Maggie McKay (Host): Welcome to Total Health Talks, your Cook County Health podcast, where we empower your journey to better health. I'm your host, Maggie McKay. And today, we're going to talk with Dr. Florian Stroie, board-certified urologist and director of men's health urology services, about men's health. Thank you so much for being here.

Florian Stroie, DO: Thank you so much for having me again, once again in the hot seat, Maggie. Thank you.

Host: So when people hear men's health, they usually think about a yearly checkup, but it's way bigger than that. How do you explain what men's health really means and why guys should start thinking about it sooner than they usually do?

Florian Stroie, DO: Well, look, Maggie, by the time you and I are done here, I'd say more than about 30 men will have been diagnosed with prostate cancer in the United States alone. And over 300 men will have been diagnosed with erectile dysfunction in that same period, in less than an hour.

So, Maggie, when we talk men's health, certainly we make it a point to say that it's so much bigger than a yearly physical. It's about how a man functions physically, emotionally, sexually, socially, over the course of his entire life. And Maggie, a lot of men are taught either directly or indirectly to ignore symptoms, push through the fatigue. Don't talk about sexual problems. Don't talk about urination. Don't talk about stress. And then, what happens is we wait until something becomes a crisis before we even pay attention.

Look, the truth is men's health is not just about living longer. It's about living better. It's about energy, strength, confidence, relationships, fertility, sexual functioning, urinary health, cancer prevention. I could go on and on and on. And above all, quality of life. And I always tell men who come into my office, "You don't have to wait until something is broken before you take care of yourself," right? The earlier we identify problems, the more options we generally have. And so, prevention is easier than rescue. Maintenance is easier than repair. And taking ownership of your health, particularly your men's health early, is not weakness, it's responsibility.

Host: Absolutely. Well, let's talk about erectile dysfunction. A lot of guys deal with it, but almost no one wants to say it out loud. So, why is ED about more than just sex?

Florian Stroie, DO: So, in the past couple minutes, several men have just been diagnosed with erectile dysfunction nationally, and it's incredibly common. But certainly because ED can touch on pride, confidence, masculinity, and relationships, how do men suffer? Well, unfortunately, we know that they suffer silently, quietly. They assume they're the only one dealing with it, and they feel embarrassed, and they avoid the conversation. ED, or erectile dysfunction, it's not just simply a sex issue. It can be a vascular issue. It can be a hormonal issue. It can certainly be a medication issue. And it can be related to a whole host of diseases that we as urologists and we as a medical community, as primary care physicians and providers treat on a day-to-day basis. It's related to diabetes, blood pressure, stress, sleep, depression, obesity, smoking, cardiovascular disease.

And, you know, the way I think about the penis, I think of it as a vascular organ. Erections depend on what? Good blood flow in and healthy nerves, adequate hormones, a well-functioning mind and body connection. And so, when these erections change, the body is giving us some information. It's giving us a warning signal. And what I tell patients and why I tell patients is that ED is not something to be ashamed of. It's something to evaluate. It's that warning sign that comes on the dashboard that says, "Hey, you got to get this checked out." In fact, it may even be the first actual sign of something larger going on under the surface. And so if we treat it seriously, we can often improve not just the sexual functioning, but your overall health, including your heart health.

Host: You touched on this just a little bit, but let's go into it a little more. How often does ED turn out to be a sign that something else is going on? Like you said, heart issues, blood sugar problems, hormones being off. How often is that?

Florian Stroie, DO: Very often. Very often, Maggie. And look, not every case of ED means a man has heart disease or a man has diabetes. No, no, no. We're not saying that. But it is common enough that we should not ignore that link, that connection between the two. We touched on this a little bit, but the blood vessels in the penis are smaller than the blood vessels around the heart. Certainly much smaller than the blood vessels going to the brain. So, sometimes problems with blood flow show up as erectile dysfunction years, in fact, generally seven years before they show up as chest pain, shortness of breath, or a heart attack or a stroke. So in that sense, ED is an early warning signal.

When I see a man, with erectile dysfunction in my clinic, especially if he's a younger gentleman or the symptoms came on suddenly, listen, I'm thinking way beyond the bedroom. I want to know, "All right, does this young gentleman, does he have diabetes? His blood pressure, is it well-controlled? Is it high? How's his cholesterol? Is this gentleman smoking? Is he sleeping? Is he exercising? Are his testosterone or hormone levels appropriate? Or is he under major stress at home or at work?" And really, I want us to zoom out for a moment and look at that bigger picture. And that is it. You know, ED gives us a window into a man's overall vascular, metabolic, hormonal, psychological health. And that actually is very good news because it means we have an opportunity to impact meaningful, significant change early.

Host: Speaking of conditions that are common to men, we hear a lot about finding and treating prostate cancer, but not as much about life after treatment. So, what are some of the challenges men don't expect once the cancer is gone?

Florian Stroie, DO: In prostate cancer, we often focus on diagnosing and treatment, right? We talk about the biopsy, we talk about the surgery, the radiation, the PSA blood test. Those things matter. They certainly do. But for the patient, the story does not end when the cancer is treated. And that's where, I come in. And urologists who are specialty trained in these types of conditions come in. You know, many men are surprised by what comes after prostate cancer treatment. They may deal with erectile dysfunction, urinary leakage, changes in the way that they orgasm, a shortening of the penis, fatigue, anxiety, certainly relationship stress, and loss of confidence.

And so, sure, some men do feel grateful that cancer is gone. But at the same time, they're grieving changes in their body and identity, and we as a medical community have not always been very great about tending to those needs, and that's where we at Cook County Health come in.

