Man to Man: Gay Men's Health Made Easy by Men's Health Forum

MAN TO MAN Gay Menâ&#x20AC;&#x2122;s Health Made Easy

Are you running smoothly?

HAYNES Haynes Publishing Group is the world’s market leader in the producing and selling of car and motorcycle repair manuals. Every vehicle manual is based on our experience of the vehicle being stripped down and rebuilt in our workshops. This approach, reflecting care and attention to detail, is an important part of all our publications. We publish many other DIY titles and books about motor sport, vehicles and transport in general. Haynes Publishing, Sparkford, Yeovil, Somerset BA22 7JJ, England

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MEN’S HEALTH FORUM The Men’s Health Forum’s Man MOT mini-manuals contain easy-to-read information on a wide range of men’s health subjects. Founded in 1994, the MHF is the independent voice for the health and wellbeing of men and boys in England and Wales. Our goal is the best possible physical and mental health and wellbeing for all men and boys. Man To Man © Men’s Health Forum All rights reserved. You must not reproduce or transmit any part of this booklet in any form or in any way without written permission from the Men’s Health Forum. This includes photocopying or scanning it. Printed in the UK. ISBN: 978-1-906121-90-7 Men’s Health Forum, 32-36 Loman Street, London SE1 0EH Registered charity number 1087375 Company limited by guarantee number 4142349 – England

020 7922 7908 www.menshealthforum.org.uk Grant funded via the Health and Care Voluntary and Community Sector Strategic Partner Programme A full list of references is available at: menshealthforum.org.uk/MMreferences The MHF encourages your feedback at: menshealthforum.org.uk/MMfeedback

CONTENTS What’s the point?

Hair Loss

p30

Be good to your head

p16

Smoking p27

You are what you eat & drink

p20 Eyes, ears & teeth

Be good to your tackle

Move those legs: get active

p30

Be good to your heart

p15

Sun on your skin

p29

p24 What to do when you’re ill p32 Who can help?

p35

ONE MAN IN FIVE DIES BEFORE HE’S OLD ENOUGH TO RETIRE… Written by Kristian Johns and Jim Pollard • Edited by Jim Pollard • Thanks to the advisory team led by Matthew Hodson of GMFA (the gay men’s health charity) and Dr John Chisholm and all those who helped with the booklet • Photo credits p35 Published: May 2015 • Revision date: May 2017.

MEN’S HEALTH MADE EASY WHAT’S THE POINT? Gay men’s health is about more than just sex - important though that is. We’re gay but we’re also men and we need to understand how both of these things affect our health. That’s what this booklet will do. It matters because men’s health is generally not as good as women’s. One man in five will die before he reaches 65, two in five before the age of 75.

ARE GAY MEN LESS HEALTHY? Well, compared to straight men, gay and bisexual men are: >> more likely to smoke >> more likely to drink more often and to take drugs >> less likely to get enough exercise and >> more likely to take our own lives and self-harm. >> Plus nearly one in sixteen of us are living with HIV.

Sometimes dying young is bad luck - an unavoidable accident or something in your genes - but often, it is down to stuff we can all do something about very easily. We’re not talking about anything dramatic; just a few little changes that will make life easier and more fun. We can tell you everything you need to know in these 36 easy-to-read pages. So how do you increase your survival chances still further? My complex diabetes is the direct result of not going to the GP.

Simple: catch it early. That means that if you are worried about anything, get it checked. If you’re offered screenings or check-ups, go for it. There is more on the Men’s Health Forum and GMFA websites. (Web addresses are on page 35.)

WHO ARE GMFA? GMFA is the gay men’s health charity and the Men’s Health Forum’s partner on this publication. Established in 1992, GMFA aims to ensure that all gay men are able to make better choices, enjoy better health - and have great sex.

DO THE MATHS: DO YOU DO THESE? > NOT SMOKE

> DRINK FEWER THAN 14 UNITS OF ALCOHOL A WEEK

> EAT 5 FRUIT & VEG A DAY > TAKE AT LEAST HALF AN HOUR EXERCISE A DAY Research shows that doing all four adds about 14 years to your life.

WHAT ABOUT FAMILY HISTORY? Heart disease, cancer, strokes, depression and mental health challenges many health problems run in families. So you can get a good idea of the hand you’ve been dealt by knowing your history. Find out if your parents, grandparents, aunts and uncles have had any of these illnesses, especially if they died young. Make sure your GP knows your family health history.

HOW TO HANDLE YOUR TACKLE IS MY DICK TOO SMALL? Limp dicks come in all shapes and sizes but when erect, they're pretty much the same. Genuine problems that might stop you enjoying sex or taking a piss are rare and usually picked up when you’re a baby. If you’ve passed that stage, you’re probably good to go. Trying to enlarge your penis is expensive, probably dangerous and almost certainly won’t work. Don’t. All surgery has risks. You only have one cock and it cannot be replaced.

I CAN’T GET AN ERECTION Erectile dysfunction (ED) affects most men at some time (about 1 in 10 of us at any given moment). Often the cause is physical: >> diabetes

>> blocked arteries (see p15 on the heart) >> drinking too much >> drug side-effects >> spinal cord injury >> prostate or other surgery in this area. Sometimes the cause is psychological:

Saw my GP. Got my sex life back. It was that simple.

