DEAR DR. ROACH: I am a 78-year-old man. Yesterday, I read that I am considered intersex because urine does not come out the end of my penis, but rather under the penis shaft. This does not surprise me much, but I am really curious about it. I want to see a psychiatrist just to talk about it. What do you think? — Anon.
ANSWER: Hypospadias is a common condition where the urethral meatus (the opening where urine comes out) is on the underside of the penis. About one male per 200 has this condition.
There are many, many DSDs, or differences in sex development (the term “intersex” is no longer used in medical literature, but some people with DSDs choose to describe themselves that way), which are conditions people are born with in the genitourinary system and reproductive systems that sometimes affect sex determination and differentiation. The terms used in this field are changing, as is the understanding of the complex biology. It is not as simple as many think — that a person’s chromosomes determine their sex.
Some of those born with hypospadias have other conditions that are commonly thought of in the large group of DSDs, but most cases do not have other differences in their genitourinary and reproductive anatomy. A common, and usually relatively minor, difference in sex development does not have to change your identity.
I am in favor of talking to a psychiatrist, therapist or other mental health professional to discuss your concerns. Questions about the function of the penis, whether urination or sexual, should be presented to a urologist.
DEAR DR. ROACH: Your recent column mentioned the need for a lot of calcium for bone health. As I understand, bones also contain a lot of phosphorus. Why is it that we do not get phosphorus supplements? — K.O.S.
ANSWER: Phosphorus is needed for phosphate ions, which, along with calcium, are the key mineral ingredient of the bone. Phosphate deficiency is quite uncommon in healthy people, since phosphate is found in many foods such as meat and dairy products, beans, lentils, nuts and cereals. Low phosphate is commonly found in unusual kidney diseases or hyperparathyroidism, but some gastrointestinal and metabolic diseases may also cause a low phosphate level. High phosphate is much more common in people with chronic kidney diseases, so much so that medicines to prevent phosphate absorption are universally used in people with severe kidney disease, and a low-phosphate diet is recommended.
DR. ROACH WRITES: Several people wrote in about the recent column on the studies from the U.K. and Florida that showed people who had the COVID vaccine are less likely to die than people who have not gotten the COVID vaccine.
Some asked whether I meant to say that COVID protects against all diseases and infections — no. All-cause mortality just means that people are less likely to die from any cause, not all causes.
People are protected against COVID, and since COVID is a major cause of death, and the downsides from the vaccine are very small, there is a net benefit in overall mortality. Some people have been concerned that the vaccines may have side effects that make the vaccines more dangerous than beneficial, but the data conclusively proves that they are not.
Several people wrote in to opine that those who get vaccines are more likely to take better care of themselves than a person who chooses not to get the vaccine. That would help explain the observed outcome, but there is no evidence to support that in the published data. Furthermore, some people have medical illnesses that preclude them from getting the vaccine, while others may get the vaccine and won’t respond to it. These may complicate the picture.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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