The Healthy Male. issue 59. Is this the end for Andrology Australia? CONTENTS. Winter Is this the end for Andrology Australia?

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1 The Healthy Male NEWSLETTER OF ANDROLOGY AUSTRALIA Australian Centre of Excellence in Male Reproductive Health Winter 2016 issue 59 CONTENTS 1 Is this the end for Andrology Australia? 2 From the Director 2 Inbox 2 Health spot Looking after your sperm 3 Focus on Checking for lumps in the testes: could it be testicular cancer? 5 Professional education GPs can get free education on caring for young men (and an orchidometer) 5 Research round-up How readable is online health information? 6 In brief 6 Latest News Supporting young men s health in Australia Is this the end for Andrology Australia? After 16 years (and 59 editions of The Healthy Male) as the only national body providing evidenced-based information, best practice support and education, and policy advice in the area of male reproductive health and associated conditions, the Federal Government has withdrawn ongoing funding for the program. This government decision will affect not only the staff and affiliates of Andrology Australia but all of our readers and the much wider network of Australian men and their families, and health professionals, who all benefit from our resources. We have always believed it is vital to provide information that is free of commercial influence and readily available to the whole community. The loss of Andrology Australia means there will be no independent body working to ensure that clinicians and consumers get the necessary information to support this important area of men s health. We are now lobbying the government to reverse this decision for the sake of the health of Australian men. As a valued reader of The Healthy Male, we ask for your support. Could you (and your friends and family) please sign and return the petition enclosed here. This petition will be presented to the Federal Government House of Representatives. In order to communicate with you in the future, we would like to be able to contact you via . So, if you receive this newsletter in hard-copy only, could you please complete the tear-off section on the back page with your preferred contact and return in the enclosed envelope (with the signed petition), so we can keep you informed of the campaign s progress. If we are unable to obtain sufficient support we will try to maintain some of our core activities until we are able to seek refunding after the election. See our campaign page on the website ( to follow our progress.

2 From the Director The devastating news about the withdrawal of government funding for Andrology Australia is front and centre of our focus in this issue of The Healthy Male, although you will also find our regular features, with the Focus On featuring testicular cancer, the young men s cancer. The funding announcement may lead to Andrology Australia closing its doors in the coming months. For the past 16 years, Andrology Australia has been the main and sometimes only voice raising awareness of male reproductive health disorders and their associations with chronic disease. As readers well know, there are many websites and commercial clinics who misdirect and even exploit men. Andrology Australia has always been a trusted source of independent advice at no cost to consumers and its loss will be felt across the country. The news about funding was in stark contrast with the very successful Andrology Australia Young Men s Health Stakeholder Forum held in Canberra in March (see the Latest News on the back page). Bringing together key organisations with an interest in young men s health, the Forum started the process of finding effective ways to engage young men with the primary health system to ensure they are set for a healthy life. All those attending the Forum agreed this is an important and often neglected area of health and we all hoped to be able to take this initiative to the next stage. To take men s health into the future we need some consistency and commitment from governments. We ask for your help in our campaign to save Andrology Australia from closing its doors; the front page article outlines the ways that you can help, including signing the enclosed petition. We look forward to putting men s health on the agenda for the upcoming election campaign so please help us make our voices heard. Professor Rob McLachlan Inbox Health spot Looking after your sperm 5 April 2016 Dear Editor As a former tobacco policy officer, I was extremely pleased to see the current feature on smoking and fertility in The Healthy Male. Lots of little-known and little-appreciated information that should be of interest to many men (and women). I have posted a link to the newsletter to the Facebook group, Global Tobacco Network (the world-wide group of tobacco control advocates). Best regards, M.S. Men don t often think about fertility or the health of their sperm until it comes time to start a family. For the best chance of a healthy pregnancy it s important to make large numbers of sperm that are good swimmers and able to fertilise an egg. The genetic information (DNA) in the sperm also needs to be in good condition. Testes are important for fertility because this is where sperm and the male sex hormone testosterone are made. Whether young or old, with a current partner or not, you should be looking to protect your fertility and there are some things you can do. Your chances of fathering a child may be better if you pay attention to your overall health: watching your weight, having a healthy diet, exercising regularly, not smoking and drinking alcohol in moderation is the key to healthy sperm. Some factors that may affect sperm and fertility include: sexually transmitted infections (STIs) such as chlamydia, infections of the prostate or testes, the mumps virus in adults (it s important for young boys to be vaccinated), too much heat around the testes, certain medicines and drugs, some cancer treatments, older age, some work environments (make sure you wear protective clothing), injuries to the testes, having very small testes (may indicate conditions associated with infertility), and a twisted testis (severe pain will let you know when there is a twisted testis). If you think you may have an STI or other infection, or you have any injury to your testis, it s important to check it out with your doctor. For more information see: your-sperm-health/

3 Focus on: Checking for lumps in th testicular cancer? Although relatively rare overall (about 700 cases per year in Australia), testicular cancer is the second most common cancer in young men (aged years). Testicular cancer has a very good cure rate (over 95%) so it is a good idea for young men to check their testes regularly for any lumps or swellings to help find any problems early. It should be remembered that often a lump in the testes or scrotum is not cancer but a less serious problem that is easily treated. If concerned, a man should see his doctor straight away. What is testicular cancer? Testicular cancer starts as an abnormal growth or tumour in a testis. A cancer will usually appear as a painless lump in a testis. If a man sees a doctor as soon as a lump, swelling or pain in a testis is noticed, the cancer can remain localised (remain within the testis). However, if not treated, the cancer typically spreads to other parts of the body via the blood or lymphatic system. What are the risk factors for testicular cancer? Apart from testicular cancer affecting mainly younger men, those with a history of undescended testes are at higher risk. it is important for families to share details of medical history with boys so they know the importance of regularly checking their testes. Other risk factors include a personal or family history of testicular cancer, previous infertility and Down syndrome. Can I do anything to prevent testicular cancer? As the causes of testicular cancer are unknown, there are no known ways to prevent it. There is no evidence that injury or sporting strains, life-style (for example smoking or diet), or sexual activity are linked with testicular cancer. However, an injury to the groin area may prompt a man to notice a problem with the testes. What are the symptoms of testicular cancer? A hard, painless lump in either testis is the usual symptom of testicular cancer. In about 1 in 10 cases, the lump is painful or tender. In a few men, constant backache, coughing or breathlessness, and enlarged or tender nipples may mean that the cancer has spread. A man with any of these symptoms should see a doctor straight away; however, there may be many other reasons for these symptoms. When should I see a doctor if I have a lump in my testis? If you notice a hard lump or any change in your testes, see your local doctor straight away. You may be referred to a urologist. How is testicular cancer diagnosed? To determine whether a lump in the testis is cancer a doctor will take a detailed medical history, do a physical examination and an ultrasound scan of the testes, and may request blood tests and other scans. Many lumps are found to be fluid-filled cysts within the scrotum and are not cancer. The chest and abdomen will also be checked in case the cancer has spread to other parts of the body. How is testicular cancer treated? The treatment options for testicular cancer depend on the type and stage of cancer. An orchidectomy (surgical removal of the affected testis) is the first stage of treatment for all suspected cases of testicular cancer. The removed testis is then sent to a pathology laboratory to confirm the stage and type of cancer. In recent years, surveillance (careful monitoring) has become a more popular option after orchidectomy for localised testicular cancer. This is where the man is checked regularly to assess whether the cancer has moved elsewhere in the body, including the other testis. Chemotherapy or radiotherapy may be given after surgery to kill off any cancer cells that may have spread to other parts of the body. The level or amount of chemotherapy and radiotherapy will be different for each man and will depend on the stage and type of cancer. The doctor will look at each case individually to assess the chance of the cancer moving from the testes before deciding on the best treatment.

