205: Almost 40? Here’s What Actually Matters

Scot: All right. Milestone birthdays, guys. Mitch just kind of had . . . He's getting close to one. John, I think today's conversation really is a therapy session for Mitch. Just letting you know.

Dr. Smith: I love it. I'm down.

Scot: But no, I think anybody that's heading in towards a milestone birthday could hopefully get some value out of this, because that's what this is all about. So Mitch is heading towards 40, and at his last birthday, he's not 40 yet, I guess some of your buddies had a few thoughts about you getting closer to 40. What went down?

Mitch: It was a subtle but significant change in how people were joking about the age. I had a very serious conversation with one of my friends who's a little older about just, "Hey, man, it's time to buckle up. Everything's going to go downhill."

Scot: Buckle up.

Mitch: Yes. My birthday cards went from, "Ha-ha, let's go get drinks and be goofy," to over the hill, there was a 3D Grim Reaper that says, "Not yet," etc. And so I don't know, man. There was something about this birthday that was different than any of the others, so I called in the brain trust.

Scot: All right. So that's what we're going to talk about today. And I think the crazy thing is it's not like you're 40th. Over the hill and the Grim Reaper cards, John, have you gotten those yet? Has that hit you?

Dr. Smith: So when I was in medical school, I went to medical school when I was 30, and I think my second year of med school, I got together with my friends, and they gave me a bag of Depends, like a package of Depends.

Scot: That's too early. What are we doing?

Dr. Smith: It might have been foreshadowing of the urology, but I don't know. It seemed a bit aggressive at the time.

Scot: Yeah. That seems way . . . Mitch's friend's seems a bit aggressive too. Over the over-the-hill balloons, 50 maybe, 60, but he hasn't even . . . All right. So today's show is what guys should know about heading towards 40. We're going to talk about that on the podcast, not only from an emotional health aspect, a physical health, the appearance factor, but any other ways that we might be able to. We've got to help Mitch through this, because I think these cards really shook him.

This is "Who Cares About Men's Health." Information, inspiration, a different interpretation of men's health. My name is Scot. I bring the BS. The MD to my BS, Dr. John Smith.

Dr. Smith: Good afternoon, gentlemen.

Scot: And Mitch, who is on the health journey of his own. He started out with this just being a job, and now he actually does care about his health, which I think is the best testimonial for this podcast possible. So Mitch, thanks again for letting us talk about your life.

Mitch: Absolutely.

Scot: Yeah. So do you hear about this or is this anything guys bring up in clinic, Dr. Smith? This milestone birthday anxiety, whether it's 30, 40, 50, 60, 70, 80. I mean, that's a lot of years I just rattled off. Do guys talk about this? I tend to believe this is probably more of a cultural thing than a medical thing, but what's your experience?

Dr. Smith: No, I have guys come in all the time, and there's either an event or a birthday or something that puts them in that sphere where . . . For instance, I had one gentleman come in and had a family member who was younger than they were had a heart attack.

Mitch: Oh.

Dr. Smith: And so they came in and they're like, "Hey, doc, I need to get all this stuff taken care of. I want to lose weight. I want to get healthy, all that, because this happened."

Or a guy that's in his mid-40s will come in and go, "My brother, who's 15 years older than me, just got diagnosed with prostate cancer and I need to know what to do."

Those are the things that I hear, but there are some folks who come in and they're like, "Yeah, man, I just turned 40. I need to come in and get things checked out. What do I need to do at 40?" Or X age. It hits everybody differently, but there are those milestone ages.

Scot: All right. Hey, Mitch, I should circle back around. When you got all these things from your friends, the Grim Reaper cards, the over the hill balloon, what was going through your mind at that point? What were you thinking?

Mitch: See, I hit 30, no big deal. That one also had a whole lot of extra pressure to it. I had friends being like, "Oh, no, 30 is when you're no longer young. Everything's downhill from here." But it was kind of a joke.

But there were a couple of interactions that were a little more serious than I thought I would think about, and so all of a sudden, it kind of hit me and I'm just like, "Oh, no, I'm still a couple years out, but if there are people who are currently in their 40s who are telling me, 'Hey, buckle up, partner,' that is . . ." It set me a little back. And I tell myself, "They're probably not . . . You're fine. Everything's fine." But man, I don't know.

