Have You Looked Under Your Hood?

By Harvey B. Simon
Special to the Washington Post
Tuesday, March 13, 2007

Many men would rather diagnose the roar of their muffler than the rasp in their throat; they'd sooner talk about what's going on with their engine's fuel injection system than about their own cardiovascular health.

Those are sweeping generalizations, of course, but they are borne out by 33 years of experience working as a primary-care internist at Massachusetts General Hospital in Boston. Women, I have discovered, tend to pay attention to their own health and the health of other family members, while men busy themselves keeping everything running -- in the garage, in the office and in the house. Everything, that is, apart from their own bodies.

Those tendencies are reflected in some troubling statistics about men's health. Men are not likely to live as long as their wives and sisters. While the average American woman has a life expectancy of 80.4 years, American men lag more than five years behind, at just over 75 years. And if you are black and male, the odds are stacked even more heavily against you: Black men can't even expect to reach the biblical milestone of three score years and 10; they have a life expectancy of about 69 years. Living in poverty and often with less access to routine preventive care, as many black men do, exacerbates the male disadvantage.

There are many reasons for those statistical discrepancies, based in both biology and behavior, but if men want to close the health gap and live longer, we should learn to live more like women: We have to gain a better understanding of our bodies, take better care of ourselves and get the medical care we need. We need to pay more attention to our health.

Many of us, both men and women, fail to have regular checkups with our primary-care physicians. But women typically make annual appointments with their ob-gyns who, by default, become their primary-care physicians. (How many men see a urologist every 12 months?) Women also tend to be the ones to take the children to the pediatrician, who will sometimes discuss issues of importance to the health of the whole family; they still often cook family meals and oversee the household's nutrition; they talk among themselves about health-related topics and report feelings of ill health to their doctors; and they tend to read health-related magazines and newspaper sections like this one.

And, oddly enough, they don't usually obsess about the car in the driveway.

The health gap between men and women is not just a longevity issue. For every year of their life from the moment they are born, American males have a higher death rate than American females. They die younger than women and have more chronic diseases than women. And when it comes to our five leading causes of death -- heart disease, cancer, stroke, chronic lung disease and accidents -- men die at rates 40 percent to 220 percent higher than women do.

Check out these numbers: American men are almost four times as likely to contract AIDS; they are more than three times as likely as women to develop kidney stones, to become alcoholics or to have bladder cancer. And they are about twice as likely to suffer from emphysema, a duodenal ulcer or a heart attack.

Why? A complex mix of biological, social and behavioral factors is at play. Here are some possible contributors:

Biological Factors

· Sex chromosomes: Men have one X chromosome while women have two, which may make men more vulnerable to mutations on the X chromosome.

· Hormones: Men have much more testosterone than women, while women have much more estrogen. Testosterone tends to impair cholesterol metabolism, while estrogen has the opposite effect.

· Blood fats: Women typically have higher HDL ("good") cholesterol levels and men more abdominal fat, which lives in and around your organs and is a major cardiac risk factor.

Social Factors

· Work stress: Men suffer more work-related stress than women, putting them at greater risk for stress-related illnesses such as heart disease.

· Social networks and supports: Men have smaller networks of friends and tend to rely on their wives for their social life; social support helps protect people from mental and physical problems.

Behavioral Factors

· Risk-taking: Men are more likely to engage in risky behavior, aggression and violence.

· Smoking: The gap is narrowing, but 23.4 percent of men compared with 18 percent of women smoke.

· Addiction: Men are more likely to abuse alcohol and other substances.

· Diet: Men are less diet-conscious than women.

· Exercise: Women are more active than men on the whole.

But the underlying problem is that men suffer from what I call "real-men-don't-see-doctors" syndrome. When it comes to health, men put their heads under the hoods of their cars and deny their symptoms for as long as possible.

Look at it this way: You can buy a new car as soon as the sheen goes from the paint job, but your own body has to last you a lifetime. ·

Harvey B. Simon is the founding editor of the Harvard Men's Health Watch newsletter, in which he has written about the health gap between men and women. He is also the author of "The Harvard Medical School Guide to Men's Health" (Simon and Schuster). Comments:health@washpost.com.