The male population of the United States is increasing and aging at the same time. This trend is oftentimes referred to as the “graying of America.” The most significant contributor to this demographic has been the maturation of the baby boomer generation, typically defined by persons born between 1950 and 1970. Concomitantly, we have made societal improvement in the overall healthcare delivery system (despite the known and oftentimes controversial aspects of the third-party payor system), which further prolongs the average actuarial male life expectancy in this country.

Not only are our social security system, Medicare program, financial systems (estate planning, longterm care, assisted living, etc.), marketing/technological industries adapting and planning for this phenomenon, but so must the urologic workforce. The incidence of genitourinary cancers in the United States will increase over time as will the incidence of male lower urinary tract symptoms, whether prostate and/or bladder related. Erectile dysfunction, and all its associated implications, must be continually addressed, as quality of life parameters and its implications assume paramount importance to not only the targeted male patient population but also to the service providers and the reimbursement systems.

In addition to this partial list of urologic issues confronting the male populace as well as its regular caregivers (urologists and primary care physicians), other male-specific topics of concern are already capturing the attention of the male public, researchers/industry, as well as Madison Avenue.

Most obviously on this list includes the battle to prevent and/or reverse “andropause”, ie, the belief that male aging and decline, inclusive of physical, sexual, and intellectual well being, is strongly correlated to the changing endocrine milieu of the aging male. Currently, there is a dramatic paucity of data, especially any level-one evidence, to support or recommend any known standard of care regimen for the maintenance of male health.

Unfortunately, this does not prevent a multitude of practioners, licensed and not, from recommending and oftentimes prescribing unregulated and unproven supplements, oftentimes anabolic and sometimes entirely unknown agents, with regard to efficacy, content, safety profile, or mechanism of action. The claims are predicated upon anecdotal reports of enhancing sexual performance; improving virility, cognition, libido; enhancing genital size; thwarting and/or reversing hair loss; stabilizing and/or increasing bone density; reversing and/or preventing aging, etc.

The challenge for any busy community based urologist is to continue to stay well educated and up-to-date on all aspects of urologic disease states. Urology must not abdicate its role in understanding the disease state issues which are resonating amongst the US male population and must stay current and at the forefront of male-related health concerns, besides being knowledgeable of the medical school curricula which we are traditionally taught during residency and then retested on for our recertification.

The community urologist is the most educated and most well suited to evaluate and guide the aging male population regarding issues of aging. We must safeguard our patients from unproven supplements, devices, and therapeutics which at best may be harmless albeit financially deleterious, and at worse may severely impact overall individual health. Hopefully, we can remain the experts who counsel our patients on any and all potentially beneficial advances regarding the aging male.