A little knowledge and awareness by a man's mate can help him maintain his health and prevent disease.
He changes the oil in his car every 3,000 miles. He listens for any rattle or ping coming from under the hood. He rotates the tires, and checks their air pressure on a meticulous schedule.
If only he maintained his own body as religiously.
Men tend to avoid going to the doctor far more than women do, even when dealing with simple problems that a doctor could easily help solve, national studies show.
Consider this: fewer than one in five American men ages 18 or older said they would seek immediate medical help when they were sick or in pain, according to a 2000 survey. About 25 percent of men surveyed had not seen a doctor in the past year, far greater than the 8 percent of women who made the same claim.
Face it-in today's Internet-savvy, media-focused world, there are many ways for men to learn how their bodies work and take an active part in staying healthy, physicians say. Still, sometimes it is up to the women in their lives to subtly suggest they get that test or checkup. Although many human health concerns cross genders, men do have their own set of issues that may be unfamiliar to women.
That's why when it comes to men's health, there are three watchwords for women: Know your man.
Staying healthy
Some physicians believe that men tend to see a doctor less because they never experience a natural entry point into the medical system.
Women commonly begin seeing a doctor after puberty to deal with issues of reproductive health such as annual pelvic exams. But aside from a sports injury or accident, no common thread seems to drive young men to see physicians.
Still, young men could benefit from getting an "owner's manual" for their bodies by visiting a physician, to help prevent disease before it happens.
In part, that means discussing the advantages of exercising regularly, maintaining ideal body weight and eating a balanced diet, which can help prevent the onset of cardiovascular disease, adult diabetes and some cancers. "You can show the patient that eating right and exercising are to his own benefit," says John L. Brodhead Jr., M.D., USC associate professor of internal medicine, "and he can get his health under control before he has a problem."
Prevention starts best during youth, adds Howard N. Hodis, M.D., USC associate professor of medicine and preventive medicine and director of the USC Atherosclerosis Research Unit.
"It's never too late to modify your dietary intake and exercise patterns," says Hodis, who specializes in cardiovascular disease. "That means exercising a minimum of three days a week, 30 to 40 minutes each session-and eating the right proportions of fruit, vegetables and fat, in reasonable servings."
Walking can be especially effective if a man and his partner set up a consistent routine together, he notes. And as for checkups, the American Heart Association recommends that men have their cholesterol levels tested every five years starting at age 20, and more frequently after age 45.
Matters of the heart
In popular culture, cardiovascular disease often is seen as a male problem. But Hodis says that the popular stereotype is only half right. "The reality is that one of two men and women will die of cardiovascular disease," he says.
Men and women do differ in a few ways when it comes to matters of the heart, though. Men tend to experience heart attacks and strokes about 10 years before women do, for one, he says.
Experts believe the female sex hormone estrogen protects women from cardiovascular disease. But when a woman goes through menopause, her estrogen levels drop, protection from estrogen declines and heart disease begins.
Men's bodies, in contrast, rely more on the male sex hormone testosterone. No one really knows if testosterone affects heart disease, as estrogen does in women, Hodis says. But some initial studies indicate that certain levels of testosterone raise HDL, the so-called "good cholesterol," and lower LDL, the "bad cholesterol."
During adulthood, the level of testosterone in a man's body declines, but some believe that keeping it at the level of a 40- to 45-year-old man might help the heart. "There is evidence that this may be a worthwhile area of investigation for the prevention of heart disease," says Hodis. But, he warns, adding testosterone may seriously increase the risk of prostate cancer. For now, testosterone therapy for heart disease is just an idea, he says; men should follow good prevention habits already shown to work.
His hormones
Testosterone and its related hormones have other effects-besides male pattern baldness, acne and the onset of puberty-that are important to understand.
Studies have linked declining testosterone to osteoporosis, or thinning bones, popularly and incorrectly considered a women's disease.
"It's estimated that about 2 million men in the U.S. have osteoporosis," says Robert Rude, M.D., USC professor of medicine. "Most men, as they get older, don't think they're susceptible to this disease."
Osteoporosis greatly increases the chance of breaking bones after a fall, Rude says. Men can lessen osteoporosis risk by exercising and eating well during their teens, since bones reach peak density at age 20. Over the years, getting plenty of calcium (1,000 mg a day, or 1,200 mg a day for those over 50), performing weight-bearing exercise and avoiding alcohol and smoking can keep bones strong.
Doctors can perform a painless bone mineral density test on men if they suspect osteoporosis. If low testosterone levels are to blame, physicians also can provide hormone replacement, Rude adds.
The male hormone dihydrotestosterone, meanwhile, contributes to another bane of the aging man: benign prostatic hyperplasia, or BPH-the gradual enlargement of the prostate gland.
Found behind the bladder, the prostate, a male sex gland, produces fluids important in reproduction. It normally is about the size of a walnut in an adult, but over time, dihydrotestosterone prompts the prostate to grow.
When the prostate becomes enlarged, a woman might hear a man complain about getting up several times at night to urinate, or that he urinates slower than he used to, says Jeffry Huffman, M.D., USC professor of urology.
Although men often believe BPH is an inevitable part of growing older, these are not symptoms to ignore. Usually the urinary problems are harmless, Huffman says, but men should be encouraged to get checked to rule out an infection-or prostate cancer.
Curable cancers
The most common form of cancer among American men is also one of the most easily detected: skin cancer.
There are three basic types of skin cancer: basal cell carcinoma, squamous cell carcinoma and melanoma. Men are twice as likely as women to have basal cell cancers and three times as likely to have squamous cell cancers of the skin. The good news: Most basal cell and squamous cell cancers grow relatively slowly, and doctors can treat them almost routinely if caught early.
