Caring about men and boys. In this episode we look at the gender gap in life expectancy; how biology and socio-economic factors conspire, presently at least, to negatively influence male health and premature death. A nowhere near exhaustive range of men’s health issues are explored including the impact of too much or too little testosterone. And of course, there’s a good guy of the week....Vilenti Tulloch, an Adjustment Counsellor, creator of 'The Young Gentlemen’s Club', a youth mentoring programme in Massachusetts.
Link referred to
http://www.healthscotland.scot/health-inequalities/measuring-health-inequalities
Caring about men and boys. In this episode we look at the gender gap in life expectancy; how biology and socio-economic factors conspire, presently at least, to negatively influence male health and premature death. A nowhere near exhaustive range of men’s health issues are explored including the impact of too much or too little testosterone. And of course, there’s a good guy of the week....Vilenti Tulloch, an Adjustment Counsellor, creator of 'The Young Gentlemen’s Club', a youth mentoring programme in Massachusetts.
Link referred to
http://www.healthscotland.scot/health-inequalities/measuring-health-inequalities
men’s life expectancy and health; exploring the gender gap
Let’s look at life expectancy first; currently, in England and Wales, females live an average of 3.6 years longer than males. Men and women have different likelihoods of reaching age 90; the latest data from the government’s Office for National Statistics shows that while one in three new-born females could expect to live to at least age 90 only one in five new-born males can expect to do so.
Premature death is defined as ‘death before the age of 75’ and there is a clear excess of premature male deaths over female deaths by a staggering 43%.
But, there’s a further really important, startling and distressing fact that William Collins tells us about in his excellent book, The Empathy Gap; it’s a fact which few know about, and even fewer talk about, it is that the excess male over female premature death rate doesn’t apply just to the elderly; there is a greater death rate of males compared to females, in every age range up until the age of 83; William Collins doesn’t say this but I’m guessing it’s not that male longevity improves at age 83, rather it’s that there aren’t enough men left alive to outnumber female deaths.
In his book, William shows us that cardio-vascular disease is by far the most significant cause of male premature death with various cancers being the second most significant cause of premature male deaths. However, if premature male deaths by suicide, drugs and alcohol were grouped together, they would constitute the second most significant cause of premature male deaths.
There are differences between the sexes in both the incidence of ill health and mortality; it appears that in many cases males have an impaired immune response when compared with females; I spoke a lot about testosterone in three earlier episodes, and testosterone has been implicated in the male weakened immune response.
There is a higher death rate for male infants. William Collins tells us that, biologically, contrary to cultural assumptions, the male is more fragile than the female.
Men’s life expectancy is significantly more affected by economic disadvantage. Socio-economic circumstances make a big difference to men and women’s life expectancies.
The Scottish National Health Service found that men living in poorer socio-economic areas, fare less well than women living in the same areas, and significantly less well than both men and women living in more affluent areas.
Let’s look now at life expectancy in two different areas of Glasgow and two different areas in Edinburgh. There are two great diagrams to be found on healthscotland.scot – the link is included in the episode notes http://www.healthscotland.scot/health-inequalities/measuring-health-inequalities which show life expectancy inequalities by gender and socio-economic group within two local areas of each city.
The first diagram shows male life expectancy going down by two years for every station stop on the Glasgow trainline between Jordanhill (in the more affluent west end) to Bridgeton (in the less affluent east end). On average, a man born in the less affluent Bridgeton can expect to live a whopping 14.3 years less than his counterpart in Jordanhill; a woman born in the same circumstances can expect to live an almost as whopping 11.7 years less.
The second diagram highlights life expectancy inequalities across Edinburgh. Similarly, despite being only two miles apart, the gap in average life expectancy between those living in the residential neighbourhoods near the less affluent Bankhead tramline stop compared to those living near the more affluent Balgreen tramline stop is almost 11 years for men and 8 years for women. Still a very significant difference, though not quite as bad as the Glasgow example.
Young men aged between 18 and 30 have more than double the death rate of women, and it’s three times as great when they’re in their early twenties.
