By Lillea Hartwell, ND, RH

The gap between men’s health and women’s health continues to grow. In fact, “According to most health studies, men generally have a shorter life expectancy than women.”¹

Getting to the root cause of why seems to be a multi-layered issue. There are many obstacles to men’s health care. Off the bat, in general, men don’t want to go to the doctor². Men polled in a study about this had this to say: “I avoid going to the doctor as much as I can…unless I absolutely have to.” Or, “I go when necessary. I don’t just go to go. If it’s important enough that I feel it’s important, I go.” Or, “I’d say that I avoid going to the doctor, at all costs.”³

My practice is no exception. It’s full of individuals who are hopeful their husbands or partners will share a journey to health with them. Occasionally, they will come in for an initial visit but may not follow up. And my practice is not alone. This is a general trend amongst my colleagues in the naturopathic and conventional professions. This article deep-dives into why that might be and what can be done about it.

Perhaps you’ve heard these exclamations from men you know in response to their injuries or health concerns, “I’ll just push through the pain.” Or, “I’ll live.” Or, “If it ain’t broke, don’t fix it.” Or “It’ll heal on its own with time.”

Men tend to put off health care⁴ and mostly seek health care for energy, hormone concerns, sexual health concerns, hair loss concerns, or pain they can’t keep pushing through⁵. A glance at a local compounding pharmacy’s “Men’s Health Compounds” list outlines the most common medications being sought. The list confirms the findings as the bulk of the pharmacy’s offerings include testosterone, PDE-5 inhibitors, and hair loss compounds. And yet, the conditions that take the life of the male patient may not bring them into the office, including mental health disease, suicide, stroke, and vascular disease⁶.

I recently voiced the concern about lack of male patient follow-up and interest in preventative care to a male colleague of mine who is a fellow naturopathic doctor. This colleague’s insightful responses frequently make me pause to think, and this one was no exception. I’ll share this case study with you, as he did with me, to highlight the point.

Case Study

“Melvin,” a 54-year-old male was presented to the clinic with multiple areas of joint pain and muscle weakness that would progress/migrate to shoulder pain and debilitating fatigue. Pain then progressed to his hip and thigh which was described as, “tight, burning, and throbbing.” The pain was so severe it prevented him from sleeping. He went to his primary care provider (PCP) who ran labs. Lab results at that visit were mostly within normal limits. The PCP ended up referring the patient to a rheumatologist for further workup. The rheumatologist made a working diagnosis of polymylagia rheumatica. The initial symptoms started in March 2024, he saw other doctors in April 2024, and by the time he saw my colleague in May 2024, his pain was reaching a severity level that was difficult to manage with no indication of the root cause in sight, despite extensive lab and imaging work up. In July 2024, my colleague decided to send him to the emergency room due to his pain severity, where the appropriate diagnosis of prostate cancer with metastasis to local lymph nodes was made. “Melvin” is currently undergoing treatment for this diagnosis.

When I asked my male colleague, why he thought his patient put off care, he said “I don’t quite know. The feeling I get is that he was/is a tough guy who always felt he was the person who needed to be strong, take care of his family, and be resistant to pain or weakness… I believe he held out until it totally crippled him, mentally and physically.”

Research supports this conclusion. It indicates that men often display these common tendencies:

To avoid seeking preventative health care services^7,8
To see if things will heal on their own before seeking medical advice⁹
To research online or self-diagnose¹⁰

Participants in one study consistently mentioned that injuries, with a large impact on daily function, actually get them to schedule with a medical provider.¹¹

Once they do seek a medical appointment, they may not follow up. Troubleshooting the issue is even more challenging. When polled, data from several studies seemed unified in these findings for why a male patient did not return for follow-up with their healthcare provider:

Felt like their autonomy wasn’t respected¹²
Felt judged or patronized by their provider¹³
The doctor didn’t take time to get to know them¹⁴

Many men may feel they already understand their health issues and that a doctor’s visit won’t add much value. If this perspective resonates with you, consider sharing any steps taken to understand the condition, and what has or hasn’t helped to receive more effective, personalized care from healthcare providers.