Scot: Yeah, it's hard to sort through what's just birthday ribbing versus what is something that you should legitimately be concerned about.

Mitch: Yes.

Scot: Yeah. I don't know if it's worth talking about or not, but let's start here. What about the appearance factor, Mitch? Is that a concern for you? Do you think you're looking so much older than almost 40 that . . .

Dr. Smith: Or have your eyes gone already and you can't even see what you're looking at anymore?

Mitch: Well, that's actually maybe part of it. My eyesight has been getting worse and worse over the last couple of years. I've had Lasik since my 20s and all of a sudden I'm wearing glasses, talking about readers, and I'm not even 40 yet.

So there's something about that too where there are some physical changes that are happening. I'm wearing glasses. That makes me feel a little bit older than I would before when I look in the mirror. I'm also seeing some wrinkles, but that doesn't quite bother me too much, around the laugh lines and things like that.

I'm starting to pick the first bits of gray hairs, and I've got this stray eyebrow hair that gets long and thick and crazy every so often, and I'm just like, "What is happening to me? When did this happen?" But it's minor, and it's not like, "Oh my god, who am I?" or terrified of mortality, but I am starting to notice some things.

Scot: Yeah. So I would imagine, Dr. Smith, the appearance factor probably isn't something we should worry about too much, or is it? What's your thought on that? Is there a self-worth thing or is there something in our appearance that could tell us something more about our health otherwise?

Dr. Smith: I mean, some of those things, yes. Some of the things we do can affect the way our skin looks and things like that, sun damage. Some substances can change the look of your skin. People who smoke, things like that, you will see changes in the appearance sometimes a little sooner than others.

But those are the big things that . . . sometimes in men they care less than, say, our female counterparts. But I think guys are more cognizant of that these days, for sure.

Scot: That's interesting that you said . . . So maybe as you're getting older, if you're noticing that appearance thing, maybe that's a good little hint to check in on some of your lifestyle stuff. When you're 20 and you're drinking through your 20s or doing bad behaviors through your 20s, when you hit 30 it doesn't necessarily show as hard as if it's been going on for 30 years.

Dr. Smith: Yes.

Scot: Yeah, the cumulative damage of sun or whatever.

Mitch, you mentioned the physical thing. You mentioned the readers. I've got to tell you, I had heard that when you turned 40, that's when your eyesight starts to go. And for me, it was kind of 42 or 43 where I had pretty stable eyesight, and then it started to kind of get a little bit worse.

Dr. Smith, is that something that you've noticed with guys, and is that something that you should be concerned about necessarily, or is that just part of getting older?

Dr. Smith: It is part of aging. So it was explained to me . . . I worked with an ophthalmologist when I was in residency, and he said, "You do start to see changes in your vision, and some of it has to do with just the body changing."

He explained it to me, and I'm not an eye doctor by any stretch of the imagination, so any of our listeners that are can reach out and fact-check me on this one. He said that the fat pads surrounding your eye, you start to lose some of that plumpness of that as you get older. And so it changes the actual . . . If you know anything about optics, it changes the distance between your lens, and so it changes the way your eye can focus. That's why you start to see it as you get a little bit older.

And for some people, it's in their late 30s, early 40s. Definitely by the time you hit 50 is what he told me. But take that anecdotally from an ophthalmologist that I worked with.

Scot: Right. A urologist talking about what he learned from an ophthalmologist when he was in residency.

Dr. Smith: Yeah. That sounds like telephone at its finest.

Scot: It does a little bit, doesn't it? I guess we have to keep in mind that Dr. Smith is a urologist in this conversation, and we probably have to have some very specific conversations with an ophthalmologist to see if there is a certain amount of vision changing that you should expect versus is there something that's troubling. Because that's kind of what this is about, right, Mitch? What do you need to be concerned about?

Mitch: Yeah.

Scot: So it sounds like, generally, eye change issues aren't necessarily super concerning.

Mitch: No. I did go to a doctor the minute I started to notice it, and he's like, "It happens." And I'm like, "So everything's fine? I just need you to say these words to me," and he did.

