Men's health

• There are significant differences in access to healthcare and health outcomes between men and women. This has been exacerbated by the COVID-19 pandemic.
• In 2008, the Department of Health published The Gender and Access to Health Services Study which was carried out to understand the gender inequalities and to offer suggestions around removing these inequalities.
• Men's life expectancy is now in decline for the first time since the 1980s. There are also significant differences in the life expectancy of men from different socio-economic backgrounds, with men in the least deprived areas expected to live for 9.4 years longer than those in the most deprived areas.
• Statistics on men's health

  • 19% of male deaths in the UK are before 65 years of age
  • 74% of deaths from suicide were men in 2023
  • 75% of premature deaths from coronary heart disease are men
  • Men are 37% more likely to die from cancer
  • Older men are about twice as likely as women to have diabetes
  • 65% of admissions related to alcohol were men

  
• Barriers to men accessing healthcare

  • A significant proportion of services being female friendly, with ready access to contraception clinics and female screening programmes such as cervical cancer and breast cancer screening
  • National policy often doesn't take into account the differences in requirements of men and women
• In England, a Women's Health strategy was published in 2022. There are currently no plans for a Men's Health strategy, but several organisations such as the Men's Health Forum, are campaigning to make this happen.
• Men's approach to health

  • It can be difficult to get men to think about potential health issues and how to avoid these
  • Men can also be reluctant to talk about health issues they are experiencing and often will bury their head in the sand, believing that if they ignore a problem it will resolve itself
• Overweight


  There are more overweight men than women. Obesity rates are about the same in both genders and, whilst there are more obese women than men, the trend is that men are increasingly experiencing health issues due to their weight.
• Men's approach to weight loss


  With most weight loss programmes catering to women, this can make it even more difficult for men to lose excess weight.
• Lifestyle risk factors more prevalent in men

  • Smoking
  • Alcohol consumption
• Cardiovascular disease in men

  • Cardiovascular disease occurs 7-10 years earlier in men than women due to the cardioprotective effects of oestrogen in pre-menopausal women
  • The incidence of cardiovascular disease is about the same in men and women but men are less likely that women to identify an emergency. As a result, mortality due to a cardiac event is higher in men, with death mostly occurring before they reach hospital
  • Many of these deaths are preventable by modifying lifestyle and other risk factors, but men are less likely than women to have modifiable risk factors identified and managed
• Mental health in men

  • Far more women than men are diagnosed with mental health conditions. However, depression and anxiety is likely significantly underdiagnosed in men
  • There is a lack of knowledge as to the barriers men experience in relation to accessing mental health services
  • As a result of the low levels of access to mental health services, men are more likely to be 'sectioned' under the Mental Health Act. Suicide is also much more common in men than women, with three quarters of all reported suicide deaths being men
• Suicide rates are recorded based on the year the death is registered, therefore some of the recent statistics are not accurate for when the suicide took place due to delays in death registrations over the last few years due to the pandemic.

  
• As awareness of men's needs around mental health issues grows and stigma of discussing these issues is reducing, more novel ways for men to look after their mental health are being introduced in the UK. More ways to support men, such as the Talk Club charity and tools such as Mettle, a toolkit designed to help men look after their mental wellbeing, are being developed specifically with men in mind.
• Substance misuse in men

  • Substance misuse is more common in men than in women
  • Alcohol disorders are twice as likely in men, yet more women use alcohol dependency services than men. This may be due to women being considered more vulnerable if they have been drinking, whereas men can become more aggressive
  • Men who misuse alcohol are likely to reduce their life expectancy by over 20 years
• Sexual health in men

  • Contraception is not always seen as the responsibility of men. Women often assume this responsibility due to the implications to them if contraception is not used
  • Whilst there is a lot of opportunity to provide health promotion advice to women when they access contraceptive services, there is a lack of opportunity to speak to men about their sexual health. There also tends to be less willingness by men to access advice and screening
  • Men tend to use condoms for contraceptive purposes, rather than preventing STIs, making them more at risk of STIs during sexual encounters where alternative contraception is used or contraception is not needed
• Androgenic alopecia (male pattern baldness)


  • This is hair loss which follows a particular pattern and is caused by dihydrotestosterone (DHT) hormone which changes to the growth cycle in hairs on the scalp
  • It is very common, with approximately 80% of men developing it at some point
  • Hair loss usually starts later in life, but it can be experienced by young men in their late teens
  • Hair loss is gradual, progressive and follows a set pattern which can be classified using the Norward-Hamilton classification

  
• Diagnosis and clinical investigations for androgenic alopecia


  • History taking is particularly important to establish the timings of and areas affected by hair loss. Family history is also important as well as any medication use or recent lifestyle changes. It is important to establish the phycological impact the hair loss is causing
  • Examine the hair loss and compare with the Hamilton-Norwood scale
  • Check for any abnormalities on the scalp, such as scaling or areas of inflammation, which would indicate an alternative cause of the hair loss. More rapid hair loss, or patches of hair loss would also indicate an alternative cause
• Differential diagnosis for hair loss

