Men’s Health: “Men Are Genetically the Weaker Sex“

Men are masters in pushing their health issues aside. They often feel far too physically fit and healthy to schedule a check-up with a doctor. The male assessment - as positive as it may seem- has very little to do with reality. In fact, lifestyle still defines a man‘s identity. It is considered uncool to go to preventative medical check-ups or admit to physical ailments. 22/12/2010

Professor Dr. Frank Sommer;© UKE

MEDICA.de asked Professor Frank Sommer at the University Hospital Hamburg Eppendorf to which extent the clichés about the “stronger sex“ are still valid in Germany and whether Herbert Grönemeyer‘s song about men as the ”soft, weak sex“ is more current than ever. Professor Sommer is the only University professor of men’s health in the world and the president of the German Society for Men and Health.

MEDICA.de: Professor Sommer, until now medical research and practice was predominantly geared toward the male body. Consequently by now we know more about a man’s organism than the organism of a woman. In spite of that, what makes men’s health such an important topic today?

Frank Sommer: This is a fallacy, because this type of “men research“ primarily pertained to pharmaceutical studies with male subjects. Above all in the different phases I, II and III of these pharmaceutical studies, one tried to prevent women of childbearing age from becoming involved and thus causing potential damages to the unborn child.

However, if we compare the research grants in Germany for breast cancer with those for prostate cancer, the ratio is three to ten. There are ten times more research grants spent on breast cancer than on prostate cancer for men. You will also notice that publications in medical libraries on gender differentiated health clearly register more hits on women’s health. A study can substantiate this, because interestingly enough 80 percent of scientists are men. These scientists concentrate more frequently on women’s health than the health of their own gender. Apparently, men are often not interested in the fact that they also have health issues. They don’t want to have a mirror held up to their own face.

According to men’s own assessments they feel very well, which of course isn’t always the reality. Herbert Grönemeyer (a popular German singer) chose the right words in his song: men are strong and powerful, yet still weak.

MEDICA.de: Which illnesses do men suffer from most frequently today?

Sommer: Cardiovascular and oncological diseases are still the Top 10 illnesses. The top three most common oncological diseases include bronchial carcinoma and colon cancer. But women can be afflicted by these kinds of diseases just as well as men do. Aside from these, prostate cancer and testicular cancer, but also diseases of the bladder and the kidneys need to be added here.

MEDICA.de: Are men victims of modern living conditions?

Sommer: There are two answers to this question. One study explains why men rather do restorative medicine and why women ”prevent“. Girls and young women are more trained in terms of prevention. They visit a gynecologist early on in their lives and get checked. The first period, birth control questions, the first Pap smear tests and the care during pregnancy are accompanied by a physician. Doctor care is a natural occurrence for women from an early age. Women are ahead of men in this area by about twenty years. Most men don’t start with preventative check-ups until they are forty years of age – if at all. More often than not, somebody on the outside tells them they should go and see a doctor. This is a development that evolved over the course of history.

The reason why men don’t go to a doctor is mostly due to the fact that they are afraid of bad news. But there is another explanation: Men don’t like to wait. If they are required to wait a long time in a waiting room, they are less willing to go to the doctor. Doctors are therefore asked to establish special men consultation hours.

MEDICA.de: For a while now, “sensitive“ diseases of men are more intensely discussed. Were issues like depression, erectile dysfunction and other illnesses previously not sufficiently known?

Sommer: Depression was and is being swept under the carpet. There is a study that was initiated by us, the German Society for Men and Health. For this purpose, we hired two male and two female actors, who presented the same disease pattern during doctor visits. They all slipped into the role of patients who are all afflicted by the same depression symptoms. We gave the actors the same assignments, meaning a guideline, for their visit to different male and female doctors. They were asked to use the same facial expressions for instance. The decision to use two women and two men, was particularly influenced by the fact that our “trained patients“ were asked to dress differently. The amazing thing is that depression was diagnosed three times more frequently in the female patient actors regardless of whether the actor went to a male or female doctor. Time and again, men got the same standard responses. They should try to relax, go on vacation for a couple of weeks and everything would be OK again afterwards. These associations and consultation in connection to depression have stunned us. Even female physicians did not pick up on the pathology, even though they normally are more sensitive than their male colleagues toward this subject matter.

Depression is underrepresented in men and far less acknowledged. The death of soccer goal keeper Robert Enke was a particularly sad incident. It provided many affected men with a reason not to ignore symptoms and to discuss them more often.

In the past, sensitive diseases were often repressed, because there was no reasonable, adoptable treatment. This was particularly true for erectile dysfunction. Back then, men were treated with an injection or had to undergo surgery. Nowadays there are therapeutic options by using different drugs and pills. A second point is that the media has made this difficult topic socially acceptable. Fortunately today we approach this topic in a more relaxed fashion.

MEDICA.de: Even though life expectancy in Europe has increased, on average men still die six years earlier than women. Is this because of the different risk behavior in men, meaning unhealthy food, too much alcohol and smoking?