Scot: What other physical things, Dr. Smith, should guys start thinking about when they hit their 40s, not only from a standpoint of particular health concerns that might start arising when they turn 40, but just behaviors that they should start considering doing in order to make sure that when they hit 50, it's not just a Grim Reaper card? You know what I'm saying?

Dr. Smith: Sure. Well, I think a lot of the things that we tell people all the time are healthy weight is one of the best things for all-cause mortality and cancer risk avoidance, is maintaining a healthy weight. And so if you can keep your weight at a healthy weight and just be as healthy as you can in that regard, that's probably the number one thing that's easy to do and hard to do at the same time.

Scot: Right? Thank you for saying that.

Dr. Smith: Yeah. I mean, it's easy to say, right? "Yeah, just lose some weight." But then there are some changes physically. I have a lot of gentlemen who we have on testosterone who their bodies are not producing as much, and so they have difficulty losing weight or they have difficulty with those things like losing weight. When they go to the gym, they have a tough time recovering and those types of things where their energy levels are down and things like that.

So those are things to go in and talk to your doctor about, and get your primary doc to just order some lab work or something, if that's the case. But those are things that definitely men should look out for.

And then just overall cardiovascular health. There was a study that I read when I was in med school, in residency that said that your cardiovascular health in your 30s dictates things down the line because you've set that benchmark.

I think we've mentioned that before on the podcast, but, again, that goes back to healthy weight, exercise, and these healthy habits that we're trying to build and maintain.

Scot: Mitch, when you think about closing in on 40, what physical changes worry you the most or what physical health things worry you the most?

Mitch: Well, for me, especially since being on this podcast, etc., it is more like making sure that I can still function and live and have a good quality of life as I do get older.

It's funny that we mention making sure you're in a healthy weight range and stuff like that. I'm working on that right now. It's taken me a lot longer than it used to when I was younger, but I know that that will pay off for a long, long time if I can maintain it.

But as I'm hearing people joke about, "Hey, enjoy your knees working as they have before right now," I'm just like, "My knees are fine. What do you mean my knees are going to go out in a couple years?" It's that kind of mobility functional thing that is catching me off-guard when people are bringing it up. It's like, "Oh, I don't even know what to do to fix the knee."

Scot: Dr. Smith, what's your take on people that say something like that, that say, "Oh, enjoy your knees while they work"? Is it because those individuals weren't using their knees? Is it just your knees are going to start wearing out as you get older? What's going on there?

Dr. Smith: A lot of those people probably have had injuries. I had some knee injuries when I was younger and my knees definitely feel it when I wake up. I definitely have some arthritis there. And so some of them probably have that and they're just giving their lived experience to you, a lot of those things.

And then there are certain people, like I mentioned earlier, they have family members or friends who have health problems and there might be genetic things of high cholesterol, things like that, that we can look at.

When we talk about good quality of life and things like that down the road, those are things that we can look for. Talk to your family, have an open conversation. "Hey, Mom, hey, Dad, do we have any health problems in our family that seem to be there? I know grandpa was sick before he passed. What was going on there?" Get to know the family history side of things of your family and it can really pay dividends.

And then if you know that you have a family history of high cholesterol or high blood pressure or diabetes when people hit their 40s or 50s or whatever, keep an eye on that. Get those labs done. Go to your primary doc. Let them know your family history, and they can order those labs and keep an eye on that. Be proactive, I think, is the number one thing.

Scot: From a urologist's point of view, what are some things that somebody that's heading up towards 40 should keep in mind?

Dr. Smith: So I think keep an eye on function. Usually, urinary function starts to decline in the early 50s into the 60s. But being proactive in your 40s of making sure you keep your health healthy, watching those things, looking out for a possibility of fatigue, things like that that may be testosterone driven. And if you do have any issues, be proactive.

From a urologic side, there's not a lot of things you necessarily need to do at 40. Back in the old days, they used to do rectal exams starting at 40s, and that's kind of fallen out of favor in the primary care space. In urology, we'll still do them for folks. But those are kind of the things we look at.

But I think the big things in urology that I see are just watching your urinary health, making sure that the flow is maintaining a good steady stream, things like that.

