The Medical Minute: Men's health needs more attention

June 25, 2003

By John Messmer, M.D.
Penn State Milton S. Hershey Medical Center

On average men die sooner than women and are more likely to suffer from more serious diseases. But the causes might not be biological. In 1920, life expectancy was almost equal for men and women. For babies born in 2001, however, life expectancy for males is 74 years and 80 years for females. Today, men are almost twice as likely to die from heart disease, one and one-half times more likely to die from cancer and have two and one-half times more accidental deaths. They are also three to four times more likely to die by suicide or homicide.

But these statistics aren't just bad news for men. Consider that 80 percent of elderly individuals living alone are women and half of the elderly widows living in poverty were not poor before the deaths of their husbands. Add the social cost to the cost of treatment and men's health becomes a significant problem for our nation - so much so that Congress has drafted legislation to create an Office of Men's Health.

Maybe the trouble has something to do with men making half as many doctor visits as women. Men are less likely to get a routine check up and less likely to see a doctor when ill. Some think this is because men are socialized not to appear weak or in need of assistance. We laugh at clichés about men refusing to stop and ask for directions, but the damage caused by high blood pressure, high cholesterol and diabetes that may go undetected is far more serious then getting lost on the freeway for a few hours.

Men who do not see a doctor regularly should consider a general exam even if they feel fine, fit and healthy. In addition, men from 15 to 40 should do a monthly testicular self exam to look for testicular cancer which is often completely curable when detected early. A cholesterol and blood pressure check at about age 18-21 can identify those needing early intervention. Besides a doctor's exam, there are some things a man can do to reduce the chance of health problems. Not smoking is perhaps the most important item. Next to this, regular exercise is vital. Maintenance of a normal weight can reduce the risk of many problems ranging from heartburn and snoring to heart disease, diabetes and cancer.

Men are much less likely than women to complain of depression even though men get depressed at about the same rate. This combined with a tendency to be more violent leads to a higher risk of suicide among men.

Although heart disease is more common and begins at an earlier age than women, there is not yet an effective screening tool for heart disease. Risk factors can be managed in most cases however, if men get to a physician for an evaluation. Men who experience symptoms of chest pressure, weakness, shortness of breath and so on can be tested for heart disease. Unfortunately, men are more likely to ignore or minimize symptoms of heart disease.

Erectile dysfunction (ED) occurs in up to a third of men by age 60. In most cases the cause is atherosclerosis - the same process that causes heart attacks and strokes - and may be prevented by the same methods recommended to reduce heart attack risk: not smoking plus regular exercise, balanced diet, control of blood pressure, cholesterol and blood sugar. Unfortunately many men do not address these problems until they develop ED - a sign that they may also be developing heart disease.

Colon cancer screening is now recommended for everyone at age 50 although insurance coverage is not universal. If colonoscopy can not be obtained, annual testing of stool for blood is recommended possibly with sigmoidoscopy which looks at the lower half of the colon.

Prostate cancer is the fourth most common cancer and the most common for men over 50. The interesting thing about prostate cancer is that older men are typically less at risk of dying from prostate cancer as it tends to be less aggressive in older men. In fact, sometimes the best course for an older man with a low grade prostate cancer is to do nothing. There is currently no well accepted and reliable screening test for prostate cancer although the prostate specific antigen or PSA is commonly used. It is most valuable for men at higher risk: African-Americans and those with a father or brother with prostate cancer.

Osteoporosis is more commonly associated with women, but men over 85 are also at risk for osteoporosis. Poor diet, inactivity, and sometimes medication, can contribute. Vitamin D deficiency from limited sun exposure can reduce calcium absorption. Older men should discuss a bone density test with their doctors since osteoporosis is both preventable and treatable.

Some men are extremely health conscious but the data shows the majority of men tend to neglect health concerns. The cure for that problem is education and awareness. Men in general must understand that it's not a sign of strength to ignore preventable problems. Just as you can't expect a car to continue to function without preventive maintenance, you also can not expect your body to provide continued service into old age unless you take it in for a check up once in a while.

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Last Updated March 19, 2009