>> relationship problems or sexual boredom >> stress, depression or anxiety >> sexual identity problem. If you can’t get an erection with your partner, but can when masturbating or during the night, there's a good chance your ED has psychological causes. There are many treatments available. See your GP. They treat ED every day. Don’t buy drugs privately. Life-threatening problems like heart disease and diabetes can cause ED and you need to rule these out. Moreover, drugs sold online are often not what they claim to be and can be dangerous fakes.

MY ERECTION WON’T GO DOWN If an erection lasts more than four hours, it could be a condition called priapism. See a doctor right away. Untreated priapism can be dangerous leading to, for example, permanent ED.

MY ERECTION IS BENT Some bend is normal but if it’s so bent it makes sex uncomfortable (for either you or your partner) it could be a condition called Peyronie’s Disease. Ask your GP about it.

I CUM/COME TOO QUICKLY Premature ejaculation (PE) is very common. It’s usually caused by stress or anxiety. The good news is PE can nearly always be treated. There are techniques to try yourself - see the Men’s Health Forum website - or your GP can prescribe.

THERE’S BLOOD IN MY SEMEN/URINE It’s probably nothing but could be a symptom of something more serious like a prostate problem so see your GP. For semen, go if you get blood twice. For urine, once.

MY FORESKIN IS TOO TIGHT Frequent, careful, lubricated masturbation can help (honest). Your GP can also advise on creams and stretching techniques. A last resort is full or partial circumcision, but that comes with risks.

THE HOLE IN MY PENIS IS IN THE WRONG PLACE If you’re not peeing out of the end of your penis you may have a condition called hypospadias. It can be treated, improving both urination and sexual function. Your GP can refer you to a urology specialist.

I’VE LOST INTEREST IN SEX Libido is a complicated mix of emotions and hormones. Ups and downs with time and age are normal. But it can also be reduced by: >> stress, depression and/or relationship problems >> the side-effects of drink or drugs (including legal drugs such as anti-depressants and blood pressure medication) >> hormonal changes (as men age levels of testosterone go down) >> medical conditions such as heart disease or diabetes. If prolonged loss of libido concerns you, see your GP.

MY PENIS IS SORE, RED OR ITCHY A red, sore penis head could be balanitis. This occurs in uncircumcised men who don’t wash their dicks. Your GP can treat it and advise on prevention. If you’ve had unprotected sex, it could be a sexually-transmitted infection (STI).

COULD I HAVE AN STI? STIs are increasing rapidly. In England in 2013, men who had sex with men made up 81% of syphilis diagnoses, 63% of gonorrhoea (the ‘clap’) and 17% of chlamydia. Sexually-transmitted infections (STIs) can be caught through oral or anal sex (as a bottom or a top) or skin-to-skin contact. Some can also be passed on through rimming and fisting. Common symptoms include: >> a yellow discharge from your penis >> swollen tender testicles >> irritation of your penis >> pain when urinating. Your GP can help. Or for something more anonymous, try a specialist sexual health clinic. Many STIs can be treated if caught early. Some STIs such as chlamydia may not have any obvious symptoms. It is recommended that all gay men get a full sexual health screen at least once a year, even if you always use condoms or believe you are in a monogamous relationship. You should get tested more often if you have any unprotected sex with new partners.

WHAT ABOUT HIV? Men who have sex with men account for over half of HIV diagnoses in the UK. It’s possible to have HIV without knowing it. Most men experience some symptoms around two to six weeks after infection (such as a sore throat, fever, body aches or rash). These symptoms are common to other illnesses and many people do not realise they could be a sign of HIV infection. It’s estimated that 16% of HIV-positive gay men don’t know they have the virus. If left untreated, HIV attacks the body’s immune system, leaving it vulnerable to infections we would normally fight off.

There is no cure but, if you are diagnosed with HIV and treated, you should have a normal life expectancy. HIV lives in the blood and in some body fluids. To get HIV, one of these fluids from someone with HIV has to get into your blood: >> cum and precum >> anal mucus (found inside your arse) >> blood. Sex without condoms is the most likely way for gay men to become infected with HIV. HIV can also be found in vaginal fluids, including menstrual blood, and breast milk. You canâ&#x20AC;&#x2122;t get HIV from: >> kissing >> spitting >> being bitten >> contact with unbroken, healthy skin >> being sneezed on >> sharing baths, towels or cutlery >> using the same toilets and swimming pools >> mouth-to-mouth resuscitation >> animals or insects like mosquitoes. The more HIV someone has in their bodily fluids, the more infectious they are, and the more likely they are to have serious health problems. HIV treatment lowers the levels of HIV in the body and can make the carrier less infectious, but it wonâ&#x20AC;&#x2122;t get rid of the virus completely. Men who have sex with men should get tested roughly every six months for HIV. You can get tested at any sexual health clinic. A lot of places do one-hour

testing or even quicker. It just involves a finger prick, so no worries about needles. You can also get home testing kits by post. If you think you’ve been exposed to HIV, go to your local sexual health clinic or A&E as soon as possible, preferably within 48 hours. They will be able to prescribe you with a 28-day course of anti-HIV medication called post-exposure prophylaxis (PEP), which may prevent you from becoming infected with HIV. HIV isn’t a death sentence, and many people with HIV live long and healthy lives with the right care. But that doesn’t mean it’s trivial. GMFA provides information and advice for gay men living with HIV on their website.