There are people who have earlier onset, what we call, lower urinary tract symptoms, which are frequency, urgency, waking up more at night, hesitancy to get started, feeling like you have to strain to empty your bladder. I mean, those are things that you can watch out for in your 40s no problem and easy things to do.

If you go to the golf course, you golf nine holes with your buddies, you go pee three times, they don't go at all, that might be something to think about, right? Those are the little things that sometimes guys don't think about, but then they'll end up in my office in their 40s, and they'll go, "Doc, I'm peeing all the time." And then sometimes there are some of those things that you want to come in and have a conversation about. So if something does seem a little off, get in.

Scot: This is so funny. It's kind of like when you were kids and your buddies would tell you about sex, right? It was always a lot of hearsay and speculation and probably made-up stuff.

So is there anything that you really want to sort through because you've heard other guys say and you're like, "Is this true or is this speculation?" You kind of already got there with the knees, right? There could be a lot of reasons why these guys' knees are going bad. What else is going on with you that way?

Mitch: Well, that's the kind of thing that I feel like I'm in a good spot with this podcast, with the different approach to my health, etc., is that I'm kind of now a person who goes and talks to a specialist whenever I have a question, right?

I was having some urinary issues, and I went to a urologist. We talked, and I got a medication, and I'm good to go, right? I worked with Dr. Smith to figure out my testosterone because I was feeling lethargic, etc. I was having conversations with the men in my life, the men in this show, etc.

And so I can't quite think of anything that would be super pressing right this very moment, but . . .

Scot: John, check out how cocky he is now all of a sudden.

Dr. Smith: Hey, man, when you're the youngest guy on the podcast, you can kind of swing that around a little bit, right? I mean, I'm not mad at him for it either. Good for him. He's in a good spot. Man, tell it.

Scot: Yeah. Before we move on, I'm going to come back to this idea that I think that these stories and these cultural rumors, made-up facts start happening where somebody does say something to you like, "Oh, you better enjoy your knees while you've got them." Then when your knees start going bad, you just go, "Well, I guess it's just part of aging."

As opposed to the approach you're taking, Mitch, which is, "Hey, wait a minute. This doesn't seem quite right. I'm peeing every three holes when I go out and play golf with my buddies." That wasn't you, by the way, but that was the example that was used. "Is that just part of getting old? Or maybe I should talk to somebody that can give me the real deal as opposed to listening to my friends on the playground." You know what I'm saying?

Mitch: A hundred percent.

Scot: Yeah. So I just came to that, guys. I guess we could end the podcast. I think that would be the big takeaway message, probably.

Let's talk about mental health, though, and maybe come up with some of these things that you hear about with your mental health. So do milestone birthdays get in your head, Mitch? Anything there like stress, purpose, identity?

Mitch: It didn't until someone started to make fun of the age thing, and then I second-guessed myself and I brought you guys in on this episode. But there is something that is happening where when I hit milestones, I get really reflective, right? Like, "How was the last decade? How were things going?"

And for me, this last 6, 7 years of my 30s was very much finding a stable place, whether it be financially, whether it be in my relationships, my mental health, my physical health, etc.

And as I'm now sitting on the other side of that and I'm staring down that 40, it's like, "What's next? What am I supposed to be doing? Am I behind?" Those thoughts do show up every so often. I don't find myself just really zoning in and hyper-focusing on them, but it does kind of come up every so often. Just, "What am I doing? What am I doing here on this earth?"

Scot: John, did that happen to you when you hit those milestones, or not so much?

Dr. Smith: I'm too dumb for that stuff to hit me, to be quite fair.

Scot: You're a creature of the present and not the future.

Dr. Smith: Well, I tend to tell people I'll still go play basketball or something, and I still think I'm 25, until I get half a game in and I realize, "Dude, this guy is blowing by me. What's wrong with me?" I'm like, "Oh, yeah, you're 44 years old, dude. And he's 20. That's the . . ."

Mitch: Sure.

Dr. Smith: I don't know. I just think, to me, I guess some of that stuff doesn't hit me, but there have been other things that I think have hit me when different things kind of hit home. When things happen to other people, I think I reflect a little bit more than on myself in the present moment.

Scot: For me, milestone birthdays really didn't impact me too much. It was more things that happened in my life that might have been kind of around those milestone birthdays.

