Dear Dr Ren,
I’m a 25-year-old gay man with a problem I didn’t think I’d have to be dealing with at my age.
I’m writing to you to get information before I see my doctor because I want to be knowledgeable instead of just panicked.
A guy I’ve been dating remarked on a lump on my ball while we were making love. I was taken by surprise but played it down because I didn’t want to get into it with him. I explored it later and now I’m really worried. It’s hard but doesn’t hurt. I really don’t know how long it’s been there. Can it be anything other than cancer?
If it is cancer, what happens next? How serious is this? If not cancer, what else could it be? What do I need to know before I get this checked out? Aren’t I too young for something like this anyway?
Panicked
***
Dear Panicked,
Though I’m sad that this has happened to you, I’m glad that you’ve chosen to write in with your concern, as this is an issue that is affecting more and more men of younger ages.
A colleague of mine who teaches a sexual health course at a major university tells me she has found two out of every 60 male students aged 21–26 reporting testicular lumps every semester for 20 years!
She now routinely “preaches” self-examination and urges partners to examine their lovers, much as heterosexual men are urged to pay attention to their lovers’ breasts for suspicious lumps. Early detection saves lives!
Lumps in the testicle in young men should not be ignored — they are almost always going to be malignant.
The problem for the lay public is distinguishing between a testicular versus an epididymal lump.
The epididymus is a tangle of ducts that rides atop the testicle and feels very much a part of it. These epididymal lumps are common and almost never malignant.
Getting to your doctor for a proper and speedy evaluation is important because they can determine where the lump is located and what treatment is appropriate. In questionable cases, imaging with an MRI is always very helpful and quite easy to perform.
You mention that you believe you are too young to experience this problem. Actually, that is incorrect. The important age range for testicular cancer risk is about 14 to 45 years. It is because we do not speak about sexual matters and do not educate our young men about the need to examine their ball sacs, that this potentially dangerous condition remains hidden in our society.
In fact, its incidence has increased over the past few decades. Why?
We have some theories. The first is pollution of our waterways. We know that the dumping of EDCs (endocrine disrupting chemicals) causes fish and frog populations to produce fewer and fewer males and, in some instances, male fish actually convert to female.
The role of these compounds in the development of male reproductive disorders has been a source of great concern. The connection with cancers is constantly being investigated.
Second, among the routes of human exposure to estrogens, we are particularly concerned about cows’ milk and other dairy products, which contain considerable amounts of estrogens and are a major source of animal-derived estrogens in the human diet. Today’s milk may be quite unlike that consumed 100 years ago and may be responsible, at least in part, for some male reproductive disorders.
Third, the rise in the incidence of testicular cancers parallels the popularity of disposable diapers. We suspect that the chemicals used in those diapers may be responsible, especially in cases of penile cancers in freshly circumcised boys placed in disposables before their wounds have healed.
Whatever the cause(s), it is vitally important that males understand the need to check regularly for changes in their testicles, just as women are reminded to do the same with their breasts.
Testicular cancer is more than 90 percent curable, especially if detected early.
Gay men have an advantage here. You are familiar with your own balls and those of your lovers. You notice when something is awry. Just as your lover alerted you to the lump on your ball, you now know that you can be aware and check others’ packages in similar situations. We can keep each other healthy by being subtly vigilant and speaking out when we notice something out of the ordinary.
Public awareness is important, too. Be fearless in telling others of your experience. Have your lump evaluated quickly. Proceed with whatever appropriate treatment is needed immediately.
Remember that epididymal growths are almost never cancerous and testicular cancers are almost always curable if treated swiftly.
Those in the gay community sometimes do not report their orientation to their health care professionals and sometimes hesitate to approach their doctors for sexually related medical concerns. This is a case in which such silence can kill. Tend to this NOW.
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