WHAT IS HEPATITIS? Like HIV, the only signs of hepatitis — a blood-borne liver disease — may be a short flu-like illness. There are three sexually-transmitted forms of hepatitis (hep): A, B and C. There are vaccines for Hep A and B. These will usually clear up on their own (although you should seek advice just in case yours doesn’t). Less common but potentially more serious is Hep C. There is no vaccine and it won’t clear up on its own. All of these activities can transmit hepatitis: >> unprotected sex >> rimming >> fingering >> sharing toys >> fisting >> group sex >> sex without condoms

I feel more relaxed using condoms as I’m not worried about HIV or STIs

>> sharing needles or drug straws.

SAFER SEX The ins and outs (and ins again) of getting the sex you want, and having a bloody good time while you’re at it.

I’M SCARED OF BOTTOMING Most gay men will consider bottoming at some time. However, the thought of doing it for the first time can be scary. Don’t let that put you off. You may prefer to douche before bottoming, especially if indulging in deep arse play like fisting or with large dicks/toys. Use plain, clean water, preferably at body temperature. Avoid using shower attachments - the water pressure can be dangerous. You can get douche bulbs online or from any good sex shop. Try not to go overboard and irritate the lining of your arse, as this can make you more vulnerable to STIs. Get yourself relaxed with lots of foreplay like rimming or fingering. Some men do use amyl nitrate (poppers) to relax the muscles around their arse but there are two major health warnings. Poppers: >> have been linked with an increased risk of HIV transmission >> don’t mix with erection drugs like Viagra and may cause a heart attack. Deep breathing is far safer, helps you to relax and relaxes the arse too. Find a position that suits the size, angle and curvature of your partner’s dick. Any position where your knees are bent and drawn into your chest, whether you are kneeling, lying on your back or on your side, will probably lead to more comfortable sex, or will be a good position to start from. There’s no such thing as too much lube. It just makes everything more slippery, which isn’t a bad thing. Use water- or silicone-based lubricants if you're using latex condoms. Avoid any lube with nonoxynol-9. It irritates the lining of the arse, may make sex more painful and also increases your risk of HIV. Look after your arse. You can't get a new one. So know your limits. With time you may be able to take larger objects but there's always a maximum size: about 4-5 inches diameter (the width of your pelvic opening).

GREATER SEX HOW CAN I BE A GREAT TOP? Take your time and listen to your partner. This is as much about the emotional as the physical side. If he’s nervous, he might want reassuring that you’re not going to hurt him and that he’s in control. Find out what he likes. For some guys, topping is about being dominant (and some bottoms like that), but for others, it’s a two-way street. Ask him how he likes it. Listen to his reactions too. If he’s making noises that suggest he's in pain, ease up a bit. The first time you top, you may be a little anxious. This may make your erection less hard than usual. Relax – you're both there to enjoy yourselves. If you have erection problems, concentrate on something else like kissing for a while. (If getting or staying hard is a regular problem, see our section on ED on page 6.) Our advice above on lubes and position apply as much to tops as to bottoms. Lube is essential when topping. If you have a bigger than average cock, any position where the cheeks of his arse can provide a buffer to your length (like him lying face down) will be a good bet until he’s used to it. Remember: It’s not only bottoms at risk of HIV. Tops are at risk too, although it’s statistically less likely. Anal mucus can carry high concentrations of HIV, and the membrane just inside the tip of your cock and the foreskin can absorb that directly into the bloodstream if you fuck a guy's arse without a condom. You know the solution. Rubber up. There’s more on sexual health and sexual pleasure on the GMFA website.

GOING CRUISING? Don't put sex before safety. Trust your instinct about where and what isn't safe. Carry condoms and lube. (If bottoming, you might want to put the condom on the top yourself.) Don't flash cash and make sure you know where the exits are.

I HAVE PAIN/A LUMP IN MY TESTICLES Testicular cancer is rare. True, it is the most common cancer in younger men but this is only because cancer is so rare in young people. But don’t let that keep you from the doc. It’s rare but the risk is real. So if you notice a lump in your testicles, see your GP immediately. Testicular cancer can be treated very successfully if caught early.

CAN YOU GET PENIS CANCER? Yes. But it’s very, very rare. If you have a lump or sore, see your GP or sexual health clinic.

I HAVE TROUBLE PEEING All of these could be the sign of a prostate problem: >> a weak flow when pissing >> a flow which stops and starts >> having to wait before you start to go >> having to piss more often than previously >> a sudden urgent need to piss >> pissing more often at night. It is normal for the prostate to grow as we get older. Because the prostate is right next to the bladder, this growth can push on the bladder and cause peeing problems. See your GP to check that it is not prostate cancer and for advice on the many various treatments. Incontinence (peeing when you don’t want to) may also be a sign of prostate growth but there are other causes too. See your GP.

THE MALE G-SPOT Some gay men call the prostate the ‘male G-spot’ as it is responsible for a lot of the pleasure you feel when getting fucked. Substances like steroids can also cause the prostate to enlarge. But there’s no evidence gay men are more or less likely to get prostate problems than straight men.

HOW TO BE GOOD TO YOUR HEART The heart needs:

>> fresh air

> a balanced diet

>> a healthy weight

> regular exercise and

>> a relaxed attitude. Heart disease is caused when the arteries that pump your blood get damaged with gunk called plaque. This makes the arteries harden and narrow. The main causes are: >> smoking The health check was simple - less than twenty minutes.

>> high blood pressure >> high cholesterol >> diabetes >> lack of exercise >> being overweight >> family history.

