1. The Health Hazards of Being Male

In the movies, James Bond is the quintessential bulletproof male. He just doesn’t ‘do’ healthcare. He gets shot at, ambushed, beaten up regularly and still keeps coming back for more. ‘Shaken, not stirred’, as the saying goes. He perceives himself to be pretty much invincible. He can sail off into the sunset after every life-threatening encounter, battered and bruised but always ready for the next round of double martinis.

Real-life stories are rather different, however. Many Irish men think their health is ‘excellent’ – and they’re literally dying on their feet to prove it. Irish men live shorter lives than Irish women and have a higher risk of serious illness. Compared to women, men are often less interested in and less knowledgeable about health matters and are less likely to accept personal responsibility for their health. These health beliefs of men are linked with behaviour that hinders their health and an increased risk of death and disease.

This tendency to not go to the doctor combines with lifestyle behaviour often best left to Hollywood stuntmen. The result is a shortened lifespan; by about five to six years on average compared to women. Men perceive themselves as being less susceptible to ill health than women. This is a false and dangerous assumption, which further increases their health risks. Many men fail to get routine check-ups, preventative care or health counselling. They often ignore symptoms or delay seeking medical attention when sick or in pain.

It is clear that the two sexes are different, not just in the obvious biological ways, but in every system of their bodies. Far from being the stronger sex, we men are more fragile throughout our lives. This male fragility can be partly explained by the different ways in which men and women approach health, healthcare and illness. Men are less likely to discuss health and personal issues with friends than women are and they are also less likely to access healthcare services. Unfortunately, men often suffer in silence, disregarding the symptoms of a potentially serious condition, to their cost. There may be many factors that help to predetermine the shorter lifespan for men in comparison to women.

Men tend to have poorer knowledge of basic health information and less understanding of the anatomy and functions of their own bodies than women. This knowledge gap in the basic anatomy of the human body makes some men embarrassed to seek health advice. Most men know more about how the home heating system works or the internal mechanics of their car than they know about the systems at work in their own bodies. Indeed, women may have a better understanding of the male body than many men have themselves. As a result:

Men differ from women in that men have a different genetic make-up. We all have twenty-three pairs of chromosomes. The difference between men and women is in the twenty-third pair, known as the sex chromosomes. We men have a Y chromosome, whereas the fairer sex don’t. The presence of this Y chromosome confers our maleness on us, which means we produce testosterone. The male hormone testosterone is believed to be the cause of male aggression. The tendency to aggression can have adverse health consequences, notably resulting in more violence and more accidents. This can lead to more deaths from both road traffic and work-related accidents, as well as more incidence of homicide and suicide in men, particularly young men. Testosterone may also make men more prone to risky behaviour, including casual sexual encounters, use of illicit drugs and binge drinking. All of this risk-taking behaviour can have adverse health consequences.

Hormonal differences between men and women may at least partly explain why women live longer than men. Women have lots of oestrogen, the female hormone, and this seems to protect women against heart disease by having beneficial effects on their cholesterol levels, at least until menopause. Men have much less oestrogen in their systems; however, they do have plenty of testosterone. The effects of testosterone on the male system are the subject of ongoing research, but it is thought that it may have adverse effects on cholesterol, encouraging the deposition of fat around the belly area (belly fat), as well as having some effect on the clotting system in the blood.

Testosterone may also have some effects on the ageing process. It is implicated in both benign enlargement of the prostate gland and the development of prostate cancer. Testosterone can also be involved in the development of heart disease and stroke in men.

Men have limited contact with the health services compared to women. Men are often afraid to seek medical help when sick and can struggle to openly acknowledge fear as a normal part of coping with sickness. This fear or anxiety about going to the doctor may relate to the prospect of having private parts examined, concern about having a serious condition diagnosed or fear of having to go to hospital. One of the big challenges for men is to accept that going to the doctor does not represent failure or personal weakness.

Men often go late to the doctor with an illness when symptoms may have been present for some time. This can also be called ‘head in the sand’ or ‘ostrich’ syndrome. You would often hear a man say, ‘Sure I am as fit as a fiddle. I haven’t been to the doctor in over twenty years.’ This doctor avoidance mentality has to change and men need to become more proactive about their own health – after all, they will bring the car to be serviced once a year, why not give themselves the same treatment?

Women tend to be more in touch with their feelings and to have better and stronger social networks. They can call on their friends to discuss worries and problems. They are generally better able to communicate their feelings, which has a positive de-stressing effect. This strong sense of socialisation is good for your health.

On the other hand, men tend to be less communicative, bottle up their feelings, internalise stress and soldier on regardless. Indeed, men may be taught as boys to adopt the very attitudes and behaviours that kill them as men: ‘big boys don’t cry!’

The socially isolated male, dealing with things on his own in his ‘own way’, can be very bad for his own health, causing stress to turn into distress (see Chapter 14), with its attendant risks of depression, anxiety and potential overdependence on alcohol and/or other drugs. Chronic internalisation of stress can also clog up the arteries and raise blood pressure, helping to cause heart attack and stroke.

