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The problem with men

The problem with men
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First Published: Sat, May 05 2007. 01 20 AM IST
Updated: Sat, May 05 2007. 01 20 AM IST
When it comes to health, one of the biggest risks a man faces in his lifetime is being a man.
At every stage of life—from infancy to the teen years to middle age—a man is at far higher risk of getting sick and dying than a woman. The average life expectancy of a man in the US—75 years—is more than five years shorter than that of a woman.
The reasons for the troubled state of men’s health are complex. Biology—such as the different ways men and women react to stress—likely plays a role. And men, taught since boyhood to be stoic, often are their own worst enemy, avoiding doctors and engaging in risky behaviour such as reckless driving that threaten health. Men’s health issues also get less public attention and funding at a time when women’s health concerns—such as breast cancer—are in the US spotlight.
There’s now a growing effort by doctors and health researchers to bring more resources to improving men’s health. Medical schools such as Johns Hopkins and Columbia University have created departments devoted to gender-specific medicine. Men on their own can take a few simple steps to boost their health. Doctors say that by focusing on a few key areas—blood pressure, cholesterol, waist size and sexual function—a man can make dramatic improvements in his overall health. One recent study in the medical journal, JAMA, found that preventing weight gain and alcohol abuse in midlife were two major factors in determining whether a man lived and stayed healthy until the age of 85.
“Men need to know that they are vulnerable, but that they can change things,” says Harvey B. Simon, an internal-medicine specialist and editor of the Harvard Men’s Health Watch newsletter.
Part of the problem is that for most of the past 30 years, issues of women’s health have been the focus of government research and private advocacy in an effort to atone for years of neglect of women by the health-care system.
Unintended consequences
Now some experts question whether the intense focus on women has had the unintended result of allowing men’s health issues to slide. Nobody thinks breast cancer should get less attention, but there is growing concern that the big killers of men—heart disease, prostate cancer, injuries and suicide—aren’t getting equal billing.
Even though men historically were over-represented in research, science still has not answered many questions about men’s health, says New York physician Marianne J. Legato, who was recently appointed adjunct professor at Johns Hopkins for gender-specific medicine. For instance, why do men typically have more abdominal fat—considered to be the most unhealthy type of body fat? Why do men have naturally lower HDL or “good” cholesterol than women? Why are men more vulnerable to heart disease at a younger age? Why are boy babies more likely to have health problems than girls?
On average, men at any age are 40% more likely to die than women. A 20-year-old man, for instance, is three times as likely to die in an accident as a woman. A 60-year-old man is 39% more likely to die of diabetes. And when diseases such as diabetes, heart disease or hypertension are diagnosed in men, they tend to be at a far later stage in the disease process, after extensive damage has already been done.
One of the biggest obstacles to improving care for men may be men themselves. Boys and girls receive similar levels of paediatric care—likely because their mothers are in charge of it. But after males reach adulthood, their participation in health care plummets. A Centers for Disease Control and Prevention (CDC) study found that even when visits for pregnancy are excluded, women are twice as likely as men to schedule regular annual exams and use preventive services.
Another survey found that three times as many men as women hadn’t seen a doctor in the past year. And one out of four men says he “waits as long as possible” before seeking help for a health problem, according to Harvard Men’s Health Watch. One problem is that while obstetrics and gynaecology are dedicated to women’s health, there’s no speciality dedicated to men. In surveys, about 90% of women report having a personal physician, while only two-thirds of men do.
“When women go to the gynaecologist, they don’t just get gynaecological problems diagnosed—the doctor checks her for diabetes, blood pressure, depression,” says Jean Bonhomme, a preventive-medicine doctor in Atlanta and board member of the Men’s Health Network, a nonprofit advocacy group. “But we don’t have anything analogous to that for men. We need to use the opportunities we have to bring men back into the health-care system.”
One such opportunity may be the success of erectile dysfunction drugs like Pfizer’s Viagra. Studies show that erection problems are one of the earliest warning signs of heart disease because the same unhealthy buildup that damages the arteries to the heart also damages the arteries to the penis.
Last year, the Archives of Internal Medicine reported on a study of nearly 4,000 Canadian men that showed men with erectile dysfunction were nearly 50% more likely to be diagnosed with diabetes or metabolic syndrome—a collection of health risks that are associated with heart disease.
The link between erectile health and heart health has triggered a new push in the medical community to use the “Viagra visit”—the time when a man asks his doctor for an erectile-dysfunction drug—as a way to screen men for heart disease. Teaching a man that erectile function is linked to cardiovascular health, diabetes and weight gain can help motivate him to make healthy lifestyle changes. “Sexual health is the portal to men’s health,” says Ridwan Shabsigh, associate professor of urology at Columbia University in New York.
Two major health issues for men—stress and depression—exact a serious physical toll on men, but are currently ignored by many doctors who treat men.
New research shows there may be major differences in the male stress reaction compared with the female stress response. The typical stress response is called “fight or flight”—a physical reaction to danger that helps the body rapidly mobilize energy, delivering glucose to muscles and boosting the heart rate and blood pressure. While the stress response protects us in the face of danger—such as fighting a war or fleeing a burning house—it causes damage if stress is chronic—as is often the case with job deadlines and financial worries.
