcised, a fold of skin called the foreskin covers the glans and slides back. The opening at the tip is the end of the urethra, the tube that carries both urine and semen out of the body, though never at the same time.

The scrotum is the pouch of skin behind the penis. It holds the two testes, also called testicles. The skin between the scrotum and the anus is the perineum.

The testes make sperm and testosterone. Along the back of each one is a coiled tube called the epididymis, where sperm finish developing and are stored. It’s the part men most often mistake for a lump.

From there, a longer tube called the vas deferens carries sperm up into the body and over the bladder. It joins the duct of a small gland called a seminal vesicle, and together they empty into the urethra inside the prostate. The prostate is a walnut-sized gland just below the bladder, wrapped around the urethra.

Choose a part on the map below to see what it is and what it does.

In plain words

Put together, the parts make one route. Sperm are made in the testes, finish developing in the epididymis and travel up the vas deferens. Fluid from the seminal vesicles and the prostate joins them, and they leave through the urethra.

Most of semen isn’t sperm. Around 70% of it comes from the seminal vesicles, including a sugar that gives sperm their energy.

That’s also why a vasectomy works. Cutting or sealing the vas deferens stops sperm joining the fluid, while the testes, the hormones and the rest of the route carry on as before.

In plain words

All of this runs without you thinking about it, and the instructions come from the brain. A small area called the hypothalamus sends out a hormone called GnRH in pulses, every one to three hours. GnRH tells the pituitary gland, just below it, to send two hormones through the blood to the testes. They’re called LH and FSH.

LH tells the testes to make testosterone. FSH, together with testosterone, keeps sperm production going. Testosterone also drives the changes of puberty, supports sex drive, and affects muscle, bone and mood.

The testes answer back. As testosterone rises, the brain eases off. A hormone from the testes called inhibin B does the same for FSH. Estrogen isn’t only a female hormone. Men also turn a little testosterone into estrogen, and research suggests that’s one of the main signals telling the brain to slow testosterone production down. Together it works a bit like a thermostat, keeping levels within a range.

Sperm are made all the time from puberty on, millions a day, and each one takes roughly two to two and a half months. So anything that affects sperm can take weeks to show up in a semen test, and improvements take a couple of months to show too. If you’ve made a change, give it time!

In plain words

Size is one of the most common private worries. Researchers pooled studies in which health professionals measured more than 15,000 men the same way. On average, the penis was about 9 centimeters (3.6 inches) long when soft and about 13 centimeters (5.2 inches) when erect. Most men were close to the average. Height had the strongest link the researchers found, and even that was loose.

These figures are more reliable than most, because professionals did the measuring, and men who came forward worried about their size were left out. The main limit is that fewer than 700 of the men were measured erect, and few of those in a clinic.

Try the chart below to see where a length falls.

In plain words

Testosterone does fall with age, but slowly, by about 1.6% a year from middle age in one large study. Men in good health had higher levels than men in poorer health, so some of the drop is about health, not age alone.

One low result on a blood test isn’t a diagnosis. A true deficiency means low testosterone together with sexual symptoms, and in a large study of men aged 40 to 79, only about 2 in 100 had both. Levels change through the day, so the test is usually done in the morning and repeated before anything is decided.

If a true deficiency is confirmed, treatment can help. In the largest safety trial so far, in men aged 45 to 80 with a raised risk of heart disease, testosterone didn’t lead to more heart attacks or strokes over about three years. An irregular heartbeat called atrial fibrillation, sudden kidney problems, blood clots in the lungs and broken bones were more common, though, and the trial was partly funded by a company that makes testosterone gel. It’s a treatment for a diagnosis, not a pick-me-up.

Erections during sleep are usually a good sign. They happen on their own several times a night, closely linked to the dreaming stage of sleep called REM, and the morning erection is just the last one. If you still get them, the physical side is usually working, and trouble at other times may point to stress, anxiety or tiredness. It doesn’t rule out a physical cause, though, so if the difficulties keep happening, they’re still worth raising with a doctor.

