Giving men's health a quick checkup

It's common knowledge that women live longer than men, but that gap in life expectancy has grown in recent years, bringing attention to shortfalls in American men's health.

As of 2021, women lived an average of 5.8 years longer than men, marking the largest gap recorded since 1996, according to data published in November 2023 by JAMA Internal Medicine. That total is also an increase from a low of 4.8 years, recorded in 2010.

In addition, over one-quarter of working-age American men (26%) reported being unable to work due to illness or disability in 2020, data from the Annual Social and Economic Supplement of the Current Population Survey showed. That's compared to 18% of women.

These statistics form part of a broader negative trend affecting men's well-being. In recent years, “we've seen a precipitous decline in males being successful in education, and that has important implications for men's jobs and employment rates,” said Derek M. Griffith, PhD, the Risa Lavizzo-Mourey Population Health and Health Equity University Professor at the University of Pennsylvania in Philadelphia.

While physicians can't fix unemployment, there are steps they can take for their male patients, experts say. “We don't often look at ‘How is the health care system prepared to receive men?’” said Dr. Griffith.

Meeting men where they are can go a long way in increasing care utilization and improving men's health in the long term, according to experts who offered their advice.

Causes of the gap

There are a number of contributors to the gap between men's and women's health.

Between 2019 and 2021, COVID-19 was the main driver, accounting for a difference of −0.33 year in life expectancy between the genders, the JAMA Internal Medicine study found. Unintentional injuries, including drug overdoses, were the second leading contributor, accounting for a difference of −0.27 year.

What's more, deaths from suicide, drug use, and alcoholic liver disease, often referred to as “deaths of despair,” disproportionately affect men, the authors noted in a press release. These deaths are typically linked with depression, stress, and economic hardship.

Another reason is the toll of chronic illness. Men are more likely to die of cancer and chronic diseases of the heart, blood vessels, lungs, kidneys, and liver than women, former FDA commissioner Robert M. Califf, MD, noted in a 2024 FDA Voices article on the topic.

When it comes to drivers of chronic disease, stressors and how men interpret and cope with them play a significant role, said Dr. Griffith. Unhealthy coping mechanisms, such as drug and tobacco use, are more common among men.

According to the National Institute on Drug Abuse, men have higher rates of use or dependence on alcohol and illicit drugs than women, as well as more related ED visits and overdose deaths. Men also tend to smoke more cigarettes per day and use cigarettes with a higher nicotine content than women.

“The other biological factor that really seems to make a difference is having estrogen versus testosterone,” said Howard E. LeWine, MD, chief medical editor at Harvard Health Publishing at Harvard Medical School in Boston and a former primary care physician, noting that estrogen seems to have a cardioprotective effect in premenopausal women.

As physicians are well aware, one of the best ways to stave off disease is regular engagement with primary and preventive care. But men fall short in that regard, too. A 2020 survey by KFF found men were less likely than women to have a regular place of care or doctor and to have visited a health care professional or had a checkup in the past two years.

“We often make the assumption that men don't want to go to the doctor, or don't want to seek care,” said Dr. Griffith. However, he said, “we haven't—when we've actually talked to men—found that that's necessarily true.”

Barriers to care

Instead, research has shown that more pragmatic concerns like uncertainty about the benefit, value, and cost of care and where to receive it prevent uptake, explained Dr. Griffith, who also serves as chair of Global Action on Men's Health and editor-in-chief of the International Journal of Men's Social and Community Health.

There's also the problem that doctors' visits are not something men have been socialized to do. From a relatively young age, women are encouraged to seek regular care with OB-GYNs and internal medicine specialists to manage sexual health, including birth control, and undergo routine screenings. This early and frequent engagement with the health care system, and lack of a parallel structure for men's health, may help explain gender differences in health literacy, according to Don Casey, MD, MPH, MBA, MACP, an internal medicine physician and associate professor of internal medicine at Rush Medical College in Chicago. “There's a much lower health literacy rate among men about their overall health because it's less specific,” he said. “There [is] probably, in most cases, less awareness of health risks and how to mitigate them, compared to women at a much earlier age.”

For many men, their memories of routine medical care may only be a brief physical if they played sports in adolescence, Dr. Griffith said. “But that's really the extent of it. We don't tend to have a regular history of growing up [visiting the doctor].”

This might result in a lower sense of urgency when it comes to addressing medical issues, or forgoing care altogether, both of which can worsen health outcomes down the line.

Another barrier that might inhibit men's health care uptake is stigma.

“There's a cultural difference historically between men and women about their perceived value of seeing a doctor and whether it's socially acceptable to go in and report that you're having a problem,” said Bradley Anawalt, MD, FACP, an endocrinologist at University of Washington Medicine in Seattle.

Sean Cahill, MD, FACP, an internal medicine physician in Chicago, has seen that play out firsthand. “I have male patients all the time say, ‘Man, I'm usually not this needy, Doc.’” But engaging in medical care is not being needy, he stressed. “It's that you don't feel well and that you're seeking health care and you're seeking some help, and that's OK.”