4 e testes: could it be What follow up is needed after testicular cancer treatment? Follow-up and ongoing health checks by qualified health professionals are important after surgery, radiotherapy and chemotherapy, to make sure that the cancer has not returned. Check-ups may include physical examination, blood tests, X-rays and scans, and continue for at least ten years after treatment. Does testicular cancer treatment affect sexual function? Many men find that testicular cancer and its treatment do not affect their sexual performance in any way. However, the stress and anxiety of cancer can affect sexual function. Concerns about changes in body image may also cause sexual problems and anxiety. Can testicular cancer cause infertility? Cancer in a single testis may not affect the chance of having children. After a cancerous testis is removed, in many men the remaining testis continues to make testosterone and sperm. However, some men who have had testicular cancer may have trouble having children. Men who are diagnosed with testicular cancer are more likely to have lower fertility before any treatment starts. Fertility can be further affected by cancer treatments such as radiotherapy and chemotherapy. Why is sperm storage important? All men who are going to have chemotherapy or radiotherapy should speak to their doctors about their fertility before treatment begins. It is highly recommended that men produce semen samples (through masturbation) for sperm storage (also known as sperm banking). Sperm storage should take place before chemotherapy or radiotherapy starts. Semen can be frozen, using special equipment, and stored long-term for future use. If a man wants to father a child at a later stage, the frozen semen is thawed and used in fertility treatments such as IVF (in vitro fertilisation). Modern IVF treatments can be successful with just a few moving sperm. Testicular Self-Examination (TSE) A testicular self-examination (TSE) is a quick and simple process, which may be easier after a warm bath or shower when the skin of the scrotum is relaxed. A testicular self-examination involves feeling the testes, one at a time, using the fingers and thumb, and should only take a few minutes. How is testicular self-examination done? Using the palm of your hand, support your scrotum. Gently roll one testis between thumb and fingers to feel for any lumps or swellings in or on the surface of the testis. Repeat with the other testis. The testes should feel firm and the surface should feel smooth. Using the thumb and fingers, feel along the epididymis at the back of the testis. The epididymis is a soft, highly coiled tube that carries sperm from the testis to the vas deferens. Check for any swelling in this area. It is normal for one testis to be slightly bigger than the other and the left testis often hangs lower than the right. If there is any change to how the testes feel normally, see your local doctor straight away. Even if you have had testicular cancer, or are being treated, it is important to still perform a testicular self-examination. About one in 25 men who have had testicular cancer may develop cancer in the other testis. Andrology Australia acknowledges Dr Gideon Blecher and A/Prof Peter Royce as expert reviewers for our testicular cancer information. See

5 Professional education GPs can get free education on caring for young men (and an orchidometer) A NDROLOGY AUSTRALIA provides a free Active Learning Module (ALM) Reproductive health disorders in young adult males (Younger men s health), accredited for 40 RACGP Category 1 QI&CPD and 30 ACRRM PRPD points. Individual cases can also be done for 3 RACGP Category 2 QI&CPD and 2 ACRRM Core points each. Benefits of completing the ALM GPs who complete all case studies in one ALM will receive a complimentary Andrology Australia orchidometer (a medical device for qualified health professionals to measure testis size in the clinical setting). 40 Cat 1 or 30 PRPD points The Younger Men s Health ALM aims to provide knowledge, skills and communication strategies to assist GPs to confidently engage young men in discussions about sexual and reproductive health, involve partners (if applicable) in management, and routinely undertake genital examinations as part of the assessment of a young man s health. GPs will be more alert to the facts that some male reproductive health disorders are under-diagnosed and most can be managed in the primary health care setting. They will also gain knowledge, skills and communication strategies to diagnose and treat a range of reproductive health disorders affecting young adult men. The four case studies cover the following topics: male infertility, testicular cancer, Klinefelter s syndrome, premature ejaculation and prostatitis. All courses are available for any health professionals as self-directed learning. Find this and other accredited courses for GPs here: org/health-professionals/gps/ Research round-up How readable is online health information? T HE USE of the internet to find health information has increased greatly over recent years and it is now common for people to use the internet even before seeing a doctor. Although internet searching can be simple and convenient, the health information may be written in language that many people find hard to understand. Surveys showing that 44% of Australians have low health literacy suggest that health information needs to be written in simple language if it is to be understood by the average person. A recent Australian study1 has assessed the readability (defined as how well a passage of text can be read and understood ) of 251 webpages with information on 12 common health conditions. Standard readability measures were used and compared to a Year 8 level of reading ability (13-16 years old), as an average reading level in Australia. 1. C. Cheng & M. Dunn. Health literacy and the Internet: a study on the readability of Australian online health information. ANZ J Public Health 2016; Online; doi: / Fewer than 1 in 100 (1%) of webpages were considered readable using the Year 8 standard. From the webpages included in the study, information on dementia was hardest to read and obesity information the most difficult from government websites. The study is a call to those writing health information for the internet to be much more aware of the likely reading ability of the audience. For those using the internet, it may take some searching before they find information that they can understand and will be helpful to them.