This booklet will help you with all these. For more on the heart-friendly diet, see page 20. For more on exercise and weight, see page 24. Meanwhile, get your blood pressure and cholesterol levels checked. If youâ&#x20AC;&#x2122;re over 40, ask your GP practice for an NHS Health Check which will estimate your risk of getting heart disease. Hereâ&#x20AC;&#x2122;s a little incentive to look after your heart: everything that is good for your heart is good for your penis. Clear, unblocked arteries mean firm, durable erections. For more on erection problems (an early warning sign for heart disease), see page 6.

HOW TO BE GOOD TO YOUR HEAD What’s going on between your ears is probably the biggest single factor in staying healthy. If you feel good, you’re more likely both to notice when you’re ill and to do something about it. Keep an eye on the main causes of stress: work, relationships, money, bereavement, drink and drugs. Too much stress can: >> damage your immune system and heart >> increase your risk of serious health problems >> reduce life expectancy >> damage your sex life. Get to know what triggers stress and low mood for you.

Talking about my feelings was tough at first but I felt much better afterwards.

WHAT ARE THE SIGNS OF STRESS? If you spot any of these, ask yourself if they could be early warning signs of stress-overload. If they are, do something. The sooner you act, the easier it will be to deal with, and the less damage it will cause. >> eating more or less than normal >> mood swings and anger >> low self-esteem >> feeling tense or anxious >> not sleeping properly (or wanting to sleep all the time) >> poor memory or forgetfulness >> excessive drinking and/or drug use >> feeling really tired and lacking in energy >> withdrawing from family and friends >> behaving out of character >> finding it hard to concentrate and struggling at work >> losing interest in things you usually enjoy >> having unusual experiences, like seeing or hearing things that others donâ&#x20AC;&#x2122;t. There may be physical signs too like headaches, irritable bowel syndrome or aches and pains. You can beat stress by: >> eating better - see page 20 >> sleeping better - see page 19 >> exercising - see page 24 >> having fun - singing, dancing and laughing are all proven to boost mood. >> not becoming isolated - you donâ&#x20AC;&#x2122;t have to talk about whatâ&#x20AC;&#x2122;s stressing you, even connecting with other people in a small way will make you feel better >> doing something different - volunteer, learn something new, do something creative >> finding some time for things you enjoy >> having sex or a wank or cuddling up with someone can work wonders.

Try to live in the moment. If you’re walking with a friend or partner, enjoy the company and the experience. Turn off the phone. Don’t think about work. If you still feel stressed or anxious, see your GP. There are treatments and they don’t need to involve drugs. But don’t ignore the warning lights. Men who commit suicide are not so different from those who don’t. Mostly the only difference is treatment and support. So take care of yourself. There’s more on this topic in the Men’s Health Forum’s man manual Beat Stress, Feel Better.

HOW DO I COME OUT? Closets aren’t fun. You may worry that others will treat you differently once they know. But there are plenty of gay celebrities and sportsmen coming out every day, proving that you can be out and proud. Not being out causes stress and isn’t healthy for your body or mind in the long run. There’s no ‘magic formula’. Most people will tell a close friend or two first. Pick someone you trust, and make time to tell them in a private setting where you can both talk openly. You may not want more people knowing until you feel comfortable, so make sure your friend can be trusted to keep it to themselves. Most people say that they feel relieved after coming out, since they can be open about their life and their feelings. But coming out is important, and it’s up to you how long you take to do it, and who you decide to tell. For stories on coming out, check out the website www.rucomingout.com

HOW DO I MAKE MY RELATIONSHIP WORK? There’s no template for any relationship. They take work. Gay men might experience additional relationship stresses, like one of you not being out, family pressures or sero-discordance (where one of you is HIV positive and the other not). Some prefer monogamy, some have happy and healthy relationships that involve threesomes or playing separately. All good relationships involve both partners feeling valued, loved and nurtured. To get the most out of your relationship:

Develop trust – make sure you can both be seen, heard, understood and accepted. Create a dynamic where you can both express problems, doubts, fears and weaknesses without fear of rejection or punishment. Be intimate. Sex is only one expression of this. Intimacy can be verbal (telling your partner why you love them) or non-verbal (doing special things for them or helping them). Acknowledge each other’s need to be autonomous and make independent decisions. Be willing to communicate. Share feelings, needs and wants. Learn when just to listen and when to get involved in fixing things. Negotiate differences with respect and generosity. You’re not going to get your own way all the time. Be aware of personal issues and baggage you bring to the relationship and take responsibility for these. Be aware of the expectations you place on others and assess how realistic they are. Take and give regular time alone to recharge and rebalance. This will allow you to give more in your relationship in the long-run. Reading and watching other Maintain and build a friendship network outside the relationship. men’s coming-out No single relationship will meet every need. stories online Don’t take yourself (and everything else) too seriously. helped. Don’t jump ship as soon as it’s not plain sailing. Even the happiest of relationships will have problems. Often it’s external stressors like work or money that cause rows rather than anything between you. The trick is to keep communication open and free, and not to dwell on resentments and the past too much.

MY FAMILY/FAITH/CULTURE DON’T APPROVE Others may choose to be offended by how you are so you’ll need to think about how you will feel and react to this. But remember, your sexuality is part of you and you have a right to it. Look for support groups involving people of your community or faith. Our view: nothing of any value was ever truly damaged by where consenting adults choose to put their dicks.