If you have a semen test, your results are compared with men whose partners got pregnant within a year. The World Health Organization’s manual puts the lower end at about 1.4 milliliters of semen and about 16 million sperm per milliliter. Falling below those numbers doesn’t mean a man is infertile.

The prostate often grows with age. That’s extremely common, and it isn’t cancer. Because the prostate wraps around the urethra, a bigger one can change how you pee. You might need to go more often, especially at night, or notice a weaker or stop-start flow, or trouble getting started. Those changes are worth mentioning to a doctor, both because they can be treated and because they should be checked rather than assumed.

Men have breast tissue too, and it can grow when the balance between estrogen and testosterone shifts. This is called gynecomastia. It’s very common in puberty, where it usually settles within about three years, and common again after 60. Extra weight, heavy drinking, some medicines, and thyroid, liver or kidney problems can all play a part. So can anabolic steroids, which are synthetic versions of testosterone taken to build muscle, and are different from the steroid creams and inhalers used in medicine.

It’s usually harmless. Still, a few signs deserve a check rather than a wait: a firm lump that doesn’t move, dimpled skin, a nipple turning inward, discharge or bleeding, or a lump under the arm. Breast cancer in men is rare, but those are the signs that need looking at.

Sexual function changes with age, and most of those changes are ordinary rather than alarming. Erections take longer to arrive and need more direct touch. That’s a normal part of getting older, and it doesn’t mean you’ve lost interest. Erection problems get more common too. In one large study of men aged 40 to 79, about 3 in 10 had them, and only about 4 in 10 of those men said it worried them. In a stopwatch study across five countries, the typical time to finish during sex went from about six and a half minutes at 18 to 30 to about four and a quarter minutes after 51.

In plain words

Maybe it happened once, and now you find yourself watching for it to happen again. An erection depends on nerves, blood flow and hormones, and also on your mind. Worry about sexual performance affects somewhere between about 1 in 10 and 1 in 4 men. It can cause erection problems or finishing too soon, and then keep them going, because the more you watch yourself for signs of failure, the harder it is for your body to respond. Talking therapies such as cognitive behavioral therapy (CBT), along with mindfulness, are recommended for this, though few trials have tested them for it directly.

Erection problems are more common than most men think, and not only in older men. In one clinic, a quarter of the men newly diagnosed with them were 40 or younger.

When you’re low, sex can become one more thing that feels hard, and when sex keeps going badly, it’s easy to feel low. Depression and erection problems often go together, in both directions. Men with erection problems are almost three times as likely to be depressed. So if you’re dealing with one, it’s worth mentioning the other to your doctor too.

Erection problems can also be an early sign of trouble in the blood vessels. In a large study of men aged 55 and over, those who developed them were more likely to have a heart attack, stroke or other heart and blood vessel problem in the years that followed. That isn’t a reason to panic about one difficult night. Ongoing erection problems are worth mentioning to a doctor, rather than simply living with them. It can feel awkward to bring up, but it lets your doctor check your heart and blood vessels too.

They’re also very treatable. Tablets such as sildenafil or tadalafil help many men, but taken with heart medicines called nitrates they can make blood pressure drop dangerously, so get them through a doctor or pharmacist rather than an unregulated website.

How you live matters, sometimes quickly. In a small study, a week of five-hour nights lowered young men’s daytime testosterone noticeably. Losing weight raises testosterone. Build up to about 160 minutes a week of moderate to vigorous aerobic exercise, which trials suggest helps, over six months, when erection problems come from inactivity, weight, blood pressure or heart disease. Smokers are about one and a half times as likely as non-smokers to have erection problems. Alcohol is less clear than the folklore suggests. A heavy night of drinking gets in the way at the time, but a review of population studies found no consistent link with regular drinking.

Medicines can play a part too. If your desire has dropped or erections have become harder since you started a new medicine, look at the medicine cabinet before putting it down to stress or the relationship. Antidepressants are one of the most common causes, and finasteride, taken for hair loss, raises the risk of sexual side effects.

Beta blockers, a common heart and blood pressure medicine, have a worse reputation than their record. In one trial where men were all given the same beta blocker, sexual problems were reported by 3% of men who weren’t told which drug they were taking, and by 31% of men told its name and its sexual side effects. What you expect can shape what you feel.

