A closer look
Testosterone is a sex hormone that makes men men. It is responsible for their sex drive, sperm production, body hair, muscle mass and bone density. Men gradually lose testosterone over time especially after the age of 40. Other causes of loss are injuries, infections and hormonal disorders. Some men have no symptoms or fail to recognize them. When symptoms impair quality of life, low testosterone can be evaluated and treated, often by an endocrinologist, a doctor who specializes in disorders of hormones.
Decrease in sex drive
Decreased bone density
Men’s health: regular checkups vital first step
Henry Jenkins is smiling, but admits his past behavior is no laughing matter. Because Jenkins refused to go for regular checkups, his high blood pressure and cholesterol went undetected. Jenkins suffered a stroke almost four years ago.
And one evening four years ago, he was having an emergency. All the years of ignoring his health came crashing down as he fell off his couch and landed on the floor. He was having a stroke.
Fortunately, his friend heard the thud and called 911. But even then, his health was not his first thought.
“When they were taking me in the ambulance, all I could think of is how soon I could have a cigarette and a beer,” he remembered.
All of that changed after the stroke. Jenkins is now 72 and is amazed that he could live so long without going to a doctor on a regular basis. “It almost cost me my life,” he said.
For a variety of reasons, men have a different attitude about their health, and an aversion to making — and keeping — regular medical appointments is just one of them.
Those attitudes are in part the reason that men — particularly black men — are suffering and dying at higher rates than any other demographic group.
In 2007, the death rate in black men in Massachusetts exceeded that in black females by more than 30 percent in all but a few illnesses. Black men die from cancer and heart disease at a rate more than 60 percent higher than that of black women.
Even when matching males against males, the picture is bleak. Black men die from diabetes, kidney failure and HIV at two to fives times the rate of white men. Homicide is another factor. Black males are murdered 11 times more frequently than white men.
These figures explain why life expectancy for black men continues to lag behind white men and women. While white women in Massachusetts are expected to live until the age of 83, life expectancy of black men is almost nine years shorter.
Dr. Jean Bonhomme, founder of the National Black Men’s Health Network, places a lot of the blame on the men themselves. Not going to the doctor is ingrained in men — sucking it up is instilled in young boys when they are in pain.
“Society has a great admiration for pain without complaint,” said Bonhomme. “Males have an expectation that if something hurts, don’t bother with it. It will go away by itself.”
Typically, men enter the health care system when their prostate kicks up, but that takes 40 to 50 years. It doesn’t take that long for cardiovascular problems to emerge — and often silently. That’s why “feeling fine” is not a reliable measure of good health. Ironically, some men begin to suffer from the very condition that concerns them the most — erectile dysfunction (ED).
Although there are many causes for ED — stress, depression, and certain diseases — one of the biggest causes is cardiovascular disease. Men with untreated high blood pressure, diabetes, clogged arteries — the very conditions that would be assessed and treated at regular doctor visits — can interfere with normal sexual functions. Add smoking, excessive alcohol use, obesity and lack of exercise to the mix, and it’s a wonder that men can perform at all.
Jenkins readily admits that he was more of the rule rather than the exception. He grew up in a small town in Louisiana, and going to the doctor was not part of the culture. The town had one doctor, and according to Jenkins, men saw him only when they had cut themselves and required stitches.
“We had our own remedies for colds and stomach aches,” he said. “I think I went to the doctor’s office only about five times in my life and it was never to see what was going on inside my body.”
And like most men, Jenkins had a simple fatalistic reason. “If there was anything wrong with me,” he explained, “just let it happen.”
But Jenkins took his short-sighted behavior to an extreme. When his friend scheduled yearly physicals for him, Jenkins would calmly sit in the waiting room for a while — and then catch the bus back home without actually ever seeing his doctor. Jenkins now blames himself. “It was me,” he said. “Going to the doctor was something I decided I didn’t want to do. I was afraid.”
Jenkins is not alone. In a recent survey sponsored by the American Academy of Family Physicians, more than 1,100 men talked about their attitudes on their personal health.
What they found was not surprising. But one pattern emerged — the answers are tempered by age. The older men get, the more likely they are to seek the care of doctors.
Men between the ages of 18 and 34 tend to consider themselves healthy — thus denying the need for a doctor’s visit. They also tend to wait as long as possible to see if they get better on their own, are less likely to have a blood cholesterol test and have a fear of knowing if something is wrong.
By the time men reach 55 years old, their views are completely different. They tend to seek medical advice as soon as possible, are more likely to have had a recent cholesterol test (89 percent), do not consider themselves particularly healthy and do not fear what the doctor may find.
There are many reasons for men’s behavior and fingers can be pointed in several directions — even at the medical profession. For starters, there is no counterpart to gynecologists, doctors specially trained in the female reproductive system. While services for women and children and specific diagnoses abound, men are hard pressed to find programs geared to them alone. Even treatment of the elderly gets more play than male-designated care.
J. Jacques Carter, M.D., M.P.H.
Assistant Professor of Medicine
Harvard Medical School
Beth Israel Deaconess Medical Center
And what does receive an inordinate amount of attention — sexual performance — is not exactly a fatal condition. In fact, of the top 20 leading causes of death in men, the lack of sexual prowess is not one of them.
Dr. J. Jacques Carter, an internist at Beth Israel Deaconess Medical Center, is extremely blunt. “There’s more to men’s health than prostate cancer and Viagra,” he says.
Not all is lost. Over the years, Carter has seen a change in attitudes. Although most of his male patients are between 45 and 55 years old, he says he sees a significant number of thirtysomething men.
“You want to get them early,” he said. “You don’t need to see them every year, but you want to get a baseline.”
The trick, Carter explains, is to establish a strong and trusting relationship with his patients. “They won’t come back if they don’t like what you say,” he said. He’s also learned the art of bargaining. If he can get a patient to do at least one of the four suggestions he makes, he’s partly there.
Jenkins has made a remarkable recovery. Though he still wears a short-leg brace to support his right ankle and he uses a cane to walk outside, his speech has improved and he is slowly gaining strength in his right arm.
He now attends the Rogerson Communities Adult Day Health Program three times a week where he spends several hours in the exercise room.
In hindsight, Jenkins marvels at his past behavior, but admits, “The stroke is the best thing that has happened to me.”
He has no problems going to the doctor now. “Every six months I go for a physical,” he said. He takes his medications faithfully. And his fear of doctors has disappeared — just like his smoking habit. “Now if anything is wrong with me, I go to my doctor right away. If it’s on the weekend, I go to the emergency room.”
But more than anything else, Jenkins wants people to learn from — and not repeat — his experience. He’s become a preacher of sorts. He says he stops people in the street — complete strangers — to warn them of the dangers of not going to the doctor or not getting screened. For Jenkins, it’s personal.
”I don’t want others to go through what I went through,” he says.
Listen to advice from Dr. J. Jacques Carter:
*Courtesy of Beth Israel Deaconess Medical Center