Stress and evolution
In recent years, evidence has been mounting that women may be evolutionarily better equipped to cope with modern stress. She can still fight or flee if necessary, but in times of stress, a woman’s body also releases oxytocin—which is known as a bonding hormone. This has been dubbed the “tend and befriend” stress response and may help explain why women are more likely to seek counselling and confide in friends and family during stressful times.
A unique female stress response makes evolutionary sense. Imagine an ancient village being invaded by marauders. The men have to gear up to fight, but the best strategy for a woman may have been to gather children close, comfort them and surround herself with other women to help during the crisis. Though still only a theory, this coping mechanism may help explain at least part of the reason why women overall are more healthy than men.
And in the case of depression, twice as many women as men are diagnosed, fuelling the belief that depression is a woman’s health issue. But many mental-health researchers believe that the medical community is culturally biased to find depression in women and ignore it in men. For instance, one key question to diagnosing depression is to ask whether a patient has crying spells.
“We miss a lot of depression in men because we look for emotional expressions that men have been taught not to show,” notes Dr Bonhomme. “The first thing you learn as a young man is that men aren’t supposed to cry. When women are depressed, they may show sadness, but a guy may go to a bar and line up a whole bunch of drinks.”
But missing depression in men has proved to be deadly. Suicide rates are four times higher for men than women, according to the CDC, and between the ages of 15 and 34, it’s the second leading cause of death among men. (It remains among the top five until the age of 54.)
Doctors say men have the most power to improve the state of their health with just a few simple steps. First, be aware of your blood pressure and cholesterol numbers, and take active steps to lower both if they reach an unhealthy range. “Just focusing on those two single things can make a huge difference in longevity,” says Peter A. Gross, chief medical officer at Hackensack University Medical Center in New Jersey. “Men may think they’re more indestructible than women, when in fact, we may be genetically inferior to women.”
Next, men need to be aware of their waist size. Abdominal fat has long been a risk factor for heart disease. A waist size above 40 inches for men (35 inches for women) puts you in a danger zone. Don’t rely on your pant size, and instead take out a tape measure. “Men say their pant size hasn’t changed in years, but they have this strategy of just lowering their belt,” notes Harvard’s Dr Simon. “I think it’s another area of real ignorance among men.”
A recent JAMA study showed that preventing weight gain in men during midlife was also a major factor in predicting their longevity. It showed that men with excessive alcohol consumption—defined as three or more drinks a day—were more likely to die before age 85 or be unhealthy during their elderly years. Men don’t have to give up alcohol altogether—other studies show that one to two alcoholic beverages a day boost a man’s heart health.
A legacy of health
Fathers of young boys have the most to gain by taking charge of their health. Studies show boys tend to mimic the behaviour of their dads, while girls tend to copy their mothers, so a dad who takes care of himself and makes regular doctor visits can have a big impact on his son’s health as well. And parents of both sexes can work to dissuade the risk-taking behaviour in boys and teens that puts young men at such high risk for accidental death. Teaching boys that it’s OK to cry and that they don’t have to be stoic when hurt can go a long way toward protecting them as they age, notes Dr Bonhomme.
“You don’t have to retrain a whole society, but for the ones that are coming up now, we can, take a different tack and raise them to be more health conscious,” says Dr Bonhomme. “When a boy is 8 years old and skins his knee, he’s taught that if something hurts, don’t pay it any mind because it will go away. That works when you’re young, but it doesn’t work in middle age.”
Know the hazards
How much do you know about men’s health? Take this test to find out
1) For a man in his early 30s, which of these problems is a bigger health risk?
a. Heart attack
b. Cancer
c. Suicide
d. HIV
2) Which of these is a bigger health risk for men after the age of 55?
a. Diabetes
b. Accidents
c. Stroke
d. Respiratory problems
3) At what age do heart attacks become a bigger threat to men than accidental injuries?
a. 35
b. 45
c. 55
d. 65
4) On what parts of the body are melanomas (skin cancer) most commonly found in men?
a. His back
b. His face
c. His chest
d. His legs
5) What is the most common cancer?
a. Colon cancer
b. Lung cancer
c. Mouth and oropharynx cancer
d. Prostate cancer
6) What is the biggest cancer killer in men?
a. Prostate
b. Colon
c. Lungs
d. Pancreas
7) Erectile dysfunction in middle age is typically caused by:
a. Stress
b. Relationship problems
c. Low testosterone
d. Heart disease
8) How many night-time erections does an average man have?
a. 1-2
b. 3-4
c. 5-6
d. 1 or more
9) Does masturbation or frequent sex affect a man’s prostate cancer risk?
a. Sexual activity has no impact on cancer risk
b. An unusually high level of sexual activity is linked with high cancer risk
c. Frequent ejaculations are linked with low cancer risk
d. Nobody has ever studied this issue
1)a, 2)a, 3)b, 4)a, 5)c, 6)c, 7)d, 8)b, 9)c
(The answers to the quiz have been tailored to the Indian context by Dr. Aashish Contractor, head of Preventive Cardiology and Rehabilitation, Asian Heart Institute, Mumbai)
(Write to wsj@livemint.com)
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First Published: Sat, May 05 2007. 01 20 AM IST
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