YOU ARE WHAT YOU EAT & DRINK Gay men may be more weight-conscious than our straight brethren, but that doesn’t mean we eat better. Eating well can help you: >> keep a healthy weight >> avoid high blood pressure, high cholesterol, heart disease, stroke, diabetes and even some cancers >> exercise better >> work better >> concentrate better >> feel better >> have better sex It may even save you money. Eat more slowly so you (and your body) both notice what you’re actually eating. You’re less likely to eat more than you need and more likely to choose a balanced diet. Go for a walk after your meal if you can - it reduces the rise in blood sugar and fat levels.

Regular meals help balance swings in your blood sugar levels and reduce swings in mood (grumpiness) and tiredness. Start with a decent breakfast then, for main meals, fill HALF your plate with salad or vegetables, one QUARTER with protein (eg. lean meat, fish, eggs, beans) and one QUARTER with starchy carbs (eg. brown rice, wholewheat pasta, quinoa, baked potato, noodles). Aim for your 5 fruit and veg portions a day (only one can be juice) and make sure you get some dairy (milk, cheese, yoghurt) to keep calcium levels up and bones strong. If you crave something sweet, distract yourself. Exercise will do this best - a walk or run - as it will also burn off the effects of stress and curb the cravings - but anything that keeps you absorbed will help. If you can’t get away, drink water or herbal tea. Often we think we want a snack but we’re just thirsty. Think about smart substitutions. Fish instead of red meat. Grilling instead of frying. Wholegrain instead of white bread, pasta or rice. Semi-skimmed for full-fat. Watch out when life changes. When you leave home, move house or job, end or begin relationships, it’s easy to forget about what you’re eating. There’s more on this topic in the Men’s Health Forum’s man manual Eat. Drink. Don’t Diet.

COULD I HAVE AN EATING DISORDER? Men get eating disorders like anorexia and bulimia too. Doctors sometimes use the SCOFF questionnaire: Sick: Do you ever make yourself sick because you feel uncomfortably full? Control: Do you worry you have lost control over how much you eat? One stone: Have you recently lost more than one stone (6kg) in a three-month period? Fat: Do you believe yourself to be fat when others say you are too thin? Food: Would you say that food dominates your life? Answer “yes” to two or more of these and you may have an eating disorder. There are sources of help on page 35.

Don’t be ashamed. Facing an eating disorder is better than living with one.

WHAT ABOUT ALCOHOL? Nobody’s saying don’t have a drink, but too much alcohol damages nearly every organ in the body. It can cause heart disease, nerve damage, liver disease, depression, ED, cancer and digestive problems. A 2008 study found that gay and bisexual men are twice as likely to be dependent on alcohol as other men. If you’re worried that you’re drinking too much, ask yourself the questions on page 28. Here are some ways to cut down on your drinking: >> Stop drinking for a week or a month. >> Download the NHS Drinks Tracker app and/or write down each day how much you drink (in units) — seeing it in black and white helps. >> If there is a situation when you always have a drink — for example, after work — try to cut it out. >> When out for the evening, don't drink more than one drink an hour. Set yourself a maximum and stick to it. >> Make your first drink a soft one. >> Don't get into rounds. >> Say "No" every so often.

I feel better and more alert since I cut down the booze.

>> If you can't do these then you need to stop drinking. If you can’t stop drinking, you need to get advice.

BEATING BOWEL CANCER Bowel cancer is one of the most common cancers in the UK, with 40,000 new cases every year. Nine in ten cases are in people over 60. You’re also at increased risk if you have a family history of the disease, smoke, drink, have a diet high in fat and low in fibre, are overweight and don’t exercise. Look out for: >> bleeding from your back passage and/or blood in your stools (your crap) >> a change in bowel habit lasting for three weeks or more, especially to looser or runny stools >> unexplained weight loss >> extreme tiredness for no obvious reason >> a pain or lump in your stomach area. If you’re aged 60-74, ask your GP about bowel cancer screening.

EAT WELL TOP TIPS Looking for simple pointers to healthier eating? >> Always have a good

breakfast to start the day right. >> Eat mindfully. Sit down and chew each mouthful thoroughly and slowly. >> Don’t eat while distracted by TV, phone surfing or reading. >> Choose healthy snacks between meals such as fresh fruit and unsalted nuts.

Plate smart. You’ll get a better idea of what you’re eating if you fill your

plate just once: half with salad or vegetables, one quarter with protein foods (eg lean meat, fish, eggs, beans) and one quarter with starchy carbohydrates (eg brown rice, wholewheat pasta, quinoa, baked potato, noodles).

Water is usually the best rehydration fluid when exercising. >> Go easy on alcohol – it’s particularly fattening. >> Smart food substitutions make healthy eating easy and painless. >> Keep a food diary - write down everything you eat and drink from the >>

moment you wake until you go to bed. Accounting for everything that passes your lips helps you make healthier choices and reduce random snacking.

Read labels. Food nutrition labels help you make healthier choices such as cutting back on salt, sugar and calories.

>> If you choose lower-fat, lower-calorie or lower-sugar versions of foods you eat regularly such as mayonnaise, salad dressings, yoghurt or milk, check labels carefully. Whatever is taken out is usually replaced with something else so low-sugar may be high-fat and low-fat may be high-sugar. >>

Enjoy all the foods you like but in moderation. If they are full of fat or sugar, simply eat less of them and/or find some healthier options that taste just as good.

HOW TO GET ACTIVE As gay guys, we may use the gym to build muscle, but many overlook the importance of general exercise, which boosts physical and mental wellbeing, and helps you live longer. Scientists now reckon being inactive is even more of a health risk than being overweight. People who do regular physical activity have a 35% lower risk of heart disease and stroke and a 50% lower risk of diabetes and of bowel cancer. Best of all, exercise feels good. It boosts feel-good chemicals that raise self-esteem and help sleep and concentration. Regular exercisers have a 30% lower risk of depression and of dementia.

