Sept. 17, 2024 -- We know that men are more reluctant than women to seek health care and self-care. But even among men, there are gaps in who gets regular care and who doesn’t.
Despite signs that gender gap might be slowly changing – a Cleveland Clinic study recently found that most men in the U.S. prioritize healthy lifestyles, and more than half of Gen X and Boomer men reported getting a yearly physical – statistics paint a different picture.
Last year, a study done by Harvard researchers revealed that the life expectancy gap between men and women had grown to as much as 6 years. Men are four times more likely to have an abdominal aortic aneurysm. They’re more likely than women to get chronic conditions like gout or bladder cancer, and die by suicide or drug overdose, or heart disease. And they are less likely than women to seek preventive screenings.
As men age, they tend to start taking their health more seriously, and that’s a trend that needs to change, experts say. Younger men, many of whom say they don’t have a primary care doctor or have ever had their blood pressure, cholesterol, or weight checked, need to start getting engaged earlier.
Sean Cavanaugh, a 55-year-old visual artist from New York City, said that after his primary care doctor left his insurance network, he still hasn’t looked for a replacement.
“I know that I should have a shingles shot. I haven’t had a colonoscopy. I need a full workup – bloodwork, etc. I’m not unrealistic, but I feel like I spend most of my time taking care of others,” he said. “If something is really wrong with me, I’ll [seek care].”
Scott Stephens, a 62-year-old retired consultant based in Middleburg, VA, said he didn’t even start to think about his health care until he reached his 40s, a time when his father developed prostate cancer.
“I don’t get sick. I’ve never had the flu, never needed antibiotics; everything I’ve gone to the doctor for has been self-inflicted broken bones, stitches, things like that,” he said. “It’s only more recently that I’ve started to be really proactive,” he said, sharing that he is on blood pressure medications and has a leaky heart valve that his doctors are keeping an eye on.
Hindsight is 20/20
There are various reasons why some men might not be as proactive about their health as their female peers. Strong beliefs about masculinity (for example, the need to be stoic, “power through the pain,” and provide for loved ones) play a significant role, as does a perceived stigma against showing any possible weakness. There’s also a superhero factor, especially in younger men.
“When you’re in your 20s, 30s, you’re indestructible, you’re Superman,” said Stephens. “It’s also a badge of courage; why should I go? I don’t need to call my doctor,” he added. “There’s got to be a life-changing event, whether it’s an illness, somebody close to you drops dead from a heart attack at a young age, or you start having children.”
This kind of thinking is common, said Ryon McDermott, PhD, a professor of clinical and counseling psychology at the University of South Alabama in Mobile, and past president of an American Psychological Association division that focuses on the psychology of men and masculinities.
“These really traditional gender roles, like the idea that men can’t seek help and have to be self-reliant, are by far and away the strongest predictors of stigma around health seeking and avoidance of health seeking,” he said.
“We’re taught from an early age to internalize everything,” noted Stephens. “So-called real men don’t seek out mental health [care].”
But McDermott warned that this type of rigidity tends to backfire.
“Medical issues are exacerbated by psychological problems, and vice versa,” he said. “The connection between depression and diabetes is a classic example. Men also tend to externalize a lot of their psychological distress into some really problematic behaviors – PTSD for example, excessive drinking, overworking, unprotected sex – which, in turn, create their own medical problems, from heart disease to sexually transmitted diseases and HIV,” he said.
Fear likewise appears to play a role.
“I’ve had many patients in the past who may have been dealing with something for a long time, and it took them years to build up the motivation to come in. On some level, they knew something was wrong but were scared to go to the doctor,” said Petar Bajic, MD, a Cleveland Clinic urologist and director of men's health at the Glickman Urological and Kidney Institute in Cleveland. “Sometimes, time is of the essence, and the sooner we can intervene, these problems can actually be reversible. If you put things off too long, damage can be done that is not reversible.”
Old Dog, New Tricks
Most athletes would not go onto a sports field and play a game without first talking to the coach or checking the playbook. The same is true for health care, which has its own playbook in terms of when, if, and how to be screened for certain diseases. And that playbook is not kept in an urgent care facility, a common and convenient go-to when problems arise.
Too many men turn to urgent care for treatment they should be getting from a primary care doctor, said John Messmer, MD, a family medicine doctor and geriatrician at Penn State Health in Hershey, PA. “Their job is not to take care of your long-term health, and they might not even take the time to ask if you’ve had various screening tests.”
Another important and fairly common issue is where men – especially Gen Z and Millennial men – are getting their health information. Technology has its limits, Messmer said. Depending on the source, “it’s like diagnosing health care through the lens of a first-year medical student (who might actually be better),” he said. “People are self-medicating, self-regulating, and not necessarily following up with a primary care physician,” he said.
Establishing an early baseline can mean that it won’t be too late to learn a new trick or two, not to mention ensuring that you stay as healthy as possible throughout your lifetime.
In your 20s or 30s?
This is a great time to lose the technology bug and make an appointment for baseline measures.
“Men should first come around age 21 for general health maintenance,” said Messmer, noting that it’s also a good time to start measuring cholesterol, especially if there is a family history. “Maybe they have a father or grandfather who died of a heart attack, never had a problem but had high cholesterol their entire life. Here, we’re looking at a dementia risk, and if you’re depositing cholesterol in your arteries throughout your life, you’re going to advance problems that could have been prevented,” he said.
Other concerns include weight, blood pressure, diabetes, and discussions about diet, physical activity, smoking, and drug/alcohol use. This is also the time to start self-examination of testicles to avert testicular cancer, Bajic said.
Messmer said if nothing is found that requires closer attention, he recommends one or two more appointments for men in their 20s, and three or four for men in their 30s.
In Your 40s?
“We’re seeing colon cancer in younger patients, which is why the guidelines now recommend screening at age 45 instead of 50,” said Raymond K. Cross, MD, director of the Center for Inflammatory Bowel and Colorectal Diseases at Mercy Medical Center in Baltimore. But take note! There are noninvasive alternatives to traditional colonoscopy like tests that check for hidden blood in stool samples.
Like others, Cross reinforced the need for primary care providers. They can capture the development of sudden digestive symptoms, low blood counts, or anemia. But Cross also said colon cancer can be silent, much like high blood pressure. “The later you find it, the more likely it is to spread outside of the colon into the lymph nodes, where it might not be curable,” he said.
Colon cancer screening should start when men are in their 40s, and then repeated every 10 years. For men with family histories, Cross said a first screening should come 5 years earlier than the age the relative was diagnosed and be repeated every 5 years. The same rings true for prostate, bladder, and kidney cancers, said Bajic, noting that family history should not be ignored.
At least two routine physicals are recommended during your 40s.
In Your 50s or 60s?
“I’ve had people say that if they knew that they were going to live this long, they’d have taken better care of themselves,” said Messmer.
Aside from common issues with bones and muscles that tend to raise their ugly heads in the form of arthritis during a man’s later years, Messmer emphasized that the 50s and 60s are the time that urologic issues tend to crop up. And although things like erectile dysfunction might bring men into the office, he said that those visits often provide a chance to explore sexually transmitted infections and prevention, which data has shown have increased in alarming rates among older people.
At minimum, older men should plan on a yearly physical, depending on their overall health, said Messmer. Immunizations, especially for the flu, COVID-19, and shingles, are also important, especially in men with other conditions.
Finally, regardless of age, it is never too late to start taking care of one’s mental health. “The brain and the body are obviously, very connected, said McDermott.
