A simple online search for “men’s health clinic” (MHC) reveals the ever-expanding landscape of centers focused on men’s health, each with its own mission and agenda. To those of us vested in providing high-quality evidence-based male-focused health care, an MHC creates a space to provide care directed at the entire man, not just the presenting symptom. Commercially driven entities, conversely, often focus solely on niche sexual or hormonal management, operating in the gray areas of current guidelines. All of these practices carry the MHC label, creating confusion for lay individuals trying to determine the best care for himself or a loved one. This article aims to outline what constitutes a high-quality MHC today and opportunities for the future.

Many articles in the men’s health literature begin with the current life expectancy in the United States: 74.2 years for men and 79.9 years for women as of 2020.¹ This 5-year gender difference has persisted for unknown reasons. Is this an evolutionary fact, or can we impact biopsychosocial factors? Many have hypothesized that decreased engagement with health care, particularly preventative, among men and more common at-risk behaviors (alcohol and drug use, smoking, injuries) are behind the life expectancy divide.² When questioned about specific barriers, male focus groups cited practical and emotional aspects including scheduling, convenience, insurance-related issues, general fear and anxiety, and a distrust of the health care system (unpublished data). Separate interviews with loved ones confirmed resistance from male partners for the reasons cited above.

Understanding the male mindset and gender disparities, there is an obvious opportunity for MHCs; however, what constitutes a “high-quality MHC” has yet to be defined, including by our own specialty associations. In preparing this article, I turned to several nationally recognized men’s health leaders for their input. The message was clear: the most important element for a successful MHC is a collaborative multidisciplinary model of care (Fig. 1). This model must be more than multiple clinicians under 1 roof; it should be interactive both in the physical space and virtually through electronic medical record communications and focused multidisciplinary meetings. Providers should believe in the mission rather than check off a box for suggested specialties in an MHC. Ideally the physical location is designed to be comfortable for men with mindful décor and entertainment selections. A consistent reception team will add another layer of patient comfort, especially when asking men to return with often-stigmatized specialties such as mental health. The health care system remains challenging to navigate even within an MHC, and a clinical navigator is another tool leveraged by some successful clinics.

Figure 1. Ideal MHC and suggested national/international collaborative efforts. MH, men’s health.

Despite the efforts of many MHCs, there are still significant opportunities for improving and creating new high-quality practices. Continued efforts to break down clinical silos are needed, helping patients and providers understand that presenting problems are not unique to one specialty but instead connect multiple disciplines. For example, the link between erectile dysfunction (ED) and early cardiovascular disease has been well documented for well over a decade, but urology-facing screening strategies to guide appropriate referrals still do not exist.³ Without a full risk factor assessment, we are left with a gut decision when to refer to preventative cardiology. Mental health is another area that is poorly screened and understood in men’s health, especially among men with ED and Peyronie’s disease. After embedding a psychologist in our practice, we began to realize the depths of distress some patients face, occasionally to the point of suicidality, a scary thought for any clinician. Better screening tools are needed in the form of patient-facing men’s health checklists to screen for preventative health issues including mental health and fit seamlessly into a urological practice.

Additional future opportunities exist in increasing diversity, equity, and inclusion in our men’s health spaces. First, we must continue efforts to increase gender, racial, and ethnic representation and understanding in our own teams. Secondly, concerted efforts are needed to improve our men’s health content’paper, online and social media’so that all of our patients, especially those identifying as LGBTQ+, feel part of the conversation. Further clarity is needed on how gender incongruent patients fit into a men’s health practice and how we can make the nomenclature more inclusive. Our outreach to our communities, lastly, should be equitable. MHCs should have local outreach plans for underserved male populations not within the direct vicinity of the clinic or with limited transportation. Virtual health, ideally with improved cross-state coverage for those needing to travel or living near state lines, can help further reduce physical location barriers to care.

Figure 2. PubMed^® MHC and “women’s health clinic” citation frequency by year.

Leadership at a national or international level to carry forward a men’s health agenda is currently lacking. While the National Institutes of Health founded the Office of Research on Women’s Health in 1990, no men’s health equivalent exists at the federal level. Research pertaining to MHCs has also lagged behind our women’s health counterparts (Fig. 2). As a result, commercial MHCs have filled the void with innumerable websites and social media ads promising results with hormonal and ED regenerative treatment options frequently not supported by current guidelines. In a recent “secret shopper” review of 152 U.S. penile shock wave therapy clinics, three-quarters of the clinicians providing experimental ED treatment were nonurologists.⁴ Further research is needed to support or refute the efficacy of ED regenerative treatments including penile shock wave therapy, platelet rich plasma injections or stem cell injections. The language describing these treatments as “experimental” or “investigational” in current American Urological Association and Sexual Medicine Society of North America guidelines may drive some overly optimistic men to seek out these treatments over recommended options. A strong national or international voice is needed to lead these and other research efforts, advocate for our male population and educate the next generation of men’s health specialists (Fig. 1).

Men’s health should include all aspects of holistic care but high-quality MHCs have lost ground to commercially driven ventures focusing on profitable areas of male sexual and hormonal medicine. These for-profit clinics or virtual health platforms, many franchised at a national level, have aggressively marketed themselves on the web and social media. Conversely there are many examples of how to provide meaningful men’s health care within an MHC but these spaces tend to exist in isolation. Reputable MHCs, ironically modeled on multidisciplinary care, need to be better aligned and collaborative. Only with a unified and louder voice will we be able to move forward refining male-focused care, creating successful MHC spaces, advancing an advocacy and outreach agenda, and finally closing the life expectancy gender gap. I do not believe it is an evolutionary fact.