Men's Health

A PSA test is a blood test to help check for prostate conditions such as prostate cancer or an enlarged prostate. 

The prostate is a small, walnut-size gland under the bladder and behind the penis. It produces a thick fluid that mixes with sperm to make semen. 

Why a PSA test is done

A PSA test checks the level of prostate specific antigen (PSA) in your blood. High levels may be a sign of a prostate condition. 

Testing may be recommended if you have symptoms that could indicate prostate cancer, such as: 

• peeing more than usual, having a sudden urge to pee or getting up often in the night to pee. 
• blood in your pee
• problems getting or keeping an erection 

If your symptoms are caused by cancer, finding it early may mean it's easier to treat. 

Risks and benefits of a PSA test 

There is a risk that a PSA test result may not be accurate, and you may be offered tests and treatment you do not need. 

You can discuss the benefits and risks of a PSA test with a GP. 

Find out more about the PSA blood test on the Prostate Cancer UK website

How to get a PSA test 

Routine PSA testing is not offered on the NHS. 

If you suspect that you have any of the above symptoms or have a family history of prostate cancer. Please contact the practice to arrange an appointment with a GP. 

If you're having treatment for a prostate condition you may be offered regular PSA tests to check how the treatment is working. 

Men aged 50 or over can ask their GP for a PSA test, even if they do not have symptoms. Anyone aged 50 or over with a prostate can ask for a PSA test. 

Preparing for a PSA test 

For 48 hours before your PSA test, do not:

• Have anal sex 
• ejaculate (come)
• do anything that leaves you out of breath, such as exercise. 

These can increase your PSA levels which could make the test less accurate. 

You can eat and drink as usual before having a PSA test. 

Having a PSA test 

A PSA test is usually done at your local hospital or GP surgery, by a nurse or other healthcare professional. 

PSA levels are checked with a blood test. 

You may also have some other tests including: 

• urine test
• a health professional feeling your prostate by putting a finger into your bottom (rectal examination). 

Erectile dysfunction (ED), also known as impotence, is the inability to get and maintain an erection. 

Erectile dysfunction is a very common condition, particularly in older men. It is estimated that half of all men between the ages of 40 and 70 will have it to some degree. 

When to see your GP 

See your GP if you have erectile dysfunction for more than a few weeks. They will assess your general state of health because the condition can be the first sign of more serious health conditions, such as heart disease. 

Why does erectile dysfunction happen? 

Erectile dysfunction can have a range of causes, both physical and psychological. Physical causes include: 

• narrowing of the blood vessels going into the penis - commonly associated with high blood pressure, high cholesterol or diabetes
• hormonal problems 
• surgery or injury

Psychological causes of ED include: 

• anxiety 
• depression 
• relationship problems 

Sometimes erectile dysfunction only occurs in certain situations. For example, you may be able to get an erection during masturbation, or you may find that you sometimes wake up with an erection but you are unable to get an erection with your sexual partner. 

If this is the case, it is likely the underlying cause of erectile dysfuncation is psychological. If you are unable to get an erection under any circumstances, it is likely that the underlying cause is physical. 

Erectile dysfunction can also be a side-effect of using certain medicines. 

Tight foreskin (phimosis) 

It is normal for babies and young boys to have a tight foreskin, but adults can also be affected. See a GP if your or your child's foreskin is sore or swollen. 

Symptoms of phimosis

The foreskin is the thin layer of skin that covers the end of the penis. If you or your child has a tight foreskin, it will be difficult to pull it back from the end of the penis. 

Phimosis is normal in babies and young boys. Most boys' foreskins do not pull back (retract) before the age of 5, but sometimes it's not possible until they're 10 or older. 

The end of a boy's penis may bulge or balloon when they pee, particularly if their forekin is tight. 

A tight foreskin is not usually a problem, unless there are symptoms such as: 

• swelling and tenderness 
• pain when peeing or a weak flow of pee 
• blood in urine 
• frequent urinary tract infections 
• bleeding or a thick discharge from under the foreskin or an unpleasant smell - these are signs of an infection (balanitis) 
• painful erections, which can make having sex difficult 

Things you can do if you have a tight foreskin 

If you or your child's foreskin is tight, but it is not causing problems like pain or bleeding, there are some things you can do to help ease it and keep the penis clean.

Do: 

• wash your penis regularly - use warm water or warm water and non-perfumed soap 
• gently pull back your foreskin as far as you can, so you can clean underneath it (adults only) 

Dont: 

• do not pull back the foreskin of a baby or young boy because it could be painful and damage it, leading to problems in later life.
• do not use perfumed soap, talcum powder or deodorants on your penis because they may cause irritation. 