And because the cancer treatment may have been successful, Maggie, men sometimes feel like they're not allowed to complain. They think, "Well, ah, I'm just going to hang my hat on this, and I should just be thankful." And yes, survival matters, an incredible amount, but quality of life afterwards matters too.

And it's my belief. And so, a man can be cancer-free and still need some help becoming whole again, and that's where men's health really becomes the crucial aspect or essential. You know, we need to treat the person, not just the tumor. And at Cook County Health, I'm a firm believer that you benefit from that hands-on care.

Host: So, how can men's healthcare help prostate cancer survivors get their energy and their confidence and their sex life back instead of just, like you said, accepting that this is how it is now?

Florian Stroie, DO: Sure. You know, the first thing we do, Maggie, is, first of all, we reject the idea that men simply have to just accept poor function after prostate cancer treatment. Some changes are real, yes. We know that. They're well-documented in the medical literature, and some are difficult. But the, "Hey, this is just how it is it's going to be from now on," should not be the default.

And for us, it's not. There are options. And what are they? Well, for erectile dysfunction, we can use medications, vacuum devices, injections, or rehabilitation strategies. And in the right patient, Maggie, a penile implant procedure can substantially change that patient's life for the better. When we look at conditions such as urinary leakage, for example, after prostate cancer treatment, surgical options exist. And they've demonstrated time and time again superior success rates.

And men are satisfied with some of these treatment options that we offer. Beyond satisfied, they're back to doing the things that they used to do before. They go and play golf, you know, and go to the gym; whereas before, they would shy away from these things because of urinary incontinence associated with activity.

You know, Maggie, for fatigue, low energy, we look at, "Okay, what's your sleep look like? What's your testosterone hormone, your weight, your activity, your mood, your medications?" I've said this time and time again, but I'll say it again, we look at you as a whole man in front of us. And more importantly than that, we give men permission to talk about these issues. We encourage it. We invite it. A lot of men, they don't bring up or they never bring these issues up because they think that nothing can be done. And so, they don't ask, or they think that their doctor's too busy, or they're embarrassed.

So look, my message, very simple. Prostate cancer survivorship, it's not just about monitoring the PSA. Yes, that's part of it, but it's not the whole story. It's about helping men recover function, their dignity, their confidence, their intimacy with their partner, and ultimately, their quality of life. And we can almost always make things better.

Host: A lot of men don't realize how much support there is out there. What kinds of issues do you help men with at Cook County Health Men's Health Clinic?

Florian Stroie, DO: We've certainly discussed some of these. But in our men's health clinic, we certainly take care of a very broad range of issues that affect quality of life, from erectile dysfunction, low testosterone, premature ejaculation, orgasmic conditions, Peyronie's disease, or penile curvature, infertility concerns, scrotal pain, testicular issues, urinary symptoms of all kind, enlarged prostate, and sexual problems in general after prostate cancer treatment.

You know, importantly, we also help men, who may not exactly know what is wrong, right? You're the patient; we're the doctors. Let us help you figure it out. You might know, and you might come in and tell us, "Hey, look, something's changed." Maybe the erection is weaker, maybe the energy is lower, maybe they're urinating all night, maybe they're worried about their fertility after treatment, or they have some pain or curvature in their penis, or maybe they're struggling after cancer treatment and have not had a place to talk about it.

And so, the goal is to create a place where you can bring these concerns, certainly without shame, and get a serious thoughtful, professional evaluation. My firm belief is by leaders in our field, who continuously publish, present at national conferences, and, really are leading the way in innovation in urological care. We want men to know that these are medical issues, and they are common. Importantly, they're treatable and that they deserve your attention.

Host: And if there's one thing you want men listening right now to remember about their health, what would that be?

Florian Stroie, DO: You know, the one thing I would want men to remember certainly is this whole podcast. But if I can pick one thing is don't confuse silence with strength in this regard. You know, a lot of men that I see on a day-to-day basis, for years now, start thinking that, you know, what does it mean to be a man? And they start thinking, "Well, strong means ignoring symptoms, avoiding the doctors, handling it all yourself." But I'd argue to say, "Well, real strength is taking that responsibility. Real strength is paying attention, when your body's telling you something. Real strength is having the courage to ask for help before a problem really becomes a crisis."

If your erections have changed, say something. if you're urinating all night, say it. If your energy's gone, please say something. You know, if you're struggling after prostate cancer treatment, and something feels off, well, do not dismiss it. Mention it to somebody. And nobody is too busy to hear that out and send you an appropriate referral to be evaluated by folks who do this day in and day out.

I'll close and say, you know, men's health certainly is not about fear, it's about ownership. It's not just to avoid disease. But, you know, men's health should be fun. And the goal here is to live with energy, to live with confidence, to live with purpose, with intimacy and dignity for as long as possible. And saying, "Well, you know, Doc, I've had a good run, and this is it," well, you know, that's not good enough. I know that we can do better.

So, my message to all men is very simple: Your health is not separate from your life. Your health, in fact, is the very foundation, the pillar upon which your life and how good that life is, is built upon. And so, do please take it seriously and take it early. Come see us at Cook County Health.

Host: This has been so informative and encouraging. Thank you so much.

Florian Stroie, DO: The pleasure's been all mine. Thank you, and thank you to all for tuning in.

Host: Again, that's Dr. Florian Stroie. As we wrap up another insightful episode of Total Health Talks, make sure to visit cookcountyhealth.org/podcast and subscribe to our podcast, share and connect with us on social media. Stay tuned for more engaging discussions. This is Maggie McKay signing off from Total Health Talks. Stay well.