Why aren't men listening when it comes to their health?

Men are notorious for ignoring health problems, which could be why one in five will die before reaching retirement age. Key causes include heart disease, mental health disorders, prostate cancer and now Covid-19.

Learning objectives

After reading this feature, you should be able to: 

• Discuss the key drivers behind the increased risk of premature mortality in men
• Help men manage modifiable risk factors
• Recognise and respond to common symptoms that male customers may be ignoring. 

Key facts

• It is estimated that one in five men in the UK die prematurely from preventable medical conditions
• Men are much less likely to access primary healthcare services than women
• As a result, serious conditions such as cancer and depression are currently going undiagnosed in men. 

Understanding the problem

Compared to their female counterparts, men are three times more likely to commit suicide, 67 per cent more likely to die from common cancers and nearly twice as likely to die prematurely from diabetes.

Men’s reluctance to engage with primary healthcare services is well documented and men of working age are significantly less likely than women to visit their GP or pharmacist. However, on reaching retirement age, the numbers for both genders even up – highlighting work commitments and being 'too busy' as one of the main barriers for men in accessing healthcare. 

As the Men’s Health Forum explains, a major factor is reluctance to take time off work – particularly for mental health issues. It is a fear that may well be justified. A third (34 per cent) of working-age men would be embarrassed or ashamed to take time off work for a mental health issue such as anxiety or depression compared to only 13 per cent for a physical injury. 

Over half of men with mental health problems (52 per cent) were concerned that their employer would think worse of them. This comes on top of men’s reluctance to take time off work for medical problems anyway. 

In the same survey, 30 per cent of men wouldn’t take time off work for blood in their urine, 40 per cent wouldn’t for an unexpected lump and 42 per cent wouldn’t for chest pain. For "feeling low or down", 85 per cent wouldn’t take time off work and for anxiety, 81 per cent. Men are also less likely to engage with routine screening for cancers and sexually transmitted infections or attend recommended NHS health checks. 

As the approachable frontline of primary care, pharmacy teams are well positioned to stop men’s health problems slipping through the cracks. Social determinants and lifestyle factors have been pinpointed as two of the biggest factors contributing to premature death in men – and are compounded by reticence in accessing healthcare. With long opening hours, weekend accessibility and no need to make an appointment, community pharmacy can help overcome the hurdles imposed by work commitments by providing a convenient and flexible outlet for men to access everyday healthcare advice. 

"Pharmacies are embedded within local communities and are therefore ideally placed to raise awareness of issues relating to men’s health," says Numark patient services manager, Lucy Morris. "By delivering either a male-specific health promotional event within the pharmacy or engaging in outreach within the communities at sites like local gyms, pharmacies have the power to make a real impact. 

"Whilst outreach or events may not directly impact the individual, it may cause their partners, families and friends to notice that actions need to be taken and that local pharmacies are a useful first port of call."

Pharmacy teams can play a key role in tackling major modifiable risk factors such as obesity, inactivity and excess alcohol consumption as part of their existing role as healthy living ambassadors. Pharmacy staff can also be alert to the early warning signs and symptoms of potentially serious conditions like cancer and mental ill health in their male customers – signposting them to sources of support and referring for expert follow-up where required.

Drivers of increased risk

High cholesterol and high blood pressure, two of the key risk factors for heart disease, can be detected with simple screening tools and treated with effective medications and lifestyle changes. Male customers aged over 40 years who have not yet taken up their NHS Health Check – the free mid-life health MOT – from their GP or pharmacist should be encouraged to do so. 

The NHS estimates this simple check saves 650 lives a year by helping to spot serious diseases such as type 2 diabetes, and identify and intervene against key cardiovascular and circulatory risk factors. Pharmacy teams can also help to promote preventative interventions that will improve the overall lifestyle and health of male customers. 

Men are still more likely to smoke, take illegal drugs and drink at hazardous levels than women – so advice on smoking cessation and recommended levels of alcohol consumption is important, alongside signposting to alcohol/drug support services as required. Other key lifestyle recommendations should centre on weight loss (over 60 per cent of men are overweight or obese yet only a fraction of those on NHS weight loss programmes are men), healthy eating (particularly out-of-home and workplace eating), and physical activity and exercise. 