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See a GP if: 

• you or your child's foreskin is tight and swollen or painful 
• there is bleeding around yours or your child's foreskin when peeing, a thick discharge from under the foreskin, or an unpleasant smell

Some men develop depression, loss of sex drive, erectile dysfunction, and other physical and emotional symptoms when they reach their late 40s to early 50s. 

Other symptoms common in men this age are: 

• mood swings and irritability 
• loss of muscle mass and reduced ability to exercise 
• fat redistribution, such as developing a large belly or "man boobs" (gynaecomastia) 
• a general lack of enthusiam or energy
• difficulty sleeping (insomnia) or increased tiredness 
• poor concentration and short-term memory 

These symptoms can interfere with everyday life and happiness, so it's important to find the underlying cause and work out what can be done to resolve it. 

Is there such a thing as a "male menopause"? 

The "male menopause" (sometimes called the andropause) is an unhelpful term sometimes used in the media. 

This label is misleading because it suggests the symptoms are the result of a sudden drop in testosterone in middle age, similar to what occurs in the female menopause. This is not true. 

Although testosterone levels fall as men age, the decline is steady at about 1% a year from around the age of 30 to 40, and this is unlikely to cause any problems in itself. 

A testosterone deficiency that develops later in life, also known as late-onset hypogonadism, can sometimes be responsible for these symptoms, but in many cases the symptoms are nothing to do with hormones. 

Personal or lifestyle issues 

Lifestyle factors or psychological problems can also be responsible for many of these symptoms. 

For example, erectile dysfunction, low sex drive and mood swings may be the result of: 

• stress 
• depression
• anxiety

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There are also physical causes of erectile dysfunction, such as smoking or heart problems, which may happen alongside any psychological cause. 

Psychological problems are typically brought on by work or relationship issues, money problems or worrying about ageing parents. 

A "midlife crisis" can also be responsible. This can happen when men think they have reached life's halfway stage. 

Anxieties over what they have accomplished so far, either in their job or personal life, can lead to a period of depression. 

Other possible causes of the "male menopause" include: 

• lack of sleep
• a poor diet
• lack of exercise 
• drinking too much alcohol
• smoking 
• low self-esteem 

Late-onset hypogonadism 

In some cases, where lifestyle or psychological problems do not seem to be responsible, the symptoms of the "male menopause" may be the result of hypogonadism, where the testes produce few or no hormones. 

Hypogonadism is sometimes present from birth, which can cause symptoms likie delayed puberty and small testes. 

Hypogonadism can also occasionally develop later in life, particularly in men who are obese or have type 2 diabetes. 

This is known as late-onset hypogonadism and can cause the "male menopause" symptoms. 

But this is an uncommon and specific medical condition that's not a normal part of ageing. 

A diagnosis of late-onset hypogonadism can usually be made based on your symptoms and the results of blood tests used to measure your testosterone levels. 

What to do 

If you're experiencing any of these symptoms, see your GP. They'll ask about your work and personal life to see if your symptoms may be caused by a mental health issues, such as stress or anxiety. 

If stress or anxiety are affecting you, you may benefit from medication or a talking therapy, such as cognitive behavioural therapy (CBT). 

Exercise and relaxation can also help. 

Do I need hormone replacement therapy (HRT)? 

Your GP may also order a blood test to measure your testosterone levels. 

If your results suggest you have a testosterone deficiency, you may be referred to an endocrinologist, a specialist in hormone problems. 

If the specialist confirms this diagnosis, you may be offered testosterone replacement to correct the hormone deficiency, which should should relieve your symptoms. 

This treatment may be given as an injection or a gel. 

Anyone can experience mental health difficulties, but fear of judgement or discrimination may prevent people from opening up and seeking the support they need. This stigma tends to affect men disproportionately, and societal expectations and traditional gender roles are thought to play a big part in this. 

• three times as many men as woman die by suicide 
• Men aged 40 to 49 have the highest suicide rates in the UK 
• Men report lower levels of life satisfaction than women, according to the government's national well-being survey
• Men are less likely to access psychological therapies than women: only 36% of referrals to NHS talking therapies are for men 

Men are often expected to be the breadwinners and to be strong, dominant and in control. While these aren't inherently bad things, they can make it harder for men to reach out for help and open up. 

Mental health difficulties can be brought on by a range of different situations or experiences. The mind report includes information on three factors which men have reported as having an impact on their mental health: 

• work and unemployment 
• physical appearance 
• social media 

Whilst there is research to suggest that men are becoming more willing to seek help for their mental health, it is likely that traditional masculine values, stigma and not knowing where to go for support still play important roles in why men are less likely than women to seek help from the NHS for a mental health problem. 

If you or someone you know are struggling with their mental health, please get in touch with a member of the admin staff to book an appointment with your GP. You can also refer yourself to the NHS talking therapies by clicking here