The topic of men’s health usually focuses on sexual health, but it is about much more than simply anatomy ‘down below’, writes Charles Gladwin

The NHS Choices website reflects some typical assumptions about ‘men’s health’. Its ‘common health questions’ page on the matter focuses on the biological differences wrought by the Y chromosome: the reproductive organs. High profile men’s health campaigns have certainly created greater awareness of conditions such as erectile dysfunction, prostate diseases or testicular cancer. But while 80 per cent of UK men have visited their GP surgery in the past year, “one in three wouldn’t seek their GP’s immediate advice if they found a lump,” says Orchid, the UK male cancer charity.

An Orchid survey, published in April, of 3,000 men aged 18-50, reveals that “a worrying two-thirds of men are unsure of how to check themselves for testicular cancer, despite 87 per cent correctly identifying a lump as a sign of the disease.” Chief executive Rebecca Porta is urging all health professionals to “play an important role in talking to their patients about testicular cancer, ensuring they know how to undertake simple but potentially life- saving self-checks and feel comfortable discussing ‘embarrassing’ signs such as a lump.”

Age matters

It is worth noting that, although campaigns have been directed at younger men (testicular cancer most commonly occurs in the 15-44 age group), around 6 per cent of the 2,300 diagnoses in the UK each year are in men over 60. And it may not present as a simple lump – any change in the testis (eg, increased firmness, size, or having a ‘grainy’ feel) should be referred. Other common men’s health questions flagged up by NHS Choices include gynaecomastia, contraception, fatherhood and paternity tests. It is only when clicking further into the pages targeting different age groups that other health issues are raised – obesity, diet and exercise, cardiovascular problems, and mental health, for example.

"A worrying two-thirds of men are unsure of how to
check themselves for testicular cancer"

The impact of these risk factors is reflected in quality of life data. The Global Burden of Diseases, Injuries and Risk Factor Study is an immense project that describes the distribution of disease, injury and health risk factors around the world.1 It looks at a range of data years, including quality of life measures such as years lived with disability (YLDs) and disability-adjusted life years (DALYs).

When looking at DALYs and attributable risk factors, there are a number of conditions where males collectively experience significantly greater health impacts than females. One is air quality and pollution due to air particulates, where the average DALYs in 2010 was estimated at 224,000 for men and 137,000 for women. That is in addition to tobacco smoking, which as a risk factor causes more disability for men than women, with average DALYs of 1,145,000 and 819,000 respectively. Second-hand smoke also causes more health problems in males than females.

Similarly, the impact of alcohol and drug misuse is greater in males than females, as are a number of aspects of diet, nutrition and exercise. Dietary risk factors where males are experiencing more adverse health impacts include diets low in fruits, vegetables, whole grains, fibre, calcium, seafood omega-3 fatty acids, polyunsaturated fatty acids, and diets high in processed meat and salt.

Occupational health

Occupational risk factors are another area where males experience greater health consequences, at 250,000 DALYs for men compared to 118,000 for women, according to the GBD study. Occupational carcinogens, especially exposure to asbestos, are a significant contributor, but it is occupational low back pain that contributes most, with 103,000 DALYs for men compared to 68,000 DALYs for women.

The impact of the work environment on men’s health is an issue the Men’s Health Forum is raising during its annual men’s health awareness week this year (June 9- 15). The MHF points out that work is one of the biggest single causes of stress. “Many experts now believe that stress is probably responsible for as many deaths as heart disease. The long hours culture is very much a British disease. And a male one. One in four blokes put in 48 hours a week or more.”

One aspect of men’s health that hasn’t received as much recognition as it should is body image. There is a misconception that eating disorders are a “women’s illness”, but between a tenth and a quarter of all eating disorders are thought to occur in men. Admittedly, one in 250 UK women are thought to have anorexia nervosa, compared to 1 in 2,000 men. But men also experience bulimia nervosa and other types of eating disorders, perhaps more commonly than anorexia.

Ulla Räisänen, of the Nuffield Department of Primary Care Health Sciences, comments: “In men’s accounts, misconceptions about eating disorders as a woman’s illness still sit tight both among health professionals and men themselves (and others around them). We believe that primary care professionals are well placed to challenge these preconceptions and offer appropriate, timely and gender-sensitive support for men presenting with signs and symptoms of disordered eating.”

Leanne Thorndyke, a spokeswoman for B-eat, the eating disorder support charity, argues that there is more pressure on men to have the ‘ideal’ body image. “Boys and men tend to want to be bigger and more muscular and toned, which is a different ideal to women.”

Data from social care charity CRI appears to back this up. It has seen an increase in the number of anabolic steroid users visiting the 21 needle exchange schemes it runs. NICE public health guideline 52 on needle and syringe programmes now includes the recommendation to provide equipment and advice to people who inject image-and performance-enhancing drugs. It proposes services could be provided in gyms.

Prescribing of testosterone has also increased – by almost 90 per cent in the decade to 2010 – reflecting increased medical marketing of testosterone replacement for men with erectile dysfunction, and for older men with low serum testosterone. But this could be unwarranted, as analysts have found that “the number of men with likely unequivocal hypogonadism remained constant at 5·2 per cent in 2000 and 6·3 per cent in 2010.”² They conclude: “Many men in the UK might be receiving testosterone replacement therapy with neither clearly established indications nor robustly diagnosed hypogonadism.”

Bladder weakness

A recent survey by TENA Men revealed that one in nine men have experienced bladder weakness at some point during their lives, with 42 per cent experiencing an urgent or unexpected need to urinate. Men of any age are prone to experiencing bladder weakness, and, while 75 per cent of these are over the age of 65, a quarter of younger men suffer, too.

Bladder weakness in men tends to have an attached stigma, making the issue difficult to talk about, so it is important that pharmacy staff feel comfortable and confident when initiating conversations, says Donna Wilson, TENA training and brand manager. “The most important thing is to reassure them that it is a common occurrence affecting one in nine men, and that there are products on the market, such as TENA Men, which are specifically designed to enable the continuation of their everyday lives.”

Getting the message out

Schemes that take the healthy living message to men – targeting fans at football matches, for example – rather than expecting them to come to the health professional, continue to report success. The Scottish Football Fans in Training (FFIT) programme, which targeted middle-aged fans, attributed success in part due to the minimal exclusion criteria; it reached men from all socio-economic groups, although ethnic minority groups were less well-represented.

An English Premier League scheme included educational activities on match days and weekly lifestyle classes at the football stadia and training venues. It reached men who were otherwise failing to meet health guidelines, as well as those who did not consult a GP or use health information services.

References

1. CL Murray et al. UK health performance: findings of the Global Burden of Disease Study 2010. The Lancet 2013;38:997–1020

2. EH Gan et al. A UK epidemic of testosterone prescribing, 2001-2010. Clin Endocrinol (Oxf) 2013 Oct;79(4):564-70.

 

TABLE 1: Health risk factors comparison

IMAGE
CAPTION: Adapted from DALYs for 259 causes in 1990 and 2010 for all ages and both sexes combined and per 100,000 for the UK¹