Topic of the Month

Focus on Men’s Health in the Later Years

Julia Bird

September 21, 2018

As they get older, men have special health needs that are different to women’s. There are certain biological distinctions that make men more prone to certain conditions and diseases. Disparities in occupation mean that men are more likely to suffer exposure to dangers in the workplace. Men also make different lifestyle choices to women, which place them at a higher risk of disease.  This translates overall to specific challenges to men’s health globally [1,2].

Biological differences

Key differences in the biology of men as compared to women affect men’s health. The basis of biological differences between the sexes begins with genetics. At the time of conception, the Y-chromosome places the basic genetic code in place that directs development toward becoming male. At 6-8 weeks gestation, embryos with the Y-chromosome start developing male characteristics [3]. About two weeks later, the male fetus begins to produce testosterone and other hormones that result in normal male characteristics [4]. By the third trimester of pregnancy, the male anatomy has completely formed. Boys undergo dramatic hormonal and physical changes with the onset of puberty that mark the start of their reproductive years but also affect their behaviour, biology, and risk of disease [4].

The genetic and hormonal differences between men and women mean that men tend to have lower body fat, greater muscle mass, higher blood pressure and higher levels of the “male” hormones, particularly testosterone. Men’s greater muscle mass is protective against osteoporosis, due to the strengthening effect of muscles on bones, and also helps protect them from obesity due to greater resting energy needs. However, higher blood pressure increases their cardiovascular disease risk [4]. Despite overall lower rates of obesity, there is a greater tendency for men to put on excess weight across their abdomen, also increasing their risk of cardiovascular disease compared to women.

Men’s behaviors, which are a result of the combination of biology, upbringing, and social environment, can place them at greater health risk than women. Higher testosterone levels provoke greater aggression levels and risk-taking in men, increasing the chance that they will be injured. They tend to visit a physician less often, and are slower to report troubling health symptoms than women [4]. For example, it was found that men are half as likely to find the dangerous skin cancer melanoma than women on themselves and on their partner [5]. Male behaviour also explains some differences in infectious disease rates compared to women [4].

Cardiovascular disease risk in men

Cardiovascular disease remains one of the leading global causes of death, affecting people primarily in the second half of their life [6]. Men tend to suffer the first symptoms of the disease approximately 10-20 years earlier than women, and have a higher mortality until they reach old age [7]. The reason for this is that men have more of the cardiovascular risk factors, such as higher cholesterol levels, higher blood pressure [4], and higher smoking rates [8]. The reason for the higher cholesterol levels and blood pressure is mostly biological. Men lack the protective effects of estrogen, which tends to increase HDL “good” cholesterol and decrease LDL “bad” cholesterol. Men’s greater body mass and height means that they have a greater chance of developing high blood pressure. The inclination of men to react to stress with a “fight or flight” response [9] means their coping mechanism for stress may predispose them to high blood pressure.

In terms of smoking behavior, many more men than women smoke globally, particularly in developing countries [8]. Men often see smoking as a way to show off their masculinity and strength and physical toughness [10]. Men may be at a greater risk of nicotine dependence than women, making it harder for men to quit smoking [11]. This difference in smoking behavior explains partly why men are at greater risk of cardiovascular disease.

Andropause and low testosterone levels

Older men experience “andropause,” which is a gradual decline in the production of the male hormones that generally occurs between the ages of 48 and 70 [4] and can affect both general wellbeing [12] and risk of chronic disease. Andropause is not equivalent to menopause in women, as the decline occurs slowly [13]. Testosterone levels in men start to drop when men enter their 30s [12]. In some men, these low levels can lead to a diffuse cluster of symptoms such as muscle weakness and frailty, sexual dysfunction and cognitive problems such as low mood and mental confusion [14]. The risk of osteoporosis increases due to the loss of muscle strength [15]. However, other complicating conditions such as obesity also contribute to lower circulating levels of testosterone [14]. A healthy diet and lifestyle are recommended in this case to improve symptoms and restore muscle mass and function.

Nutrients for older men

Good nutrition can help overcome some of aging’s effects on older men. For general cardiovascular disease prevention, a diet high in long-chain omega-3 polyunsaturated fatty acids is widely recommended by many institutions globally [16]. Meeting omega-3 recommendations helps men reduce their overall risk of cardiovascular disease. Another strategy can be to increase consumption of soluble fiber such as oat beta-glucan, to help keep cholesterol levels under control [17]. Dietary fiber helps remove cholesterol building blocks from the body, which ultimately lowers the total amount of cholesterol in our bloodstream. It is a clinically proven way to reduce cholesterol levels, in association with a healthy diet and lifestyle [17].

One of the major effects of a gradual decline in levels of male hormones is its effect on muscle mass. The fall in men’s muscle mass means that they lose physical strength, ultimately leading to frailty, osteoporosis, and bone fractures. Along with regular exercise, older men need to make sure that they consume adequate protein. Recent research shows that seniors may need a higher protein intake, ideally spread evenly over all meals, to help prevent muscle loss [18]. In addition, older men are at risk of osteoporosis injury from falling [19]. Although the number of bone fractures in men is a little lower than for women, men’s risk of mortality after a fracture is considerably higher [19-21]. Meeting intake recommendations for vitamin D and calcium helps keep bones strong, and may contribute to maintaining normal muscle function in aging men [18].

References

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  13. Saad, F.; Gooren, L.J. Late onset hypogonadism of men is not equivalent to the menopause. Maturitas 2014, 79, 52-57. 10.1016/j.maturitas.2014.06.016.
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