6 In brief Dr Mark Wenitong Chair of Andrology Australia s Aboriginal and Torres Strait Islander Male Health Reference Group, Dr Mark Wenitong, was the subject of a recent Australian Story episode on ABC TV. Not only is Mark a wonderful doctor, we were delighted to learn he is also an accomplished musician (as are his children). See: austory/content/2015/s htm to watch the episode online. Latest News Supporting young men s health in Australia Social Media Don t forget to follow us on Twitter (@AndrologyAust) and Facebook (AndrologyAustralia) to help with our funding campaign. To Donate Please visit NEWSLETTER OF ANDROLOGY AUSTRALIA Australian Centre of Excellence in Male Reproductive Health The Andrology Australia project is supported by funding from the Australian Government under the Health System Capacity Development fund, and is administered by Monash University. Andrology Australia School of Public Health and Preventive Medicine PO Box 315, Prahran, Victoria, Australia, info@andrologyaustralia.org Telephone: Web: T HE ANDROLOGY Australia Young Men s Health Stakeholder Forum 2016 held in Canberra on 3rd to 4th March provided an opportunity to explore contemporary issues affecting the health and wellbeing of young men in Australia. We were very pleased that the Hon Ken Wyatt AM, Assistant Minister for Health and Aged Care, took time out from his busy schedule to open the Forum, with a personal reflection on growing up in Australia and the importance of men looking after their physical and mental health. Lively discussion followed with an extensive program covering a range of issues facing young men, including sexual and reproductive health, mental health, communication with health professionals, and connection to health information, in particular via social media. Presentations on these pertinent topics were given by a diverse range of experts from peak bodies, the health professions and government. The program also provided the opportunity to discuss specific issues facing young men from Indigenous and culturally and linguistically diverse (CALD) communities. The Forum provided a platform to discuss the possibility of a young man s health check in the primary health care setting to detect unrecognised illness. The importance of educating young men to prepare for their future health was a key focal point of discussion. Andrology Australia thanks all the speakers and participants who made the Forum a success. To maintain the great momentum built through this collaborative effort, we are hopeful we can continue this important work. Facebook: AndrologyAustralia DISCLAIMER: This newsletter is provided as an information service. Information contained in this newsletter is based on current medical evidence but should not take the place of proper medical advice from a qualified health professional. The services of a qualified medical practitioner should be sought before applying the information to particular circumstances. Please complete the section below with your details to receive future issues of the Healthy Male and/or correspondence about our campaign to continue the work of Andrology Australia (tick all or some of the boxes below). Tear/cut around the dashed lines and place in the enclosed reply-paid envelope along with the signed petition. Name: address: I would like to be kept informed of Andrology Australia s funding campaign I would like to receive future editions of The Healthy Male by only I would like to receive future editions of The Healthy Male by and in the post (if funds available for postage)