Compared to women, men are over 25 per cent more likely to develop diabetes and also have a higher risk of serious disease-related complications. As a result, diabetes has a disproportionately high impact on male mortality. Pharmacists should be aware that type 2 diabetes can develop at a lower body mass index (BMI) in men than women and that men of African, African-Caribbean, South Asian or Chinese descent are at a higher risk of developing type 2 diabetes at a younger age.  

Suicide remains the leading cause of death for men aged 45 years and under, but older men are also affected.1 The peak age for death from male suicide in the UK currently stands at 45-49 years.1 Pharmacy teams should be alert for factors that increase the risk of suicide in men, which include alcohol/drug misuse, being middle-aged, emotional illiteracy and socioeconomic factors such as unemployment. 

Any male customer who is struggling with their mental health should be signposted to online resources, self-help groups and peer-led support services. A routine visit to the pharmacy also provides a valuable opportunity to discuss mental health and wellbeing with a team member or pharmacist.  

Many of the steps to tackle other health conditions that disproportionately affect men will also have a positive impact on cancer risk. “Most of the explanations for men’s high rates of death from cancer are to do with lifestyle differences between the sexes,” says David Wilkins from the Men’s Health Forum. “However, we cannot precisely quantify how much difference that makes in any one cancer.

“A logical response is to concentrate on improving men’s lifestyles and improving symptom awareness so that men seek help earlier. This is particularly important for those men in the poorest communities where rates are at their highest and so are gender differences.” 

All boys in England aged 12-13 years are now being offered the HPV vaccine as part of the NHS vaccination programme, which is an important step towards reducing the risk of anal and penile cancer in later life. 

Recognising the common danger signs

Improving men’s lifestyles is a key action point for pharmacy; another is to raise awareness of indicators of a potentially undiagnosed health condition that requires intervention. In particular, pharmacy teams should be on the look-out for common symptoms that male customers may be ignoring. 

Issues with urination are a key indicator of prostate problems, particularly in older men. The prostate gland tends to increase in size with age and around one-third of all men over the age of 50 years will experience some symptoms due to this benign prostate enlargement which exerts pressure on the urethra. Typical symptoms include difficulty starting or stopping urination, weak flow, incomplete bladder emptying, dribbling, more frequent urination and nocturia. 

Due to the significant overlap with warning signs of potential prostate cancer, any male customer with urinary symptoms suggestive of an underlying prostate-related problem should be encouraged to consult their GP, who will undertake a physical examination and/or prostate specific antigen blood tests, as well as prescribing medication where appropriate. 

Pharmacy staff should be particularly alert to certain customer groups who may be at increased risk of prostate cancer such as men over the age of 65 years, men of African-Caribbean and African descent, and those with a family history of prostate or breast cancer. Treatments that can help manage the symptoms of prostate enlargement include alpha blockers, anticholinergics, 5-alpha reductase inhibitors, diuretics and desmopressin. 

Self-care measures which can reduce troublesome urinary symptoms include cutting down on fluid consumption before bed and reducing intake of caffeine and alcoholic drinks that act as diuretics. Customers can also try techniques such as bladder training, double voiding (after each urination, try again immediately) and/or urethral milking (squeezing the base of the penis after urinating and working outwards to force urine out of the urethra). 

Certain OTC medicines such as antihistamines, decongestants and some antidepressants can also worsen urinary symptoms so should be excluded as potential exacerbatory factors. 

Mole hunt

Men may be less inclined to monitor moles than female customers but nonetheless should be encouraged to look out for changes that warrant a visit to the GP. Key signs to look out for include changes to the shape of a mole (particularly uneven borders), changes in colour (including darkening or the development of two or more different shades), itching, crusting, flaking, bleeding, an increase in size or raising up from the surface of the skin. 

Men can protect themselves from UV damage by applying factor 30+ sunscreen when out in the sunshine and wearing a hat and sunglasses (particularly if they already have moles on their face or are balding). It is important to highlight that it is not just sunbathing that increases the risk of developing skin cancer and requires sun protection but any outdoor activity during the summer months including gardening, playing cricket or just sitting in the pub beer garden.

