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DEAR DR. ROACH: I read your recent column stating that the HPV vaccine is recommended up to age 45. Are people older than 45 years no longer susceptible to HPV? Asking for a 52-year-old friend (who thinks he’s Wolverine). – C.F.
ANSWER: The comic character Wolverine has a mutant healing ability (that’s how he was able to survive having his bones replaced with adamantium), so he has nothing to worry about. However, non-mutants do have to worry about HPV, which can come from any kind of skin-to-skin contact with a person who has HPV.
Having the virus often means having warts, but sometimes people can have contagious HPV without having any visible lesion. It’s been estimated that 90% of people with HPV don’t know they have it.
People of any age are susceptible to HPV. Most people have been exposed by age 45, which is why the recommendations are the way they are now, but vaccination might make sense in some situations. The clearest example is someone who has had very few sexual partners and is about to become more sexually active (for example, a person recently divorced or widowed).
Although the vaccine is not indicated by the Food and Drug Administration in this situation and the person is likely going to have to pay out of pocket, it might still be worth it to get the vaccine to reduce the risk of acquiring a new sexually transmitted HPV infection. I received several letters from people who acquired new genital warts in just this situation who were upset that their doctor did not offer the vaccine.
If people have already been exposed to HPV, the vaccine will not harm them. In fact, there is some anecdotal evidence that the vaccine might help people with difficult-to-treat warts by boosting the immune system specifically for HPV.
DEAR DR. ROACH: I’m a 79-year-old male in relatively good health. During the past year, I have lost underarm hair. What could be the cause? And is there a connection with the inability to get aroused? – A.F.
ANSWER: I would be concerned about low testosterone. Androgens, particularly testosterone, are responsible for growth and maintenance of body hair. Loss of body hair, especially pubic and axillary hair, is not common with low testosterone levels unless the testosterone was very low for a long period of time, usually over a year.
Other symptoms of low testosterone include loss of muscle mass, lower energy levels, decreased libido and depression. Not all men will get all symptoms, but having more than one symptom is suggestive of low testosterone, especially in men who have difficulty getting an erection. Your doctor should check your testosterone. Ideally, the sample should be drawn while fasting between 8 and 10 a.m. when levels are normally highest, and should take into account the age of the person being tested.
Testosterone replacement is appropriate for men with symptoms of low testosterone and clear evidence by laboratory of a repeatedly low level. Testosterone replacement is safe for most men, but is generally not given to men with a history of prostate or breast cancer. Testosterone should be given with caution to men with obstructive sleep apnea and men with symptomatic prostate enlargement.
The data so far suggest that testosterone replacement in deficient men does not increase risk of prostate cancer.
Dr. Roach regrets he is unable to answer individual questions, but he will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
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