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Summary
On episode 335 of 40+ Fitness, Coach Allan sits down with Dr. Neil Baum, a professor of clinical urology at Tulane Medical School and the author of more than 250 peer-reviewed urology articles, to discuss his book How’s It Hanging: Expert Answers to the Questions Men Don’t Always Ask.
Neil’s central point is that men wait for symptoms before acting on their health, and both prostate cancer and testicular cancer produce none in their early, most treatable stages. Low testosterone follows a similar pattern, declining gradually for decades before it becomes noticeable in the mid-50s.
The conversation covers what men should actually ask for in a screening, the risks of taking testosterone without a documented deficiency, and why men die 5 to 7 years earlier than women on average.
Links
- https://www.neilbaum.com
- Episode 609 – Men’s health with Dr. Neil Baum
Key Takeaways
- Early prostate cancer has no symptoms. By the time it affects urination or causes pain, it has often already spread, so Neil recommends annual PSA blood tests and a digital rectal exam starting at 50, or 40 to 45 for African American men or anyone with a father, brother, uncle, or cousin who had it.
- An elevated PSA doesn’t automatically mean cancer. A mild elevation is more often caused by prostate inflammation or normal age-related growth, and what matters most is the trend in PSA over several years, not a single number.
- Testicular cancer, most common between ages 20 and 40, also produces no early symptoms. Neil argues men should be taught monthly self-exams the same way women are taught breast self-exams, since early detection makes it highly treatable.
- Testosterone declines about 1% a year starting around age 25. It usually doesn’t become noticeable until the decline reaches 10 to 15%, typically in the mid-50s, showing up as low libido, weak erections, low energy, and falling asleep after meals.
- Taking testosterone without a documented deficiency can cause permanent harm. Extra testosterone signals the testicles to stop producing their own, and that shrinkage doesn’t reliably reverse, leaving a man dependent on replacement therapy indefinitely.
- Testosterone fuels prostate cancer growth. No man should start testosterone replacement without a clean PSA and prostate exam first, since replacement therapy can accelerate an undetected cancer.
- Men die 5 to 7 years earlier than women on average. Neil attributes much of the gap to men not entering routine healthcare until their 50s, combined with higher rates of smoking, drinking, and other risky behavior.
- Regular wellness visits, not just sick visits, catch problems while they’re still easy to treat. Getting blood work and a checkup multiple times a year, even without symptoms, is the practical way to stay ahead of conditions that give no early warning.
“That early prostate cancer has no, capital N, capital O, no symptoms.”
Dr. Neil Baum