With special clinics, hospitals vie for hesitant patients: men

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From the gleaming limestone lobby to the chocolate and oxblood exam room walls to the percussive address, 555 Madison Avenue in the borough of Manhattan, a new clinic in New York City exudes masculinity, and that is no accident.

Still smelling of fresh paint, it is NYU Langone Medical Center's health center devoted to men, one of two such centers opened in the past two years by major New York hospitals, within 10 blocks of each other, and using marketing techniques common to lifestyle companies and luxury spas.

"The glass ceiling has been broken; now there's a health center just for men," goes one NYU Langone advertising slogan, with a tongue-in-cheek hint of transgression. Says another: "It's the gentlemen's club your wife would approve of."

NYU Langone and other medical institutions have long had services devoted to women, an outgrowth of the belief that the male-dominated medical establishment had not paid enough attention to their particular needs.

Now, men are starting to get equal treatment, as hospitals try to take advantage of an enormous untapped market: men who, studies show, avoid doctors for virtually anything short of a bullet wound. The new clinics offer one-stop shopping for services ranging from heart monitoring to hair removal to hormone therapy, from the life-prolonging to the life-enhancing if medically debatable.

The Men's Health Center at the Miriam Hospital in Providence, R.I., affiliated with Brown University, opened in 2008 and was one of the first in the nation. The Curtis D. Robinson Men's Health Institute was founded in 2010 at St. Francis Care in Hartford, Conn. The Iris Cantor Men's Health Center at NewYork-Presbyterian/Weill Cornell opened in summer 2012, and NYU Langone's center opened six months ago.

Martin Miner, co-director of the Miriam men's center, had to draw up several business plans before one was approved. The initial reaction, he said, was, "Health is about men, the whole world is about men, so what do we need it for?"

One focus is prostate health; the Curtis D. Robinson center, named after a black businessman in Hartford who financed much of the center's startup costs, is geared toward black men, who have a higher rate of prostate cancer than the general population.

Predictably, virility treatments, including for erectile dysfunction, are also a major draw. Along with a large number of urologists, NewYork-Presbyterian's center, for example, offers Botox treatments for overactive bladders and a physical therapist who works exclusively on the pelvic area to reduce stress-related pain.

"Welcome to the Casbah," center director Steven A. Kaplan said during a tour of the glass-and-gray clinic, conveying a mindset somewhere between clubby exclusivity and a pull-up-the-drawbridges fortress mentality.

But a hazard of gender-oriented health care may be that it will lead to overtesting and overtreatment, said Steven Woloshin, a professor of community and family medicine at the Dartmouth Institute for Health Policy and Clinical Practice.

A case in point is low-testosterone, or "low T," therapy, which has turned into a small industry in recent years. It is offered in small independent clinics around the country and, now, in the New York men's health centers.

Some medical authorities question whether men receiving the therapy who have no underlying medical condition are being pitched a fountain of youth, and the federal Food and Drug Administration is investigating the risk of stroke, heart attack and death in men taking testosterone products. (Several studies have shown a testosterone treatment-heart attack link.)

Another example is prostate specific antigen screening, or PSA, for prostate cancer. In 2012, the U.S. Preventive Services Task Force recommended against it for men without symptoms because in many cases the treatments may do more harm than good. The American Urological Association has since moderated its support for the testing, saying it should be considered primarily by men ages 55 to 69.

Dr. Woloshin derides low-T therapy as "the mother of all disease mongering." As for same-sex health care, he said: "I think in the abstract that's a fine idea. The thing is what they're offering. If they're focusing on low T, even prostate cancer, where the evidence is limited, they're not doing men a favor, and they may be doing harm."

Both the NYU Langone and Presbyterian clinics said they did not consider their treatments unnecessary. "If somebody has low testosterone, of course we'll treat it," said medical director Steven Lamm of the NYU Langone center. "That's part of the endocrine abnormality." PSA screening is done based on individual factors like family history and ethnicity, Dr. Lamm said.

It is an axiom of men's health centers that sexual dysfunction is a barometer of overall health, since it may betray causes such as heart disease, diabetes and obesity. In fact, Dr. Lamm said, treatment for erectile dysfunction was "not immensely profitable."

"We don't treat it in absentia," he said. "We treat it as part of their overall medical issue."

The staff at the NYU Langone center includes orthopedists, dermatologists, psychiatrists, physical therapists, cardiologists, gastroenterologists, neurologists and a specialist in male fertility.

Dr. Lamm acknowledged the risk of overtreatment but said: "Are you creating a need or are you meeting a need? I think meeting a need -- based on the longevity gap and men not taking care of themselves."

The health center's ads revel in its retrogradeness: "It's not often you get to hang with the guys, and feel better the next morning," and "Men have needs too."

Creating a safe place is one way of combating a documented male avoidance of doctors. A 1999 paper in The Journal of Family Practice attributed this behavior to a need to project being in control, a sense of invulnerability and a reluctance to ask for help.

And if there were any doubt that men are generally worse than women at taking care of themselves, a Boston Medical Center study published in 2012 put it to rest, finding that men were more likely than women to go to the emergency room within a month of being discharged from the hospital, and even more so if they were unmarried or retired, which the researchers attributed to social isolation.

Health center doctors are overwhelmingly male: NewYork-Presbyterian has one female doctor, a cardiologist, and NYU Langone has none. And though they do not turn away female patients, the centers' target audience is clear.

On a recent morning, Mike Kitson, 39, a project manager for a branding company, came in to the NYU Langone clinic to have a pimple on his chest checked. He had stubbornly ignored it for eight months until a relative fell sick, making him paranoid about his own health.

The receptionist registered him biometrically by scanning his palm vein pattern, appealing to his male gadget gene and hooking him instantly. As for the pimple, his doctor gave him a cream for psoriasis and advised him on how to get more sleep. "Everything's kind of taken care of, so for a lazy guy like me, it's very, very helpful," Mr. Kitson said.

He also liked the aura of exclusivity: "Just the fact that they're calling it 'men's health' makes it a little more inviting."

Most patients said the quality of the doctors mattered at least as much as the setting.

"If anything, we are proponents of coed," Peter Kornman, 61, a retired lawyer and patient at NewYork-Presbyterian's clinic, said of himself and his wife. But he conceded, "For a sexual issue, I guess I'd like to talk to a man."



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