Melanoma in men most commonly affects the back but can also occur in uncommon areas such as the scalp. 

Heart problems

Any customer presenting with sudden chest pain that spreads to the arms, back, neck or jaw; makes the chest feel tight or heavy; started with shortness of breath, sweating and nausea/vomiting; or lasts more than 15 minutes requires urgent hospital attention as these are all potential signs of a heart attack. 

Chest pain that comes and goes can have a myriad of potential causes, ranging from heartburn, anxiety or panic attacks, sprains or strains to the chest muscles to chest infection/pneumonia or cardiovascular problems such as pericarditis or angina. The risk of coronary heart disease as the underlying cause of chest pain is increased in men who smoke, are overweight/obese, have uncontrolled hypertension, hypercholesterolaemia or diabetes, or who have a family history of myocardial infarction or angina in close relatives under the age of 60 years. Any customer with chest pain due to suspected CV disease should be referred to their GP for a full risk assessment. 

Growths

Although lumps or growths on the skin are common and usually innocuous, any lump that feels hard to the touch and/or which persists for more than two weeks warrants a visit to the GP to rule out potential cancer. Other reasons to see a GP include if the lump is painful, red or hot, or if a lump has grown back after previously being removed. 

For men, the key places to look out for lumps are the testicles, as well as the breast tissue. Symptoms of breast cancer in men mirror those in women and include a hard, painless, immobile lump; nipple inversion or discharge; a rash; or swollen glands in the armpit. 

It is particularly important to encourage men of all ages to examine their testicles regularly as testicular cancer most commonly affects men between 15 and 49 years of age, and is more frequent in white men than other ethnic groups. 

The hallmark sign is a painless swelling or lump in one of the testicles, but any change in the shape or texture of the testicles requires investigation. Testicular cancer is one of the most treatable forms of the disease, highlighting the importance of self-examination and seeking help for any lumps that are identified. 

The negative impact of erection problems

An estimated 5 million men in the UK experience erection problems, says Martin Tod of the Men’s Health Forum – and it is not just affecting older men but those in their 20s and 30s.

Erection problems can be a sign of underlying conditions which, if left unchecked, can cause further problems such as heart disease and diabetes. However, the sense of failure and perceived loss of masculinity that many feel as a result can also cause its own problems.

"Erection problems can have a negative impact on men’s self-esteem, which if left unspoken can have a big impact on their mental health causing depression and anxiety," says Tod. And men are not the only ones left feeling isolated, anxious and under pressure. Partners are affected too.

In a survey commissioned for Viagra Connect’s Time to Raise It report, over a quarter of respondents (26 per cent) said erection problems prevented them from being intimate with a partner. And despite popular opinion, younger British men aren’t exempt either. 

Erection problems have a negative impact on men’s self-esteem, causing a third (31 per cent) to feel 'inadequate' and over a quarter (27 per cent) to feel like a 'failure'. Even more worryingly, as already mentioned, they also affect men’s mental health leading to feelings of anxiety (27 per cent), depression (19 per cent) and lack of confidence (23 per cent).

The Time to Raise It campaign has teamed up with the Men’s Health Forum to produce a resource on men’s sexual health called Size Isn’t Everything and also joined forces with LloydsPharmacy’s online doctor service.

Suicide

With suicide ranking as a leading cause of death among men, vigilance for the signs and symptoms of potential depression is vital. Symptoms of depression can be different among men and include low mood together with personality changes. Male depression may manifest as anger, aggression or irritation – rather than sadness – making it harder to identify. 

Men who are depressed may lose their libido, become less interested in work, family, sport and hobbies, and have difficulty sleeping. In some cases, alcohol or drugs can become an outlet and refuge for those struggling with feelings of depression and anxiety. 

As men are less likely to recognise and talk about their mental health issues, or seek the help and support they need, this can compound the problem and lead to depression becoming long-term and entrenched. It is therefore important pharmacy teams are aware of potential signs of depression among male customers and can signpost them to their GP or other sources of mental health support where required.