Doctors suggest keeping an eye out for unusual freckles, sores or blemishes on the skin, as well as examining for changes in the color, shape or size of moles. Danger areas to watch in men include the back, chest, abdomen, scalp and lower legs.
A skin checkup by a doctor every three years is recommended for those under 40, while those over 40-as well as those with a family history of melanoma, the most dangerous skin cancer-benefit from a once-a-year inspection.
Second to skin cancer is prostate cancer. Huffman says about half of all men have this disease by the time they reach age 80.
Evidence suggests prostate cancer growth can be tied to male sex hormones. In fact, some men diagnosed with prostate cancer choose hormone modulation therapy to keep their cancer from growing, at least for a while.
But prostate cancer and its potentially deadly effects can be softened if a man is vigilant about early detection of the cancer through regular exams.
"We are diagnosing prostate cancer at earlier stages because of the PSA blood test," Huffman says. The PSA, or prostate-specific antigen test can warn of the presence of a tumor. Doctors also perform a physical exam to feel for any lumps. And when caught early, such tumors are very curable: In the U.S., more than 80 percent of men found with early stage tumors are still alive seven years later, a high survival rate for cancer.
Men should start getting the PSA test every year starting at age 50, but those who have a family history of prostate cancer-or African-American men, who are at higher risk of the disease-should begin the tests by age 40, Huffman notes.
Just as in prostate cancer, a little knowledge and awareness can help catch testicular cancer.
Most cancers of the testicles-a part of the male reproductive system that manufacture testosterone, as well as sperm-occur between the ages of 15 and 40.
Young men should be encouraged to get into the habit of performing a testicular self exam every month to look for possible signs of testicular cancer-such as a lump, size change of testicles or tenderness-much like women perform a breast self-exam. Men in the U.S., especially white males, are among those at highest risk in the world for this cancer, but if caught early this cancer, too, is very curable.
"It's important for young men who are starting these self-exams to let a doctor show them how to do it the first time around," Brodhead explains. "We help people through it all the time."
And even when a man finds a lump, he says, it might not be cancer. Often it may be a benign growth, which can be confirmed by a simple, painless test at the doctor's office.
Mind and soul
Other health issues facing men are less overt. The top causes of death for American men between ages 15 and 34 cannot be traced to disease-instead, accidents, suicide and homicide account for the most fatalities, according to the National Center for Injury Prevention and Control (NCIPC). Encouraging the use of seat belts, bicycle and motorcycle helmets, smoke detectors in homes and other protective equipment is a good way to promote health among men, Brodhead says.
What may be especially startling about those NCIPC statistics, though, is that men make up about four of every five deaths from suicide. And that is where the health of the mind-not just the body-comes into play.
"Women attempt suicide more often, but men are more effective at doing it," explains Bruce Spring, M.D., USC assistant professor of clinical psychiatry.
Although depression is more common in women than men, experts believe one of every 10 men will experience major depression during their lives. Many cases of the dangerous illness go undiagnosed.
"There is a lot of acculturation in men not to seek help," Spring says. "Many men feel a stigma about mental health care. They believe it damages their masculinity."
But a man's partner can pick up on some standard signs of depression, he says, including: mood changes, decrease in sexual interest and activity, a loss of interest in favorite activities, sleep problems, trouble concentrating, agitation or hyperactivity, feelings of guilt or worthlessness and thoughts of death.
Nagging or harassing a spouse to see a doctor might backfire, though. Spring says, "One strategy might be not to bug the person about it-instead, give him some information about depression and effective treatments," such as medications and counseling.
Sometimes depression may hide or be a result of other problems: alcohol or drug abuse.
Among seniors, studies show that alcoholism may be far more common than previously thought, as those who become depressed seek secret escape in the bottle. One third of seniors who develop problems are new drinkers, says Loren Lipson, M.D., USC associate professor and chief of geriatric medicine. And often, loved ones mistakenly attribute key symptoms such as forgetfulness and accidents to dementia.
Among younger men, alcohol and other substance abuse continue to be a problem. Male alcoholics outnumber female alcoholics by three to one, and about 22 percent of men under 30 are believed to abuse alcohol, according to national studies. Problems are so common-but symptoms often missed-that physicians often ask questions about alcohol and drug use during regular exams.
"Whether it's drug or alcohol abuse, you often see adverse consequences," notes Brodhead. "They could include frequent accidents, anemia, gastrointestinal bleeding and liver problems."
Depression often is a key component of another aspect of men's health-male menopause-though some question its existence.
Although women's ovaries stop producing estrogen at menopause, men never stop making testosterone, but reduce production after age 40-so, defined chemically, men do not experience menopause.
But there is the so-called midlife crisis, a feeling in men that they have accomplished little in life or they have wasted their youth. Perhaps a man may feel his peers-and wife-are getting older, but he is not; so he seeks youthful thrills.
"This time of strife has many of the same emotional characteristics of menopause in women: ups and downs and depression," he says. "In that way, there is a male menopause."
If a woman picks up on her mate's depression, Lipson says, perhaps she can try to understand how he is feeling, be supportive and suggest counseling.
In some cases, problems are indeed hormonal. Some men in their 70s may have seriously low levels of testosterone, Lipson notes. A visit with a doctor, who can run tests and discuss treatment options can help.
Regardless of age, a little medical attention, a helpful reminder from a mate-and regular checkups "under the hood"-can help keep men's health running in good stead for many miles to come.