  • Alopecia areata
  • Syphillis
  • Hair being more fragile from use of chemicals such as using bleach in hair dye
  • Hypothyroidism
  • Iron-deficiency anaemia
  • B12 and folate deficiency anaemia
  • Medication such as carbimazole or anabolic steroids
• Treatment options for androgenic alopecia

  • Finasteride 1mg (inhibits DHT)
  • Hair transplant
  • Topical Minoxidil (mechanism of action unclear)
• The prostate


  • The prostate is situated at the base of the bladder and surrounds the first part of the urethra. The main function of the prostate is to help in the production of semen
  • Most men develop a prostate problem at some stage in their life

  
• Common prostate diseases


  • Prostatitis
  • Benign prostatic hyperplasia
  • Prostate cancer
• Symptoms of prostate disease

  All prostate problems have similar symptoms due to enlargement of the prostate which puts pressure on the urethra causing urinary symptoms

  
• Prostatitis


  • Acute: A rare but severe infection of the prostate which is usually accompanied by a UTI. It may be managed in primary care with antibiotics, however hospitalisation may be required for IV antibiotics in more severe cases
  • Chronic: This presents as urogenital pain and may be associated with lower UTI symptoms and sexual dysfunction. Most cases (90%) are of unknown cause. These are usually managed in primary care with treatment focussing on symptomatic control. The remaining 10% of cases are caused by a bacterial infection and require referral to a urologist

  
• Benign Prostatic Hyperplasia (BPH)


  BPH is very common in older men, affecting 50% of men 51-60 years and 90% of men over 85. It is caused by an enlargement of the prostate which then puts pressure on the urinary system, causing urinary symptoms. It is not usually a serious threat to health, but it can have a significant impact socially and emotionally on patients. Quality of life can be severely impacted with some men finding it a challenge to leave the house, particularly if he will not have ready access to a toilet or if he is concerned that he would not be able to reach the toilet in time
• Diagnosis and clinical investigations for BPH

  • International Prostate Symptoms Score: This is a validating scoring system enabling an understanding of the patient's conditions and helps to determine the severity and impact of the symptoms
  • Digital rectal examination: An examination where the prescriber inserts a finger into the rectum to feel for abnormalities of the prostate through the wall of the rectum
  • Urine test if infection is suspected
  • Consider Prostate Cancer: A blood test checking for Prostate specific antigen (PSA), a marker for prostate cancer, may be carried out

  
• Differential diagnosis for urinary symptoms

  Some other potential causes are prostatitis, UTI, prostate cancer or constipation

  
• BPH treatments


  Alpha adrenoceptor blockers: Alpha receptors in the prostate cause the contraction of the smooth muscle with α1A receptors thought to be the most dominant in the prostate. Alpha adrenoreceptor blockers relax the smooth muscle and improve urine flow
• International Prostate Symptoms Score

  A validating scoring system enabling an understanding of the patient's conditions and helping to determine the severity and impact of the symptoms

  
• Digital rectal examination


  The prescriber inserts a finger into the rectum to feel for abnormalities of the prostate through the wall of the rectum
• Diagnostic tests for BPH


  • International Prostate Symptoms Score
  • Digital rectal examination
  • Urine test if infection is suspected
  • Prostate Cancer blood test (PSA)

  
• Differential diagnosis for urinary symptoms

  • Prostatitis
  • UTI
  • Prostate cancer
  • Constipation

  
• Alpha adrenoceptor blockers


  Reverse the contraction of smooth muscle in the prostate, relieving urinary flow symptoms
• Alpha adrenoceptor blockers used for BPH

  • Prazosin
  • Terazosin
  • Indoramin
  • Doxazosin
  • Tamsulosin
  • Alfuzosin
• Side effects of alpha adrenoceptor blockers

  • Postural hypotension (especially first dose)
  • Dizziness
  • Fatigue
  • Headache
  • Drowsiness
  • Sexual dysfunction
• 5 alpha-reductase inhibitors


  Block the conversion of testosterone to DHT, downregulating prostate growth
• 5 alpha-reductase inhibitors used for BPH


  • Finasteride
  • Dutasteride
• Side effects of 5 alpha-reductase inhibitors

  • Decreased libido
  • Sexual dysfunction
  • Breast enlargement
  • Breast cancer
  • Depression
• Effective contraception needed with 5 alpha-reductase inhibitors as there is a risk of malformation in a male foetus
• Prostate cancer


  • Most common cancer in men
  • Predominantly affects older men (75% of cases in 65-79 years)
  • Men of black ethnicity at highest risk
  • Develops slowly and often diagnosed late when urethra affected by enlarged prostate