WHAT DOES ‘REGULAR PHYSICAL ACTIVITY’ MEAN? To get the full benefit, the NHS reckons you need 150 minutes a week of moderate-intensity aerobic exercise. This means I feel great exercise that makes you slightly breathless - fast walking, after exercise. cycling, jogging, mowing the lawn, swimming, playing sport. It’s a natural high.

The statistics above are based on these sorts of exercise levels. And if your exercise goal is to lose weight, you probably need to do more than this. But anything is better than nothing. Try walking. Walking reduces the risk of heart disease by a third. The further and faster you walk the better but even walking just 5-6 miles a week at a very slow pace (2 miles per hour) will help reduce risk. Little and often is fine. Get a pedometer to count your steps. If you want a target, aim for 10,000 steps a day. Stretching and strengthening muscle is also important. Again, this doesn’t have to be vigorous. Yoga is fine.

I HAVEN’T GOT TIME Build exercise into your everyday life:

How do I fit exercise in with work? I jog home from the office.

>> Get off the bus/train/tram a stop or two early. >> Park the car and walk. >> Cycle instead. >> Use the stairs. >> Exercise in your lunch break. >> Exercise at home or in your local park - you don’t need a gym. >> Get into housework and gardening. >> Walk and talk (on the phone or with colleagues). Can work help? Some employers have a gym or offer gym membership or cycle-to-work schemes. Combine exercise with your social life by joining a gym, club or team. Many of us have an aversion to gyms or team sports, but we’re all there for the same reason. There are plenty of gay sports teams and gay-friendly gyms around. GMFA has a website with details of gay sporting clubs around the UK at www.gmfa.org.uk/the-guide

I HAVENâ&#x20AC;&#x2122;T EXERCISED FOR YEARS. Take it easy. Often new exercisers find that their heart and lungs rise to the challenge quicker than the skeleton and muscles. Result: they get injured (and give up). When you start over, the only thing you really need to focus on is not getting injured. Warm up properly, build up slowly and donâ&#x20AC;&#x2122;t do more today than you will be able to do tomorrow. So start with a nice walk.

ONE FOR THE BEARS Do you need to lose weight? Being overweight increases your risk of heart disease, stroke, diabetes and some types of cancer. Next year in England and Wales alone around 50,000 deaths will be down to excess weight. So get the tape measure out. As a man, you have a: >> HIGHER risk of health problems if your waist size is more than 94 cm (37 inches) and an >> EVEN HIGHER risk if your waist size is more than 102 cm (40 inches)

Weight is not just about looking better, I feel more energetic too.

SMALL CHANGE BIG DIFFERENCE Most of us want to make little changes which will make our lives more fun. For example, most smokers want to quit.

HOW DO I QUIT SMOKING? We all know cigarettes are bad for our health. But did you know that smokers are also far more likely to get erection problems or that smoking increases the risk of illness in HIV-positive men? Here are some tips to help: >> set the day in advance >> get rid of smoking stuff like ashtray and lighters at home, work, in the car etc. >> team up with a friend or two to quit together >> try to avoid smokers >> try to avoid places or circumstances in which you usually smoke >> list all your reasons for quitting

>> when you get a craving, talk to someone, go for a walk, drink water or nibble on a healthy snack (carrots are good), get a change of scene or do something that will keep you busy

I got very, very badly sunburnt in just half an hour.

>> take it a day at a time and mark your progress >> put the money you save to one side and watch it mount up >> don’t be tempted to have ‘just one’ - it doesn’t work >> check out the NHS Stop Smoking Service and download their app.

AM I ADDICTED? You can have too much of a good thing. Think you might be addicted to drink, drugs, gambling, sex or porn or something else? Even work? Ask yourself these questions: >> Do you think about X while doing something else and look forward to it? >> Do you feel you need more X each time to get the same enjoyment? >> Have you made efforts to cut back on X? >> Do you do X for longer than intended? >> Have you put X before more important things like relationships or work? >> Have you lied to others about your involvement with X? >> Do you use X as a way of escaping from problems or of relieving, for example, feelings of guilt, anxiety or depression? If the answer to any of these is yes, you need to stop doing X. If you can’t stop, you need to talk to someone. It’s that simple. You’re not alone - at least two million people in the UK are fighting an addiction. There’s no shame. Some men are tall. Some get colds. Some get addicted. The problems really begin if you can’t admit the truth to yourself. Talk to a friend, family member, your GP or an organisation working with people with the same challenge as you.

I USE DRUGS BUT I’M NOT ADDICTED Only you know if your drug use is fun and manageable or dominating your life, leading to risky sex, wasted money and all the problems mentioned above.

‘Chemsex’ means having sex under the influence of drugs taken before and/or during sex. The most common chemsex drugs are crystal meth, GHB/GBL, and mephedrone (‘meph’, ‘meow’ or ‘plant food’). Drugs can make you hornier and lower inhibitions, but they also make it easier to take risks with sex. Drugs like crystal meth (Tina), poppers and cocaine have all been found to be associated with unprotected sex and HIV. Drugs can also mask self-esteem or self-confidence issues. If you’re worried about your drug use, there are specialist services available for men who have sex with men (see page 35).