As we have seen in an earlier episode, males suicide at three times the rate of females; in this younger age group males suicide at over three times the rate of females. In the UK, between 2001 and 2018, death by suicide, or injury or poisoning, which may or may not have been accidental, was the leading cause of death for both males and females in the 20 to 34 years age group.
In mature men, aged between 40 and 60, the death rates are between 40% and 70% higher than for women in the same age band.
Let’s turn our attention to health issues which are worse for men and boys; males get ill because of their
• exposure to physical and chemical hazards in their jobs
• because they take risks and are generally more physically adventurous than females
• men generally take less care of themselves
• and are less likely to see a doctor and then less likely to report symptoms if they do see a doctor (WHO, 2015)
• men experience health problems if they have too much testosterone, or too little testosterone (Harvard Medical School, 2015). We’ll look at this in a minute.
• prostate cancer, obviously an exclusively male illness, receives half the funding of breast cancer and is researched half as much (Prostate Cancer UK) I’m told this is improving
• while mortality rates for women with breast cancer have fallen by 31% since 1989, mortality rates for men with prostate cancer have risen by about 18% since 1989
• finally, funding for cardio-vascular disease, which affects twice as many men as women, is targeted equally at men and women.
Finally, as promised earlier, let’s look at the little known about, even less spoken about, harmful health effects of too much or too little testosterone. This is according to a Harvard Medical School paper written in 2019.
The paper tells us right up front that it is difficult to define "normal" testosterone levels and "normal" behaviour. As we saw in earlier episodes, blood levels of testosterone vary dramatically over time, and even during the course of a day. The writers of the papewr encourage caution; what may seem like a symptom of testosterone excess may actually be unrelated to this hormone.
So, let’s look at the perils of too much testosterone. That said, having too much naturally occurring testosterone, I emphasise the word ‘naturally’, is not a common problem among men.
In fact, most of what we know about abnormally high testosterone levels in men comes from athletes who use anabolic steroids, testosterone or related hormones to increase their muscle mass and athletic performance.
So, here we go. Problems associated with abnormally high testosterone levels in men include:
The science is tenuous; so, I just want to reiterate what I said earlier, the paper tells us that what may seem like a symptom of testosterone excess may actually be unrelated to the hormone.
Let’s look now at the consequences of too Little Testosterone now.
In recent years, researchers and pharmaceutical companies have given more attention to the effects of testosterone deficiency, especially among men. As I reported in an earlier episode, men’s testosterone levels drop very gradually, about 1% to 2% each year; this means that more than a third of men over age 45 may have reduced levels of testosterone than might be considered normal, although as mentioned before, defining optimal levels of testosterone is tricky and also a bit controversial.
However, symptoms of testosterone deficiency in adult men include:
· a loss of body and facial hair
· a loss of muscle mass
· low libido, impotence, small testicles, reduced sperm count and infertility
Some men who have symptoms or conditions related to a testosterone deficiency will experience improvement if they take testosterone replacement. For example, a man with osteoporosis can increase bone strength and reduce his fracture risk with such a replacement.
Health is an issue about which there is much more to say so I will be revisiting this subject in future episodes.
Good guy of the week
A YouTube video about a fantastic young men’s project caught my eye this week, at a school in Southbridge, Massachusetts. An Adjustment Counsellor named, Vilenti Tulloch noticed that teachers were spending more time on disciplining, than teaching students and that there was a great need to help students with behavioural issues. Vilenti created a youth mentoring group he called ‘The Young Gentleman’s Club’.
Each morning, the young men start their day in positive way by making a gentleman’s pledge; in a small group, they identify a personal challenge and make an agreement with themselves, and others in their group, to tackle it throughout the day.
They check in with each other in the middle and at the end of the day to encourage each other and hold each other accountable. Most touching to me was listening to the young gentlemen talking about the benefits they had experienced in the Young Gentleman’s Club; they shared their appreciation about having others to talk to when they were going through things, how they felt the club had made them kinder people, how they had made more friends and how they were making better choices. The highlight for me was to see the firefighters at the local fire station as they talked to the young gentlemen about their job, providing positive role models for them and inspiration too, suggesting that any one of the young gentleman too, could become a firefighter if they chose to. So well done Vilenti Tulloch, what a brilliant idea.