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November 3, 2001
Doctors tell men to be the new women
Why andropause and other male health issues need attentionBrad Evenson
Doctors gathering today for the first World Conference on Men's Health in Vienna, Austria, have a solution for the sad state of today's male: Men must become the new women.
Matt Sullivan, Reuters
"We must take women as our model if we hope to survive," says Dr. Siegfried Meryn, professor of medicine at the University of Vienna. Studies show women are much more vigilant about medical visits than men.
In the 25 years since the women's health movement began, once neglected topics such as breast cancer, fertility, PMS and hormone replacement have emerged to become important fields of research and public discussion. But men's health has lagged far behind.
"If men do not react to what is going on in themselves and their role in society, including their health, then they will run into big, big problems," says Dr. Siegfried Meryn, a renowned medical expert and professor of medicine at the University of Vienna
"We must take women as our model if we hope to survive."
Ironically, a large number of male health problems mirror female concerns. Breast cancer and prostate cancer kill roughly equal numbers of victims. Sexual dysfunction affects both genders.
Perhaps the most vivid illustration is andropause, a male version of menopause.
"As men get older, their testosterone levels diminish, and also, as men get older, their symptom level increases," says endocrinologist Dr. Jerald Bain, a professor of medicine at the University of Toronto who specializes in male reproductive health. The symptoms include decreased libido and erectile dysfunction, as well as fatigue, dwindling muscle mass, lethargy, irritability and philosophical doubts about their human values.
Dr. Bain says studies in recent years show hormone replacement therapy, a common regimen for women, may also benefit men.
"Men who have mood disorders and who have a low testosterone level, if you give them testosterone ... they calm down, their moods straighten out, they are less irritable and they're much easier to live with," he says.
Studies suggest synthetic testosterone, which can be taken as a prescription pill or skin patch, may also protect the heart from disease.
But first, men must be convinced to take their health as seriously as women.
Consider the evidence. Men die 7 years younger than women, a gap in life expectancy that yawns to 10 years in Eastern Europe.
Men succumb to the top 15 causes of death more frequently than women. Male reluctance to wear condoms has fuelled the spread of AIDS and other sexually transmitted diseases.
Depression, violence, alcohol and drug abuse are rising among men both young and old.
Historically, scientists presumed most medical issues were the same for men and women. Most drugs were tested on men, not out of sexism, but from a mistaken notion both genders would react the same.
One of the greatest successes of the feminist movement is it politicized health, putting women's concerns on the public agenda and raising awareness. During the late 1970s, women's magazines were born, clinics sprang up and awareness of women's health issues such as menopause, Pap tests, orgasms and mammograms became commonplace. A similar revolution is needed for men, as noted by the British Medical Journal which, this week, posed a provocative question: Are men in danger of extinction?
Doctors marvel at how much better women are at using the health system than men.
"Double the rate of women get the flu vaccination as men," says Dr. Meryn.
"We're talking about men in their 30s, 40s, 50s. We're talking about preventive medicine. What the hell is going on? Why can't they get their flu shot?"
Similarly, when men observe blood in their stool, a sign of possible colon cancer, men wait twice as long to tell their doctors as women.
"We're talking about colon cancer, which is one of the three most frequent cancers in men, one of the killers," adds Dr. Meryn.
Dr. Meryn says social factors, which are major determinants of health, are shifting in favour of women, transforming men into an economic underclass. In Britain and North America, boys earn 70% of the D and F marks in school. Boys account for 80% of high school dropouts and the vast majority of diagnoses for attention deficit/hyperactivity disorder. In 2000, females outnumbered males finishing high school and college and, by 2007, are forecast to outnumber males in university enrolment by up to 25%.
"In the new working world, where we do not need any physical abilities any more, men may not have the skills and social competence to succeed," says Dr. Meryn.
This social decline can have disastrous consequences, particularly for men, who tend to adopt risky behaviours such as drinking and smoking when they lose their jobs and social status. In parts of the former Soviet Union, for example, perestroika caused income to fall for many people, raising rates of alcohol abuse, smoking and poor dietary habits, particularly among men. As a result, life expectancy in Eastern Europe has fallen for men since 1990, though it has held fast for women.
But how can men become the new women? Unlike the feminist movement, there is no male movement that draws together men of all ages and walks of life.
The standard-bearers of this belated march may end up being gay men and ageing Baby Boomers.
"In the age of AIDS, gay men have become experts in the field of men's health, because they had to," says Alan Considine, a San Francisco public health official.
"This is a cohesive group with a political mindset. They have put many issues on the public agenda. Look at physical fitness. Look at testosterone. A huge percentage of gay men take testosterone injections or steroids to deal with the ill effects of HIV infection or andropause."
Similarly, as baby boom males enter middle age, they have begun to understand the impact of ageing on their quality of life, a revelation that led to blockbuster sales of the drug Viagra.
"Today's men are unwilling to accept [symptoms] once considered hallmarks of age, such as erectile dysfunction" says geriatrician Dr. John Morley, a professor of medicine at Saint Louis University.
Dr. Morley, scheduled to discuss andropause at the Vienna conference today, laughs off any suggestion men today are less manly -- in terms of testosterone production -- than in the past. "There is very little data, but what exists suggests very little difference." In the end, a man's best medicine may be love.
Recent studies suggest men married to nagging wives live longer, because their wives urge them to see a doctor.
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