Men’s Health

Men who live to 100 or longer are outnumbered by women by about four to one. The reason is fairly simple: women, as a whole, are healthier than men from birth throughout adulthood. On the other hand, the men who do make it to 100 actually have fewer serious medical problems—from hypertension and dementia to fractures and hearing loss—than their female peers. Most people, gender aside, aren’t expected to make it to 100: an American man’s life expectancy at age 65 is 18 more years, while a woman’s is 20.6. But it does appear that the number of men reaching the century mark may be increasing: in 2015, a British study reported a 30 percent rise in the number of men who reached 100 in an 18-year study of over 11,000 men and women.

Men who put a high value on their masculinity may be more reluctant to see a doctor for preventative health care and therefore are at higher risk for health problems. A study of 1,000 middle-aged men found that those who had an idealized view of maleness, particularly those who held blue-collar jobs, were nearly 50 percent less likely than other men their age to prioritize their health. Macho or not, men in general are more likely than women to tough out signs of illness or injury or to deem preventative care unnecessary. So when they finally see a doctor, they are more likely to be diagnosed with a serious problem. Men outpace women in almost all of the leading causes of death, except Alzheimer’s disease—and this might just be because the men don’t live long enough to develop it. Seeing a doctor for an annual checkup can go a long way in preventing serious health issues, so maybe it’s time to man up.

Fear of illness and dying is very common among middle-aged men. In particular, they worry about impotence, waning body strength, becoming useless upon retirement, losing their driver’s licenses, and dementia. Fear of dementia is actually the number one worry of both men and women. While women are more likely to develop Alzheimer’s, men more commonly have mild cognitive impairment or “pre-Alzheimer’s” and at a younger age. Middle-aged men also worry about how they would care for a spouse who develops dementia. But these fears tend to soften around the edges with age; studies show that as they get older, both men and women are more content and worry less about death than younger people.

Congress banned both Medicare Part D and Medicaid from covering erectile dysfunction (ED) medication in 2005. In 2015, Medicare also stopped covering vacuum erection devices (or penis pumps). Erectile dysfunction affects about 60 percent of men over 60 (and the percentage goes higher with age); the problem is often a result of other medical conditions including diabetes, prostate cancer or heart disease. Impotence is a looming fear for many men—for some, more so than dying. While a desire for sex may decrease somewhat with age for both men and women, many older adults have healthy sexual relationships and want to continue to do so. For men with ED, that means paying out of pocket for medication or devices unless an ED drug is prescribed for another reason. (Viagra, for instance, might be prescribed for pulmonary hypertension.)

So can too little iron and protein; drugs, including some for hypertension, depression and blood thinning; conditions like thyroid disease and illnesses that cause high fever or infection; and even stress. But what men say they worry about, from a young age, is hereditary hair loss. About 67 percent of men will be affected by male-pattern baldness. This happens when a male hormone called dihydrotestosterone binds with hair follicles, making new strands grow shorter and finer. Eventually, the hairline recedes and bald patches appear. Unlike hair loss due to too much vitamin A or other dietary (and some health) reasons, this baldness is irreversible, though there are medications that seem to slow loss or even grow new hair (Propecia and Rogaine). Yet a man shouldn’t expect to regrow a full head of hair and the drugs must be used continuously or baldness will progress. A doctor can help identify the cause of hair loss and provide guidance on the best way to combat it.

Men do indeed get the bone disease that people think of as a women’s issue. Men may develop it later and suffer from fewer fractures. Yet when osteoporosis leads to a bone break, a man is more likely than a woman to end up permanently disabled—and his chance of dying within the year is doubled. A man’s bone health isn’t checked as regularly as a woman’s, in part because doctors haven’t considered how common health conditions like chronic obstructive pulmonary disease (COPD) and celiac disease affect bone health, as well as treatments for depression, cancer and gastric-esophageal reflux (GERD). Previous bone fractures, even those not caused by osteoporosis, can play a role in bone fragility too. Sundeep Khosla, MD, an endocrinologist at the Mayo Clinic College of Medicine, says all men over 70 (and those over 50 who are at high risk) should have a bone density test, because one in five men over 50 will suffer a bone fracture caused by osteoporosis.

Unhealthy gums can be a sign or symptom of poor health elsewhere in the body for everyone, but men are more likely than women to have periodontal disease (56.4 percent vs. 38.4 percent). Gum disease involves chronic inflammation, as do cardiovascular disease and prostatitis, and scientists believe the inflamed conditions in the mouth may aggravate swelling in the heart and prostate. In addition, compared to men who have never had gum disease, men who have had it are more at risk for developing kidney cancer (49 percent higher), pancreatic cancer (54 percent higher) and blood cancer (30 percent higher). Impotency may also be a result of periodontal disease, particularly for men under 30 or over 70—again, prolonged inflammation that can damage blood vessels is the culprit. Luckily, for most men, gum disease is preventable or manageable through diligent oral hygiene and regular dental visits.

But most won’t die from it. A study published in the Journal of the National Cancer Institute found that about 50 percent of men who died from causes other than prostate cancer also had that illness. Researchers say that testing for prostate-specific antigen (PSA), while useful for detecting the cancer at earlier stages, also identifies a high number of prostate cancers that would be nonlethal. This may be contributing to overtreatment of cancers that aren’t always dangerous. Doctors say that if men live long enough, eventually they will develop prostate cancer, but it’s likely that this won’t be the cause of death. Even though this is reassuring, prostate cancer can be harmful when discovered in later stages; men should discuss their risks with their doctors to determine when and if they should consider testing for PSA.

Obesity and diabetes, in particular, have been linked with low testosterone. While the relationships are clear, researchers aren’t sure if diseases lead to a drop in testosterone or if the hormone deficiency contributes to developing the illnesses. Diabetic men with low testosterone may be more insulin resistant. Obese men have lower levels of the blood protein that carries testosterone, as well as lower hormone levels because fat cells change testosterone to estrogen. Low testosterone may also play a role in other health problems, including depression, high blood pressure and erectile dysfunction. And it can have a negative effect on a man’s bones, muscles, memory and sex drive. Low testosterone could be caused by infection, disease, testicular cancer, hormonal disorder or even a testicular injury. After a doctor determines testosterone levels by a blood test, he or she will try to identify the underlying causes of the deficiency to figure out exactly what to treat.

Men typically approach friendship differently than women, who establish ties by sharing emotion and put more effort into making and maintaining bonds. Men talk less and do more. What a friendship looks like is based on the guys’ socioeconomic backgrounds: for example, working class men loan tools or work together on home or car projects, whereas middle-class white men go to a ball game or share other leisure activities. While men in their 20s often have many solid buddies, the priority for friendship drops as men marry—and continues to drop as they age, until many have few or no close male friendships at all. Because isolation is linked with higher levels of depression, a lack of friends can be particularly harmful for older men, who may be reluctant to seek new social outlets after retirement. Joining an organization to share hobbies or dinners, traveling with a group or finding a walking club can be a low-risk way to find possible companions and prevent loneliness.