HOW DANGEROUS IS THE SUN OR THE SUNBED? They can be very dangerous. The number of people in hospital for skin cancer is increasing. What’s more, men are more likely to die from the disease than women. The main cause of skin cancer is the sun. If you have fair skin, light-coloured eyes and more moles, you’re at higher risk. Don’t avoid the sun. Being outside is good for you. But cover up. Wear a shirt and hat. Choose sunscreen that is at least SPF 15+ and has a **** rating. Keep an eye on your moles. You’re looking for changes to the ABCDE: A – asymmetry (both halves should look the same) B – border irregularity (it should be round) C – colour change (it should be tan - not red, black or white) D – diameter (it should be below 4mm) E – elevated (raised) or enlarged. Also watch for itchiness or bleeding. Any concerns, see your GP.

HAIR LOSS IS NO BIG DEAL Male baldness affects most men sooner or later. Since it’s related to testosterone, the only real cure is castration before puberty. Not recommended. The rugs and the drugs are still not great so better to just relax and remember some of the sexiest men on the planet are bald. If you’re seriously depressed by hair loss, it may be to do with something happening inside your head, not on it.

I USE TECHNOLOGY ALL THE TIME. ANY WORRIES? Staying in the same position for too long, especially unnatural positions like on the train or on the couch, may affect your back. The screen may affect your eyes. Look away from the screen, take screen breaks and get up regularly to move around. At your desk, note your seating posture, the computer screen position, the height of your chair, the position of your mouse and keyboard and the layout of the rest of your desk equipment. Adjust so your eyes are level with the screen, arms are comfortable and supported and the chair provides support for your back. If you’re using a laptop for a long period, use a separate keyboard and mouse and a laptop stand.

SHOULD I GET MY SIGHT TESTED? See an optometrist if you are having difficulty focusing close-up or seeing long distance or have pain, headaches, blurred vision or see halos around lights. As we age, some deterioration in sight is normal. The basic eye test is cheaper than you think and is free in many cases or if ‘clinically necessary’. If you already wear glasses or contacts, you should go for an eye test at least every couple of years. People over 40 and people from black or minority ethnic groups may need tests more frequently. (People from African-Caribbean backgrounds are at greater risk of glaucoma and diabetes and people from south Asian backgrounds at greater risk of diabetes.) If you use screens habitually as a significant part of your normal work, your employer should pay for a proper eye test and any glasses you might need for screen work.

WHAT ABOUT HEARING? Hearing also deteriorates with age - 40% of those over 50 have some hearing loss. Look after your ears by wearing ear protectors when necessary and keeping volume down when using headphones or headsets. Wax build-up can also affect hearing. Warmed olive oil (yes, the cooking type) can loosen wax, or try drops from My bad your pharmacist. If they don’t help, see your practice nurse. breath was down to poor dental hygiene so easily solved. Yes - at least once a year. It could prevent a lot of pain and expense later on.

DO I HAVE TO GO TO THE DENTIST?

You can reduce the risk considerably by brushing twice a day for two minutes at a time with fluoride toothpaste. Brush all surfaces including the gums gently with an up-and-down motion. Flossing or interdental brushes can help you clean between the teeth. Cleaning gets rid of the bacteria (plaque) that causes tooth decay and gum disease. Mouth cancer is more common in men than women. Watch out for white or red patches, ulcers or lumps that don’t clear up after two weeks, especially if you smoke and drink.

FIVE TIPS FOR BETTER SLEEP >> no screens in the bedroom (includes TV and phones/tablets) >> no stimulants except sex before bed (no coffee, drugs, vigorous exercise, booze etc) >> try some relaxation exercise or yoga >> writing tomorrow’s To Do list may clear your head >> reading something light or listening to the radio may relax the mind by distracting it.

UNDER THE WEATHER? WHAT SHOULD I DO WHEN I’M ILL? For coughs, colds and other minor problems, try your high-street pharmacist. For illness or personalised advice, the local general practice is the first point of contact. Make sure you’re registered with one. It’s very easy to do. Choose one that is easy to get to from home or work. Check opening hours, appointment system and what you can do online or by phone. General practices also provide information, vaccinations, clinics, healthchecks, blood tests and some simple operations.

WHAT ABOUT OUT OF HOURS? If you need information, out of hours call 111. Or your GP’s out-of-hours service. For an emergency, call 999 or go to the Accident and Emergency Department (A&E).

WHAT’S AN EMERGENCY? Call 999 or go to A&E if the patient is: >> unconscious >> in a very confused state >> having fits that are not stopping >> having persistent, severe chest pain

The A&E staff were great. The four-hour wait wasn’t.

>> having breathing difficulties >> bleeding severely and you cannot stop it. You are wasting your time and everybody else’s if you go to A&E and it is not an emergency.

WHAT OTHER SERVICES ARE THERE? Minor Injuries Units are an alternative to A&E for less serious injuries like sprains, breaks, minor burns and bites. They’re quicker and easier for non-emergency injuries. There are also some Walk-In Centres which are open out of hours providing minor ailment and some minor injury services without an appointment. Sexual health clinics offer free confidential advice, testing and treatment for sexually-transmitted infections. There are also many other NHS services for, for example, stopping smoking, mental health problems and social care. You can find services near you on the Men’s Health Forum or NHS Choices websites. Another very useful source for help with minor health problems and advice on treatment and local services is your pharmacist. There’s one on most high streets. Just walk in. Most have a private area to talk if need be. There are also public and voluntary services targeted more specifically at gay men and we’ve listed some of these on page 35.