In Dr. Griffith's research, which focuses on Black men, he's found that many don't consider doctors' visits valuable. “Often they would say, ‘Well, I would go in and essentially get lifestyle advice: You need to lose weight, change your diet, need to exercise more.’ They knew all those things before they got there,” and they often don't receive resources to make those changes, he said.

“They weren't feeling like it was a useful use of their time. They felt like often they were treated with a level of disrespect and disregard for what they said, and it just didn't seem to be particularly helpful and valuable when they would go,” Dr. Griffith said.

Showing value

Recognizing this dynamic is one way that physicians can encourage men to engage in their health.

“It's important to talk to patients about what they're interested in and what motivates them to try to maintain good health, and what things in their lives make them feel good,” Dr. Anawalt said.

He noted two major innovations in the past 25 years that have increased rates of men visiting the doctor: the approval of sildenafil for erectile dysfunction and of transdermal testosterone formulations for low T.

“With the approval of sildenafil, or Viagra, in the late 1990s, there was a marked increase in the number of men that came in seeking health care, and then the second successful health campaign related to [transdermal] testosterone products,” Dr. Anawalt explained.

These examples underscore the importance of tying men's health to their personal goals, whether those relate to higher energy or a better sex life.

At the beginning of visits, primary care physicians could ask, “What are your goals for today? What are you actually trying to get out of this?” Dr. Griffith recommended. “People value [health] because it allows you to do something else, and the more that they can see, ‘The more healthy I am, the more I can do things that are important to me.’”

Primary care physicians can also use Medicare's Annual Wellness Visits as a model, Dr. LeWine suggested. Instead of simply being a physical, the visit focuses on “the concerns that your patient has, the concerns that you have for your patient around the issues,” he said.

Once the patient's concerns and goals are clear, the physician can make the connection between those and recommended health care.

“One of the more successful things I've been able to do with men that are overweight and sedentary is to connect that to sexual function. There are studies showing that increasing your exercise and adjusting your lifestyle, including diet, to attempt to lose weight is associated with improved sexual function and sexual satisfaction,” Dr. Anawalt said.

Similarly, although most patients who are motivated to visit a doctor after viewing content suggesting they may have low testosterone do not have a deficiency, Dr. Anawalt views these recent online campaigns as successful because they provide a “wonderful opportunity to begin to talk about healthy measures that can avoid causing low testosterone.”

Taking a family history is another opportunity to connect personally important outcomes to preventive care. (See sidebar for more about genetic risk.) For example, if a patient has a family history of diabetes, physicians could ask what the patient knows about the condition.

“Oftentimes they will have heard that you could lose your eyesight … they may not have connected that to their own personal risk,” Dr. Anawalt explained. This provides an opportunity to talk about quitting smoking, managing cholesterol, and maximizing diet and exercise. “It just helps them connect that to something personal to them.”

Redefining health as a long-term means to an end, and not just how you feel on a day-to-day basis, is key. “Really focusing then the preventive health care measures centered around some of those [personal] concerns is one of the ways to get them engaged,” Dr. Anawalt said.

Dr. Griffith noted that this may entail a lot of reframing for patients. “It has not been uncommon … for men to say, often, quite proudly, ‘I've been healthy enough not to have to go to the doctor in 10 years,’” he said. But “there are things going on in your body you can't tell by not seeking preventive care.”

Aging successfully

One motivator that might resonate is the idea of successful aging, or being able to physically do all the things they envision for retirement. Physicians can prompt patients to think about what this looks like to them, whether it's living independently, traveling, or playing with grandkids, and then tailor their approach to those specific goals.

Using this mindset, regular check-ups are framed more as an internal control or baseline for comparison as patients age, Dr. Griffith said.

“You want to increase how many years you're going to live, but also how many good years you're going to live,” said Dr. Cahill. “If we're going to talk about prevention of chronic diseases across the board, ranging from coronary disease to diabetes to sleep apnea to cancer rates, a lot of those things can be prevented by moving and taking good care of your metabolism.”

He suggests using the phrase “training” for getting older. So, if patients want to go on a one-and-a-half-mile hike with their grandkids when they're 70, they should be going on a five-mile hike when they're 50, Dr. Cahill said. If their goal is to lift a 30-pound grandkid when they're 70, then they should start doing goblet squats with a 50-pound weight now, he suggested. “It's sad when people finally can travel or spoil their grandkids, or do the things that they want to do, but they're physically unable to do that because they didn't take good enough care of themselves along the way.”

Ultimately, engaging more men in their health comes down to increasing the perceived value of care, experts said.

“When you're able to help people see, ‘Oh, there's something I'm getting out of this. There is information that I didn't know’ … and they have a positive experience,” that increases the likelihood of patients visiting again, said Dr. Griffith. “If they find it useful, then they actually may be willing to do more of it.”