Why Men Die Sooner

President-elect John F. Kennedy in Miami, Nov. 14, 1960, and then-Sen. Barack Obama, Oct. 16, 2006. AP

Listen up, guys. It may be time to drop the bravado and consider these sobering statistics:

Coronary artery disease (CAD) is three times higher among men who are clinically depressed.

Male suicides outnumber female suicides in every age group.

Homicide and suicide are among the top three causes for death among males between the ages of 15 and 34.

By the age of 85, women outnumber men in the U.S. 2.2 to 1; this rises to 3 to 1 if they reach their 90s.

These are just a few of the realities examined in Why Men Die First: How to Lengthen Your Lifespan, a new book by Marianne J. Legato, MD, that focuses on the biological, cultural, and personal reasons that men's life span in the U.S. lasts an average of six years less than women's.

Male mortality is shorter in part, Legato says, because males are more fragile and inherently vulnerable than females from birth. And unlike women, who have fought hard to have their specific health needs validated and addressed, men haven't demanded equal treatment.

"It is a need that has never been addressed," Legato says. "Men have been tremendously neglected and it doesn't have to be that way."

Men's medical challenges owe a great deal to cultural conditioning. The rules are set shortly after birth, Legato says: Suck up the pain, don't be a wimp, show no weakness, and "man up." Many men only seek medical counsel when under duress from a spouse or when their condition has deteriorated to a severe state.

"Women are able to logically ask for help," says Legato, who has long promoted the concept of gender-specific medicine. "They're hardwired in the brain and very motivated."

"The cultural reasons for not going to the doctor are killing men," she says.

How Men Can Live Longer

In her book, Legato examines and champions an end to the lack of awareness among men - and even the medical community - regarding the specific health needs of a male that could help prevent male deaths. Men, she says, deserve better and should insist on higher standards.

"Don't tolerate the current situation where men die six years before women," Legato says. "If we can conquer breast cancer and AIDS to the extent we have, we can certainly save our men."

Legato highlights the following leading factors of death in men in which men can begin to make a significant difference in their health and improve male life expectancy:

1. Speak frankly with a doctor: Leave embarrassment in the waiting room. Women are taught at an early age to be candid and open with their doctors. Symptoms that can be uncomfortable to talk about - such as erectile dysfunction - can be tied to more serious ailments such as diabetes and heart disease. Men, despite cultural tradition, should also request breast checks.

"It's a part of the body and should be examined," Legato says.

She encourages men to perform testicular self-exams in the way women are taught to check their breasts for irregularities. Although men may cringe at getting a prostate check, they are far less uncomfortable than experiencing the pain of cancer treatment.

2. Check testosterone levels: Beginning at age 30, testosterone begins to dip by 1% each year, says Legato. Lowered testosterone levels can lead to a decrease in vitality, muscle mass, ability to perform prolonged exercise, memory, concentration, and libido. Not only does this impair quality of life, it can contribute to depression, which can have a significant effect on male health, potentially increasing the risk of coronary disease. There are several treatments available - including gels, patches, and injections - that can help restore this vital hormone to proper levels.

Robert Ruxin, MD, an endocrinologist from Ridgefield, Conn., says normal testosterone loss has little correlative effect on vitality or sexuality. But there are instances when dramatic loss - more likely between the ages between of 60 and 80 - can impede quality of life.

"When it drops normally, probably not, but very low, yes," Ruxin says. "A level that drops from 800 to 500 has not been shown to have a clinical effect. Maybe from 800 to 400 can be too low."

Diabetes patients, for example, may have a greater risk of significant testosterone loss. Conversely, pituitary hormones, he says, can balance out the effects of the difference in individuals who are losing testosterone at a typical rate.

"There's a wide variation of normal."

3. Immune systems: The male immune system is not as vigorous as those of females, and men die from seven of the 10 most common infections at a higher rate, Legato says, particularly tuberculosis and sexually transmitted diseases. Sanitary sexual practices are essential, beginning with use of a condom. Men should check for updated vaccinations with their doctor when traveling to foreign countries. A tetanus shot should be administered every 10 years.

"Immunization is not finished after the second year of life," Legato says.

Proper nutrition and supplementation can also be beneficial. Despite the gender-focused attention it receives, osteoporosis also strikes men.

4. Recognize and treat depression: Male depression may be much more common than has been previously estimated. Symptoms aren't always obvious.

"We glibly state that women are twice as often depressed as men throughout the world," she says. "What they do is turn to behaviors that are semi-socially acceptable: drinking alcohol, TV watching, greater sexual exploits."

Legato is convinced the vulnerability of depression can compromise men's health in other ways, leading to increased instance of disease and greater male mortality from such conditions. It's also a common symptom of "andropause," which is marked by a decrease of testosterone in males that is similar, if less dramatic, than the effect of menopause in females. Indeed, males are also susceptible to the notorious hot flashes that have often marked the change of life for women, albeit years later.

Legato says the current medical system often prevents doctors from obtaining a proper understanding of a patient's personality and life structure. Make time to discuss any such issues with a doctor and be open to treatment. "A pill is not always the cure," Legato says. "Structured conversations can be very helpful."

While Ruxin is not convinced that andropause is a genuine male concern, others are in sync with Legato's insights on male depression.

James Korman, PsyD, ACT, director of the Behavioral Health and Cognitive Therapy Center at Summit Medical Group in New Jersey, agrees that depression in men occurs far more often than reported. He also points to cultural factors as often influencing men's reluctance to get treatment.

"Men tend to express depression differently than women," Korman says. "This can result in sleep disturbances, mood change, and sexual disinterest."

Left untreated, depression can have catastrophic results.

Regarding suicide, Korman says that while women typically make more attempts, "men are much better at completing it."

Men need to realize, Legato says, how destructive depression can be to their health and openly discuss their concerns with a doctor.

"To enjoy the day and be as viable as possible in the present is the best attitude," she says.

5. Keep a close eye on young males: The reckless nature and lifestyle of adolescents make them prime targets for injury or death. Females develop a more evolved sense of judgment and decision making at an earlier age then males. Add to that the cocktail of testosterone and other hormones and, biologically, males possess a potentially lethal internal recipe. Monitoring their activities and setting careful limits is vital. "Boys have been compared to a Porsche without brakes," Legato says. "They take risks, are idealistic, intense, and believe they're invulnerable."

6. Assess your risk for coronary disease: Coronary disease, Legato says, "takes a toll on men in their prime and leaves families bereft." It's imperative to sit down and assess the risks along with any predisposed genetic tendency and discuss these with a doctor. Have any relatives died of heart disease before the age of 60? What are your cholesterol levels? Have you experienced fainting episodes, loss of consciousness, or shortness of breath?

"We downplay this tremendously," Legato says.

Again, men aren't genetically blessed compared to women in this area. The female hormone estrogen provides women with a layer of protection that men don't naturally possess, asserts Legato. Further illustrating this: Men can begin developing signs of coronary artery disease at the age of 35, Legato says, while women don't present a risk of a heart attack similar to men until much later. Men with a family history of heart disease should alert their doctor and take proper precautions beginning in their 30s.

"It doesn't have to be that way," Legato says. "We should be turning a very critical eye on why coronary disease starts in the mid-30s."
By Don Fernandez
Reviewed by Louise Chang
© 2008 WebMD, LLC. All rights reserved

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