WHAT ABOUT THE INTERNET? Choose sites that display the NHS England Information Standard ‘Health and care information you can trust’ logo. You can see the logo on p2. Be sceptical of social media and commercial sites without this. On overseas sites, the HONcode is a sign of quality. Sites like the Men’s Health Forum, GMFA and NHS Choices provide lots of useful health information. But information is all it is. You need a doctor to diagnose.

WHAT ABOUT GETTING DRUGS ONLINE? If you have a prescription from a GP, many GPs and pharmacists can handle these online.

I paid £130 for a product that didn’t work.

If you don’t have a prescription, get one. Don’t self-diagnose and buy drugs online. Many sites offering drugs without prescription are illegal. The drugs they sell may be useless or dangerous fakes. Your credit card details may be stolen. Perhaps more important, you won’t get a diagnosis of your problem. Not being able to get an erection won’t kill you. Heart disease or diabetes (of which erection problems are a sign) can.

The authors and the publisher have taken care to make sure that the advice given in this edition is correct at the time of publication. We advise you to read and understand the instructions and information included with all medicines and to carefully consider whether a treatment is worth taking. The authors and the publisher have no legal responsibility for the PHOTO CREDITS: Thanks to David Goehring, Mikael Häggström, Guillaume Paumier, istoletheTV, Trygve Ulstomo, Timothy Takemoto, bottled_void, Jim Larrison, Len Rizzi, Julian

results of treatments, misuse or overuse of the remedies in this book or their level of success in individual cases. The author and the publisher do not intend this book to be used instead of advice from a medical practitioner, which you should always get for any symptom or illness.

Mason, Paul in London, D Sharon Pruit, Alexis O’Toole, Sascha Kohlmann and chinesechef who were all kind enough to make their images available through the Creative Commons. (If this is not

the case, please contact us.) Full credits, links and licences at: menshealthforum.org.uk/ MMreferences

WHO CAN HELP? Men’s Health Forum www.menshealthforum.org.uk Health information from the Men’s Health Forum manmot.co.uk Email/text chat with a GP GMFA www.gmfa.org.uk The gay men’s health charity NHS Choices Online ‘front door’ to NHS www.nhs.uk www.nhs.uk/lifecheck www.nhs.uk/change4life apps.nhs.uk Call 111 (24 hour) for nonemergency medical advice. http://tinyurl.com/oohNHS for more on NHS out of hours. HIV & Sexual Health www.gmfa.org.uk/positive www.tht.org.uk Helpline: 0808 802 1221 www.aidsmap.com www.56deanstreet.nhs.uk Hepatitis C www.hepctrust.org.uk Helpline: 0845 223 4424 Chem Sex www.chemsexsupport.com Code Clinic at 56 Dean St BME www.naz.org.uk Sexual health services and support groups for black and minority ethnic men.

Hate crime www.galop.org.uk Galop is London’s LGBT antiviolence & abuse charity Coming Out www.rucomingout.com Drink and drugs www.gmfa.org.uk/alcohol-anddrugs www.londonfriend.org.uk Antidote drug and alcohol helpline 020 7833 1674 www.drinkaware.co.uk The NHS has a Drinks Tracker app. Or text Units to 64746 to access the NHS alcohol units calculator on any smartphone www.alcoholics-anonymous.co.uk AA helpline 0845 769 7555 British Dental Health Foundation www.dentalhealth.org Eye health www.rnib.org.uk/eye-health Cancer www.macmillan.org.uk Free helpline 0808 808 00 00 Same-Sex Domestic Violence www.mensadviceline.org.uk Men’s Advice Line (for victims) 9-5 Mon-Fri 0808 801 0327 www.endthefear.co.uk Mental Wellbeing www.mentalhealth.org.uk www.time-to-change.org.uk Smoking 0800 022 4332 www.smokefree.nhs.uk

Eating Disorders www.mengetedstoo.co.uk Prostate Cancer www.prostatecanceruk.org Helpline 0800 0748383 Groups for gay and bi men with prostate cancer: www.metrocentreonline.org (Metro Walnut, London) www.outwithprostatecancer.org. uk (Manchester) www.blgbt.org (Birmingham) Diabetes www.diabetes.org.uk 9-7 Mon-Fri 0345 123 2399 British Heart Foundation Heart helpline: 0300 330 3311 www.bhf.org.uk Back Care 0208 977 5474 www.backcare.org.uk Stroke Association Helpline 0303 303 3100 www.stroke.org.uk Organ Donor Register www.organdonation.nhs.uk/ukt/ FEELING DESPERATE? Samaritans 08457 90 90 90 Emotional support 24/7 www.samaritans.org Calm 0800 58 58 58 www.thecalmzone.net Pace 020 7700 1323 www.pacehealth.org.uk

MAN TO MAN Whatâ&#x20AC;&#x2122;s the biggest risk to your health? Being gay or being a man? The answer is a bit of both. Men are generally less healthy than women and gay men generally less healthy than our straight brethren. The good news is that a few little changes can make a big difference. MAN TO MAN covers: > how to have better sex > how to come out > how to be good to your head > how to be good to your heart > how to get active > how to get help or support when you need it. MAN TO MAN also answers all the frequently-asked questions on the male tackle. By gay men for gay men. And it couldnâ&#x20AC;&#x2122;t be easier to read.

WARNING: Reading this booklet could seriously improve your health ISBN: 978-1-906121-90-7 www.menshealthforum.org.uk