But I think your experience, when I hear that, I'm like, "Reflection's not bad, though." And really, it should be happening more than every 10 years. Maybe that's the takeaway from the purpose and identity part of that. "What am I doing here? Am I heading the direction I want to go?" But when I hear you talk about where you are in your journey right now with stability, it's like, "Stability in your 30s before you hit 40s? My gosh, that sounds incredible."

Mitch: I didn't think it would be possible, but, yeah, it's getting there.

Scot: I don't know that I hit that point. Are there other concerns you have when it comes to the mental health factor as you get older?

Mitch: I mean, it's really hard for me not to compare to the Joneses every so often. I look at some of these other guys in their 40s and some of them got into Bitcoin at the right time and they're flying high and doing super cool things. And I've got friends who are out doing one thing or another.

I don't know. Every so often, it does feel like . . . I feel like I'm a little behind sometimes, but I know that's just a bit of self-doubt kicking around up there. It's a little bit of a social construct thing going on.

But yeah, I do find myself thinking about that a little bit more when I approach these milestones in my life.

Scot: Have you ever talked to your mental health professional about, like you said, the comparison thing or the purpose or the identity? Is that a topic you've broached with them? Do you have any insights for us maybe?

Mitch: The kind of advice that I've gotten . . . I mean, I had a very unique experience with my mental health stuff, so it's not for every single person. But my guy was just like, "Recognize that a lot of your thinking is just that. And it is impacting your reality."

I was the one that was . . . It's like when you start feeling these things, go back to finding gratitude in your life. When you run into these types of thoughts and ideas, find out why you're feeling that way.

I mean, some of the stuff is if you are feeling jealous, that means that you are lacking something in your own life, right? What is that and what can we do to achieve it?

It's that kind of pausing, stopping, thinking about it, etc. It has gotten a little harder to do the last little while, but I think that that is really the way to fight some of that.

I mean, I haven't talked to him about the, "Oh my god, I'm almost 40," kind of thing, but I think those general things are probably the most helpful for me.

Scot: Right. I like that. And just like the physical health aspect, the mental health aspect of it, too, is you hear people talk about, "Well, you should be having your midlife crisis now." So then that starts getting in your head a little bit.

And even though you have a solid understanding of some of the things you can do to battle this idea of comparison or not feeling like you've accomplished what you wanted to accomplish, when people say things like that, it makes it a little bit harder to believe that, I think.

All right. So let's switch gears to what we really should be focusing on. Dr. Smith, I think you've hit on this a couple times, so summarize and then add anything else that you think really matters at 40 versus the things that just are kind of what we all joke about.

Dr. Smith: Yeah. I mean, I think there are some things to really dial in, and we've kind of talked about some of them. If you do have those concerns, family histories, look at those things.

And then the things that really do matter, I think, again, it's the Core Four. We talk about those things. And some of those are dialed in here, like maintaining healthy weight, but also, if you're noticing that you are having things that seem different . . . You do go on a foursome golfing and you notice you're peeing a bunch of times or your sleep seems to be disrupted for whatever reason or you see these things, I think those are the things that really . . . At 40, those are kind of not normal things per se, unless they've been things that you've struggled with your whole life.

Some people struggle with sleep. Some people struggle and they've had urinary problems their whole life, or they've had these different things go on in their life where they're not necessarily abnormal for their life. But when you see these changes . . . Like Mitch said, the second his eyes started going, he went into the doctor.

And I think that's the big thing I would just blow the whistle on for these folks, is say, "Hey, when you do notice these things, get in there."

I think in my practice, a lot of these guys come in because they've already done the due diligence and their primary doctor sent them over to me to talk about testosterone replacement or to talk about some of the things that they're having difficulty with, with the urinary function or whatever. And so those are the things I see most commonly that guys come in and they're really concerned about, and with good reason.

Scot: I feel like Mitch's friends did him a grand disservice in trying to be funny at his birthday, because I don't think 40 is really a thing that you should be all that concerned about at this point unless there is something that's going on. And then don't just assume that, "Well, my friends were right. This is just all part of getting older." Don't make that assumption. That's my big takeaway, I think, from this whole episode.

Mitch, what's your big takeaway?