None of this is a reason to stop a medicine on your own. Tell whoever prescribed it what you’ve noticed, even if it feels awkward to say. Keep taking it until you’ve talked, because some medicines, including some antidepressants, cause withdrawal symptoms if they’re stopped suddenly. Ask about the options, which are recognized and include reducing the dose gradually, changing the drug or trying something else.

Lots of men carry something around for months, a symptom or a low mood, and keep telling themselves it will pass. Men are less likely than women to see a doctor for a wide range of problems, and they tend to wait longer when they do, including for their mental health. What men learn about being a man plays a part. This is the part of men’s health that a therapy practice sees most often. According to the World Health Organization, more than 720,000 people die by suicide every year, and worldwide, men die at more than twice the rate of women.

Sexual problems get the same silence, for everyone. In a large survey of people aged 40 to 80, fewer than one in five of those with a sexual problem had asked a doctor for help.

In plain words

Checking your own body can feel awkward, or even a little scary. It’s worth doing anyway. Testicular cancer is uncommon overall, but worldwide it’s one of the most common cancers in young men, and one of the most treatable. Where treatment is easy to get, more than 9 in 10 new cases are cured, and most are first noticed by men themselves or their partners.

A testicle should feel smooth and firm. The soft, coiled ridge along the back is the epididymis. It’s supposed to be there, and it’s a common cause of false alarms. You don’t need a strict monthly routine. In the United States, screening guidance doesn’t recommend routine checks for men without symptoms, while the UK’s National Health Service advises checking regularly, around once a month, so you know what’s normal for you. Both come down to knowing your body well enough to notice a change, because a change is what matters. The quick check below shows how.

In plain words

Most sexually transmitted infections cause no symptoms at all, so you usually wouldn’t know if you had one. They’re also very common. The World Health Organization estimates that more than a million curable infections are passed on every day worldwide.

When there are symptoms, they’re usually discharge from the penis, burning when you pee, pain or swelling in a testicle, or sores, lumps or a rash around the genitals or anus. Chlamydia can cause a painful infection in the epididymis, which in rare cases affects fertility. Syphilis deserves special care, because its early sore is painless and heals on its own, and its rash fades without treatment, while the infection stays and can damage organs decades later.

Testing is easier than most men expect. It’s usually a urine sample or a swab, often one you take yourself, and the common bacterial infections are cured with antibiotics.

• Get tested after sex with a new partner without a condom, even if you feel fine.
• If you think you’ve been exposed to HIV, don’t wait: medicine taken within 72 hours can prevent it, so go to a sexual health clinic or an emergency department straight away.
• With no symptoms, some infections take a few weeks to show up on a test, so the clinic may suggest when to test, or to test again later. With symptoms, go sooner.
• Use condoms consistently and correctly. They’re among the most effective protections, although they can’t fully cover infections that cause sores on skin outside the condom.

Prostate cancer is one of the most common cancers in men. It usually grows slowly and often causes no symptoms early on. Autopsy studies of men who died of something else found it in more than half of men over 79, so a great many men die with prostate cancer, not of it.

That’s why screening isn’t simple. The PSA blood test can find cancer early, but a raised result often has another cause, such as an enlarged prostate, and screening also finds cancers that would never have caused harm. In the European screening trial, after 23 years, one prostate cancer death was prevented for every 456 men invited, and 12 extra cancers were diagnosed for every death prevented.

Advice differs by country. European urology guidelines suggest offering well-informed men a choice about testing from 50, or from 45 for men of African descent or with a family history of prostate cancer diagnosed before 60, or from 40 for men who carry a BRCA2 gene change. In the United States, men aged 55 to 69 are advised to decide with their clinician, and screening isn’t recommended for men over 70. The United Kingdom has no general screening program.

Risk rises with age and with a family history, and it’s higher for Black men. In England, about 1 in 4 Black men are diagnosed in their lifetime, compared with about 1 in 8 White men. If you’re Black or have a family history, it’s worth talking to a doctor about PSA testing sooner.