MEDICAL MATTERS:Unlike women, men don't do preventive health, writes Dr MUIRIS HOUSTON
BY COMMON consent, men are relative disasters when it comes to looking after their health. Unlike most women, most men simply don’t “do” preventive health. For many, it takes a first visit to the emergency department or the coronary care unit before they realise health is not something to be taken for granted.
Is this the fault of the health system or is it because men themselves simply don’t put in the work needed to stay well? Women are not put off by uncomfortable and potentially embarrassing tests such as mammograms and cervical smears. But there are few enough males who arrive into the surgery requesting a rectal examination to make sure their prostate gland is behaving itself. Then again, there is no powerful equivalent of women’s breast cancer advocacy groups for men’s health issues. Why?
One of the stereotypes is that men overreact to small symptoms and under-react to severe symptoms. But experts say there is little enough data to support this hypothesis. A large Danish study of more than 30 million patient contacts with GPs and hospital admissions found that men of all ages have less contact with family doctors than women. They are also more likely to be admitted to hospital and have a greater mortality than women.
The authors, from the National Institute of Public Health at the University of Southern Denmark, conclude: “The reason why men are reluctant to seek medical advice is probably rooted in biological and psychological factors as well as social traditions. New generations and new initiatives like ‘men’s health week’ might help to change the male reluctance toward using the healthcare system.”
So it’s the fault of men? Not so, according to other experts. There are examples of health services engaging with men to promote healthier lifestyles. In response to poor health statistics among men in deprived neighbourhoods, the St Helen’s Primary Care Trust in the UK developed a way to engage with men aged over 40 years through the delivery of free health checks. A dedicated service was built around the needs of local men, involving flexible times for health checks and non-clinical venues. The key to success was to provide exactly what the men asked for, rather than what health professionals chose.
A personal bugbear is the time wasted prioritising the so-called “male menopause” as an important men’s health issue. A recent medical education meeting and the current issue of Drugs and Therapeutics Bulletin (DTB) have intensified my jaundiced view. The DTB review concludes the use of synthetic testosterone to combat symptoms of the “male menopause” is questionable, given that it’s not clear whether such a syndrome exists, and that the evidence of the hormone’s effectiveness in these circumstances is inconclusive.
A mini-industry has built up around the “suffering” of men as they struggle through the “menopause”. But there is little evidence to support any similarity with the sudden cessation of oestrogen production in women. In contrast, testosterone levels fall by about 1-2 per cent a year from age 40 onwards in men. Presenting the latest evidence for and against the existence of an andropause (male menopause) Dr Mel Fullam, of the Irish College of General Practitioners, pointed out the term is not currently recognised by the World Health Organisation. Symptoms often attributed to low hormone levels, such as low sex drive and erectile difficulties, occur in many men with normal testosterone levels.
It would be a pity if this kind of pseudoscience was to colour men’s attitude to their health. How men deal with their health is not going to change overnight, yet ignoring their underuse of existing services is condemning them to unnecessary ill-health.
Would a walk-in service for men be better than pre-booking appointments in general practice? Maybe we need to offer health services at marts, race meetings and rugby matches. In spite of the stereotype, has the time come to offer a male check-up alongside car servicing?