Mitch: Well, just piggybacking on that, I wonder if some of these friends of mine have not . . . If they're listening, hello. If maybe there wasn't a thing you were concerned about that you got looked at in your 30s and you ignored, and then you ignore in your 40s, and now you're dealing with that, right? I just sometimes wonder if that's going on sometimes.

But I think the real takeaway for me is just that as long as you're making progress, as long as you are moving in a direction that feels good, that you have more relatively positive moments than not-so-positive moments in your brain, I don't think it matters what age you're at. Just keep on keeping on.

I thank both of you for giving me a bit of perspective and a reminder that maybe I'm just fine.

Scot: All right, John. Should we now really tell him what the real deal is?

Mitch: Oh my god.

Scot: Let me break it down for you. We'll cut out the podcast for five minutes, we'll give you the real deal, then we'll come back.

Scot: This Kumbaya Fest. I will say as I got older, so as I hit 40 and then as I hit my next decade after that, I think it's okay for our priorities to change. In my 40s, when I hit 40, I still wanted to put on muscle mass, so I was doing stupid workouts, these 5-by-5 workouts where you do five sets at a weight that you can only do five reps. And I'm lucky I didn't hurt myself.

I had a hard time getting out of bed the next day, and that was every single day. And that was the point where I asked myself, "What are we really trying to accomplish here? Are we trying to be healthy, or are we trying to achieve some physical appearance thing that I'm not ever going to be able to achieve because I don't have the time, I don't have the ability to be disciplined with the diet or the exercise or maybe even the genetics?" As we learned when we talked to our bodybuilder on this podcast so long ago.

So I think it's okay to reflect and change some of those priorities. I think it's okay to reflect and go, "All right. Well, I'm about to hit this milestone. Am I on track?" And maybe even reflect more often than that.

I think it's important, too, to just kind of maybe think that people just like to have fun at our expense. And that's just kind of that.

Dr. Smith, do you have any takeaways from this episode? Anything you'd like to add?

Dr. Smith: I want to give Mitch big-ups for taking care of yourself and getting in and doing the things, because this is what we preach, right? Not that we're preaching, but we get on this podcast, we talk about the Core Four, we talk about taking care of yourself, we talk about all those things, and I think Mitch has shown us right now he's doing it, right? He's walking the walk. He had his eye problem. He went in and saw an ophthalmologist. He had some fatigue. He went in and saw a urologist. He got those things taken care of, right?

And I think my take-home is just do the thing. A lot of this stuff is simple. It sounds stupid, right? "Just go do the thing." Well, yeah, that's easy, but is it? To make that appointment, you do have to take time out of your life. And a lot of us, if it's not a priority, we won't do it.

Those are the things, I think, that are the main thing that's my takeaway, is I want to be more like Mitch. I want to step up and do the thing, because there are a lot of times that I ignore those things and I shouldn't. You know what I mean?

Scot: And let me throw in there that one of the things that was brought up is just having those conversations about health history. That can really help determine what things you need to do.

All right. A lot of good stuff in here. Mitch, thank you for letting us talk through this with you.

Mitch: No, thank you for putting my mind back at ease because I've been . . . I don't know. I've been looking at this pop-up Grim Reaper card for way too long the last two weeks.

Scot: Dr. Smith, I just pictured Mitch sitting in the dark opening it and closing it. Opening it, it pops out with its little scythe, closing it.

Dr. Smith: His reading light is on right over his bed, just staring down, and he's just . . .

Scot: Or a candle . . .

Dr. Smith: . . . looking at it.

Scot: . . . to add to the creepy factor. Open and close.

Mitch: Yep.

Dr. Smith: Does it have one of the voice things when you open it that's like, "Ha-ha-ha"?

Mitch: Oh, no. Thank God it didn't. It was, like, a funeral march or something? Yeah.

Dr. Smith: That would have made it a little bit more appropriate.

Scot: "I shall see you soon, Mitch. Ha-ha-ha." All right. That was enough silliness. Let's shut this thing down.

Guys, if you have closed in on a milestone birthday and had the same experience and there's something you'd like to share with Mitch, I'm sure he would welcome your thoughts and advice. You can reach out to us any time, hello@thescoperadio.com.

Thanks for listening, and thanks for caring about men's health.