Irish men may feel that to access healthcare implies weakness, vulnerability and potential loss of the masculine role. It often requires a health crisis, either personally or in a friend or loved one, to act as a wake-up call.

Type A personality includes such traits as negativity, hostility, anxiety and stress. These behavioural traits are more prevalent in men than in women. It has been associated with an increased risk of heart disease. Psychologists have described the Type A personality as the highly driven macho male. The macho male image of strength and invulnerability does us no favours when it comes to healthcare. It must be one of the reasons why we delay seeking help, trivialise potentially serious health concerns, ignore medical advice and have scant regard for the value of preventative health check-ups. Some men still have a fear of being perceived as a hypochondriac if they ask too many health questions. Again, the implication is that interest in or concern about health matters belies weakness. Well, look at the statistics guys: we continue to die five to six years younger than women, so we have an awful lot of catching up to do before we can be accused of being hypochondriacs.

In general, men value their independence and, as such, are often reluctant to seek medical help. Simply admitting to pain strikes at the core of macho thinking for some men; better to be invincible and ‘bulletproof’ and eventually fall down in a heap than admit to needing help. This stoical ‘grin and bear it’ attitude is often admired in a sporting context but, let’s face it, it’s a terrible way to approach your own health.

The vital statistics of Irish men do not make for encouraging reading. The average male can expect to be seriously or chronically ill for up to fifteen years of his life. The most dangerous health risks are outlined here and the table below shows the main causes of death in Irish men.

This is the number one killer of Irish men and, together with stroke, accounts for about one in three premature deaths in men. Men usually develop heart disease ten to fifteen years before women do; therefore, men are more likely to die from heart disease in the prime of their lives.

Cancer numbers are increasing every year, mainly due to the growth in our population. While cancer can affect all ages, it is most prevalent in the over-65s. The rates of prostate and bowel cancer, while already high, are expected to increase by more than 50 per cent by the year 2020.

Testicular cancer is the most common cause of cancer in men aged 15–35. It is almost always completely curable if it is caught in time. So check your testicles regularly as testicular self-examination may literally save your life. Know your balls!

This is a common cancer in men. Be alert to warning signs of prostate problems, such as having difficulty peeing or regularly getting up during the night to use the bathroom.

Don’t ignore symptoms (such as a persistent cough and blood in the urine or faeces) – early treatment increases the chance of a cure.

Depression is common but often remains unrecognised and undiagnosed in Irish men. Up to one in five Irish men may develop depression in their lives. Suicide is one of the leading causes of death in young Irish men.

Over 60 per cent of Irish men are overweight or obese. A waist measurement over 40 inches increases your risk of health problems such as diabetes and heart disease. Eat healthily and lose that gut.

Up to 50 per cent of men with a sexually transmitted infection don’t show any symptoms. Use a condom – prevention is better than cure.

Erectile dysfunction issues are very common in Irish men and very treatable. Discuss it with your doctor if you have concerns.

Staying fit is the key to good health. Indeed, exercise may well be the greatest pill of all. Unfortunately, many men take little or not enough exercise, with long-term health consequences.

Men still smoke more and die more frequently from smoking than women. It increases the risk of heart disease, half a dozen kinds of cancer and many other illnesses, including emphysema and bronchitis. Half of all smokers will die from their habit if they do not stop. Give it up before it gives you up.

Many men drink more than the recommended limit of 21 units of alcohol per week. Heavy drinking is common among men. In moderation, alcohol can enhance enjoyment and can reduce the risk of heart disease. In excess, it leads to social and psychological distress and physical damage. Less is more!

You will see from the table above that most of these conditions are largely preventable. So the good news is that, by taking active control of your health, you can keep yourself healthier for longer, hopefully right into ripe old age.

As men, we often take pride in our cars and have no problem with the notion of having a full service done on the car annually, or at least every 20,000 miles. Some of us may even take time off work to bring the car to the garage and collect it afterwards. The paradox is that we don’t treat our bodies with the same respect. Many Irish men appear to have a lack of awareness of the need for preventative check-ups.

Positive lifestyle changes in men can help prevent heart disease, diabetes, stroke and many diseases and cancers. Effective stress management and a positive outlook can help prevent mid-life depression and feelings of emasculation and uselessness. While a need to win can make a man risk his life, it may also provide the incentive to give up smoking. In fact, many male health risks are largely preventable and, with changes in attitude, behaviour and lifestyle, men can dramatically reduce their risks. Think of your body as being like a car and treat it with the same care.

Being an Irish male is a health hazard.
Irish men die on average about six years earlier than Irish women.
Many of the serious health conditions affecting men are preventable.
Have the same respect for your body and mind as you have for your car.
Remember: prevention is better than cure.
Your health is your wealth. Treasure it!