For many men, paying for visits and health care seems like an arbitrary thing to do—that it’s not a wise use of family resources¹⁶. Here’s a conclusion drawn from those polled, “Taking time off from work to see a physician takes money away from their family.”¹⁷

Overcoming obstacles might look different for each person but a great place to focus is on convenience and having resources available for them to view at leisure, such as online scheduling capability, Telehealth-like phone consultations that accommodate their schedule, and shared decision-making about health outcomes.

Provide male patients with a men’s health checklist or infographic, educating them on the importance of annual check-ins and screening. I have found creating a looking ahead section on the treatment plan with details, due dates, and frequency for needed wellness exams and screening exams/bloodwork can be especially impactful so they know what we are working toward and can plan to budget for exams coming up.

Discuss with patients the importance of baseline bloodwork and follow-up used to create a new plan, or change the treatment plan. Work with the person’s values as a motivating factor to follow through with their care and follow treatment recommendations. For some of my patients, their main motivator is their family or grandkids, travel, longevity, mobility, living free of pain, not becoming a burden on their kids, or other things identified as motivators by the patient in their visit.^18,19

It may help to have a men’s health section on your website with FAQs, prices, online medical inquiries or feedback forms, and access to the team without having to take time to place a phone call or come into the physical office itself.^20,21

As for where to spend the energy as health care providers, it seems “men should be counseled about healthy lifestyle habits,” which are largely focused on alcohol and tobacco use, as well as screening in men for HTN, DM II, dyslipidemia, prostate cancer, colorectal cancer, and lung cancer²².

Lillea Hartwell, ND, RH (AHG) is a graduate of Sonoran University of Health Sciences. She obtained a BS in Plant Sciences, with a minor in Environmental Sciences at the University of Arizona. Dr Hartwell has earned the distinction of Registered Herbalist with the American Herbalists Guild. She teaches at the college level and practices medicine at her private practice, Saguaro Blossom Medical Center, in Tucson, AZ. Dr Hartwell has a passion for general medicine, especially in urgent care settings like wound care and minor surgery, as well as rheumatology and other autoimmune conditions. For more information, visit drlilleahartwell.com.

References

Robert H. Shmerling, M. (2020) Why men often die earlier than women, Harvard Health. Available at: https://www.health.harvard.edu/blog/why-men-often-die-earlier-than-women-201602199137 (Accessed: 08 August 2024).

2. Robert H. Shmerling, M. (2020) Why men often die earlier than women, Harvard Health. Available at: https://www.health.harvard.edu/blog/why-men-often-die-earlier-than-women-201602199137 (Accessed: 08 August 2024).

3. Novak JR, Peak T, Gast J, Arnell M. Associations Between Masculine Norms and Health-Care Utilization in Highly Religious, Heterosexual Men. Am J Mens Health. 2019 May-Jun;13(3):1557988319856739. doi: 10.1177/1557988319856739.

4. Novak JR, Peak T, Gast J, Arnell M. Associations Between Masculine Norms and Health-Care Utilization in Highly Religious, Heterosexual Men. Am J Mens Health. 2019 May-Jun;13(3):1557988319856739. doi: 10.1177/1557988319856739.

5. Novak JR, Peak T, Gast J, Arnell M. Associations Between Masculine Norms and Health-Care Utilization in Highly Religious, Heterosexual Men. Am J Mens Health. 2019 May-Jun;13(3):1557988319856739. doi: 10.1177/1557988319856739.

6. Stratemeyer, Michelle, et al. “How Challenging Masculine Stereotypes Is Good for Men.” Pursuit by the University of Melbourne, The University of Melbourne, 10 July 2024, pursuit.unimelb.edu.au/articles/how-challenging-masculine-stereotypes-is-good-for-men (Accessed: 08 August 2024).

