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12 September 2012

I HAVE written about health for longer than I care to remember, and if there’s one thing I’ve learnt, it’s that men avoid doctors like the plague (if you’ll pardon the expression).

It’s so bad, in fact, that a lot of awareness around men’s health is aimed directly at women – in the hope they will drag their reluctant partners off to the doctor for whichever check–up is necessary.

Dr Ridwan Shabsigh, head of the US International Society of Men’s Health, and professor of urology at Cornell University in New York, was in SA recently to help set up the initial structures for the society’s local arm to try to change this thinking.

MEN’S HEALTH: Get off your high horse, see a doctor

"There is a great unmet need when it comes to men’s health," says Shabsigh. "There’s an important segment – men aged 40 to 60 – who fall through the cracks when it comes to their health."

Pretoria wellness consultant Dr Christo du Preez agrees, and says: "Men probably eat the majority of the world’s apples, if the saying ‘an apple a day keeps the doctor away’ is true," he quips.

"It’s a testosterone thing – cowboys don’t cry," Du Preez says. "Unfortunately cowboys do die. And they’re more likely to die a death where the last bit of life is painfully extracted by a team of wild horses, over an extended period, given the diseases men most succumb to – such as cancer and lung diseases."

Shabsigh says men’s health is really about their behaviour: they live shorter lives, and they become ill or disabled earlier than women, regardless of geography or race.

"There are far more women pushing men in wheelchairs than the other way around," he says.

More men die of lung cancer and chronic lung disease, than women do, Shabsigh says. They smoke more. They drink more. And they don’t go to the doctor, or use the healthcare that’s available to them.

"They don’t even keep up with dental visits. It’s just not manly to go to the doctor," Shabsigh says.

Du Preez says the health risks men face are real, and they are no laughing matter, but men just don’t like to have check–ups.

"Forty percent of men in their 40s have never had a cholesterol test; 70% have never had a prostate exam; a third won’t even consider a general check–up."

Yet men take other precautionary measures seriously, he says: they have retirement plans; they work to pay pension and retirement policy premiums every month; they dream about the years after the daily toil and stress of work are over.

The problem is many of them don’t make it to enjoy these golden moments.

"Studies have shown that after age 18, men disappear from the healthcare environment," Shabsigh says.

"Up until that time, their mothers take them to the doctor. After that, men only show up again when they have their first heart attack, and they arrive lying on a stretcher."

He cites depression as an example. In some cultures, men will be ridiculed for being depressed, and even asked why they’re "depressed like a woman". It’s true that more women suffer from mild and severe depression than men appear to. Yet, when it comes to the figures around death by suicide, says Shabsigh, the numbers begin to shift.

While the ratio of women to men suffering from severe depression with suicidal tendencies is 2.5:1, actual death by suicide stands at a ratio of one woman per 4.4 men – a sobering statistic.

"It’s got to the point where women are starting organisations such as Women Against Prostate Cancer, because it’s the women who have to persuade their husbands to go to the doctor and take care of their health," he says.

Diabetes is another example, Shabsigh says.

It’s on the rise worldwide, in almost every country, and people are getting it at younger and younger ages, yet type 2 diabetes is easily preventable.

"There has been an interesting development in this area. You can have metabolic syndrome for years, and be asymptomatic – it’s a disease of numbers on a page. But in the last few years we’ve realised that frequently with metabolic syndrome we see low testosterone, erectile dysfunction (ED) and urinary symptoms.

"So this is a tremendous opportunity for us, because for the first time we have our hands on some symptoms," Shabsigh says.

Men should be having a yearly check–up, especially if they have low energy, are tired and have low sexual desire and erectile dysfunction, he says, because in middle age, ED is a predictor of a heart attack – three years in advance.

"It’s a tangible warning sign. And if you have decreased testosterone levels, you’re looking at eight years to diabetes."

What this essentially means, says Shabsigh, is that sexual health is the portal to men’s health. When you finally arrive at the doctor with testosterone deficiency and/or erectile dysfunction, it gives your doctor a good snapshot of what your health status might be.

And it’s also a good time to check all other health markers – your weight, your waist size, your blood pressure, your nutrition, any signs of depression and sleep apnoea, your prostate and your testosterone levels.

Testosterone deficiency in particular, for example, is under–recognised and under–treated, say the experts. So if you have symptoms of fatigue and low sexual desire, it is important to ask your doctor to have you tested.

"Women are very good about doing all of their checks, and they experience the retirement benefits – as cynical as that might sound," says Du Preez.

"They live between five and 10 years longer than men, but they also go to the doctor four times more frequently," he says.

Heart disease in women tends to start when they’re in their 70s and 80s, but they remain aware of it through their regular visits to the doctor, says Du Preez.

"Heart disease in men starts when they are in their 50s and 60s, when they have extremely busy calendars, golf games and networking duties.

"And if a man has a body mass index that is greater than 35 by the age of 40, his life expectancy will be shortened by six years, and his final years of life could well be riddled with the symptoms of chronic disease," Du Preez says.

He says it’s not the check–up that’s the challenge – it’s taking ownership of the results.

"Maybe some men are silently afraid that they won’t be able to handle the lifestyle changes that might be required, if they are confronted with the hard, cold facts," says Du Preez.

Shabsigh says it’s also important for medical professionals that they devise recommendations for maintenance of men’s health.

"If you have a disease, we know what to do, but there simply isn’t a list of recommendations to maintain the man who says: ‘I’m not ill – maintain me’.

"That remains a challenge.

"We also need to encourage doctors and medical communities in every country to start men’s health societies, and commission men’s health reports.

"That is the first building block to understanding how we can improve men’s healthcare."

And while the doctors are trying to understand men’s health better, and provide better care, the man’s job is take the bull by the horns and own his health.

"One visit, one set of tests, one confrontation – it can change your life and that of your family," says Du Preez.

"Apart from preventing disease – almost three quarters of chronic illness can be prevented by timely intervention – embarking on a wellness–based approach to your lifestyle will add energy, endurance and focus to your day, and deliver a competitive edge that other men simply won’t have."

"One visit, many rewards," says Du Preez.

It’s your call, cowboy, so get off your high horse, and get yourself off to the doctor at once.

One visit, one set of tests, one confrontation – it can change your life, and that of your family

Men should be having a yearly check–up, especially if they have low energy, low sexual desire, and erectile dysfunction

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