7. Robert H. Shmerling, M. (2020) Why men often die earlier than women, Harvard Health. Available at: https://www.health.harvard.edu/blog/why-men-often-die-earlier-than-women-201602199137 (Accessed: 08 August 2024).

8. Stratemeyer, Michelle, et al. “How Challenging Masculine Stereotypes Is Good for Men.” Pursuit by the University of Melbourne, The University of Melbourne, 10 July 2024, pursuit.unimelb.edu.au/articles/how-challenging-masculine-stereotypes-is-good-for-men (Accessed: 08 August 2024).

9. Novak JR, Peak T, Gast J, Arnell M. Associations Between Masculine Norms and Health-Care Utilization in Highly Religious, Heterosexual Men. Am J Mens Health. 2019 May-Jun;13(3):1557988319856739. doi: 10.1177/1557988319856739.

10. Novak JR, Peak T, Gast J, Arnell M. Associations Between Masculine Norms and Health-Care Utilization in Highly Religious, Heterosexual Men. Am J Mens Health. 2019 May-Jun;13(3):1557988319856739. doi: 10.1177/1557988319856739.

11. Novak JR, Peak T, Gast J, Arnell M. Associations Between Masculine Norms and Health-Care Utilization in Highly Religious, Heterosexual Men. Am J Mens Health. 2019 May-Jun;13(3):1557988319856739. doi: 10.1177/1557988319856739.

12. Kwon M, Lawn S, Kaine C. Understanding men’s engagement and disengagement when seeking support for mental health. American Journal of Men’s Health. 2023;17(2). doi:10.1177/15579883231157971

13. Kwon M, Lawn S, Kaine C. Understanding men’s engagement and disengagement when seeking support for mental health. American Journal of Men’s Health. 2023;17(2). doi:10.1177/15579883231157971

14. Kwon M, Lawn S, Kaine C. Understanding men’s engagement and disengagement when seeking support for mental health. American Journal of Men’s Health. 2023;17(2). doi:10.1177/15579883231157971

15. Kwon M, Lawn S, Kaine C. Understanding men’s engagement and disengagement when seeking support for mental health. American Journal of Men’s Health. 2023;17(2). doi:10.1177/15579883231157971

16. Novak JR, Peak T, Gast J, Arnell M. Associations Between Masculine Norms and Health-Care Utilization in Highly Religious, Heterosexual Men. Am J Mens Health. 2019 May-Jun;13(3):1557988319856739. doi: 10.1177/1557988319856739.

17. Novak JR, Peak T, Gast J, Arnell M. Associations Between Masculine Norms and Health-Care Utilization in Highly Religious, Heterosexual Men. Am J Mens Health. 2019 May-Jun;13(3):1557988319856739. doi: 10.1177/1557988319856739.

18. Novak JR, Peak T, Gast J, Arnell M. Associations Between Masculine Norms and Health-Care Utilization in Highly Religious, Heterosexual Men. Am J Mens Health. 2019 May-Jun;13(3):1557988319856739. doi: 10.1177/1557988319856739.

19. Kwon M, Lawn S, Kaine C. Understanding men’s engagement and disengagement when seeking support for mental health. American Journal of Men’s Health. 2023;17(2). doi:10.1177/15579883231157971

20. Novak JR, Peak T, Gast J, Arnell M. Associations Between Masculine Norms and Health-Care Utilization in Highly Religious, Heterosexual Men. Am J Mens Health. 2019 May-Jun;13(3):1557988319856739. doi: 10.1177/1557988319856739.

21. Kwon M, Lawn S, Kaine C. Understanding men’s engagement and disengagement when seeking support for mental health. American Journal of Men’s Health. 2023;17(2). doi:10.1177/1557988323115797122. Heidelbaugh, J.J. (2018) The adult well-male examination, American Family Physician. Available at: https://www.aafp.org/pubs/afp/issues/2018/1215/p729.html (Accessed: 08 August 2024).