Sommer: This was just researched in a 2010 study. In Germany men on average die 5.4 years earlier than women. This is attributed to many different factors: twelve months of this time frame is due to genetic predisposition, because XY chromosomes simply are weaker. Visually the Y chromosome already looks like an X chromosome whose leg has been pulled out. The Y chromosome is also much lighter than the X chromosome. Women are genetically more predestined and have the advantage that both X chromosomes are encoded with antioxidant processes. If a man’s X chromosome is defective, the Y chromosome cannot code the antioxidant processes. Men are genetically the weaker sex.

The remaining four years and four months among other things are made up of 18 months of sociocultural factors like upbringing and environmental influences, like for example smoking. Upbringing, in particular preadolescent education, plays an important role. Medical factors like cardiovascular diseases take up another 20 months. This also includes not assessing erections, because if men would have their penile blood vessels checked at the front end while having erectile problems and stenotic changes were discovered, you can assume that they probably will suffer from a heart attack within four to eight years. Studies by cardiologist and urologist detected this. That means that you can do prevention in this case and detect in advance during a medical check-up of the penile blood vessels, whether there might be any problems. The 20 months also include wrong diet, obesity, lack of exercise and stress.

MEDICA.de: Let’s continue playing with this cliché; do men generally pay less attention to their health and do they in fact tell themselves that they are healthy to avoid unpleasant exams?

Sommer: There is another study of seven nations, six European countries plus the USA that asked men how they would rate their health. If you extract the German data, between 65 and 90 percent of surveyed men of all age groups indicated their health as good or very good. Men between the ages of forty and eighty year of age participated in the study, while being further subdivided into age decades. Regardless of the featured age decade and what illnesses were present, many felt either good or very good. This is astonishing and of course does not reflect reality. In fact, you may even talk about some type of blindness here.

 
First goal: To close the gap
that develops between the ages
of twenty and thirty in a man’s
life;© panthermedia.net/Monkey-
business Images

MEDICA.de: For many men the term preventative check-up is still a foreign concept. How can men be sensitized? And what do you specifically recommend in terms of prevention for the aging man?

Sommer: A man should perhaps see himself as a hero, if he takes advantage of preventative check-ups. After all, the scenario often still is that a man’s colleagues snicker at him and perhaps perceive him as a wimp if he dares to openly talk about his issues. Usually some snide comments are made in this connection. If you succeed, especially with the support of the media, to present men who go to preventative exams as the smarter and more intelligent guys and to create a negative image of the other men who don’t go, you might be able to break the ice. Preventative medical exams are still a taboo issue for men in Germany. And this applies to all age groups.

MEDICA.de: By now you have developed a prevention program for young men called U25. What do you want to accomplish with it in the long term?

Sommer: Our first goal for the time being is to close the gap that develops between the ages of twenty and thirty in a man’s life. Between exams as a child and the few medical visits during their older years, there should be some type of regular medical care. The questionnaires that we created for this are also meant to raise more awareness to consciously deal with subjects like smoking, exercise and diet.

Young men should be picked up early on, so they won’t have to go through major repair work later on in their lives, because prevention is better than cure. By now there are medical colleagues who pick up on this. In our day and age however it also very much depends on how the media picks up an important topic and effectively pursues it, since this increasingly has an impact on social attitude.

MEDICA.de: At the end of October 2010 the first official men’s health study was published, which further illustrates weak spots in health care for men. What are the most urgent issues?

Sommer: You are picking up the question, the Federal Ministries for Family Affairs asked in October and I am not able to give you an answer just yet. Until the end of next year more data will be collected to be able to exactly answer this question and to more closely define goals for the Federal Ministry. After all, the subject of men’s health so far has not been defined in Germany.

Exercise and diet also play an important role in men’s health. It simply is important to communicate more knowledge in this area. Here is one example: for more than twenty years jogging has been considered a surefire way to lose weight. But we also have known for the same amount of time – and there are studies on this as well – that weight training to strengthen the muscles and to increase the basic metabolic rate are far more important to drop pounds. Now, more than twenty years after the publication of the first studies, men are starting to realize that weight training is important, because muscles increase the metabolic rate. This means that even if you don’t move, you burn lots of calories.

What’s more, men-specific strategies for a healthier lifestyle are missing. We now have developed competition-based systems to put more exercise in a man’s everyday life. We installed pedometers for instance in men that basically sit in an office every day for long periods of time. The result: An athletic competition amongst all colleagues developed to see who has walked the most steps by the end of the workday. The men were rewarded for exercising more, which motivated them and simultaneously they all did something good for their health. This is the simplest change to a busy workday.

MEDICA.de: In the future, how can men and women be better medically treated and particularly different physical characteristics of both sexes like anatomy and immunology as well as the genetic and hormonal infrastructures be more successfully incorporated into medical treatments?

Sommer: Genetics, the so-called epigenetics, is currently in vogue in medical science. I see a lot of potential in it for the future. Currently there are very few clearly defined structures that can serve as a helpful starting point. The present state of scientific studies is unfortunately not in a position to really support doctors. But personalized medicine will be the future.

A concept such as this can only be implemented if different medical specialist disciplines share a joint project, this being the respective patient. The “project“ could be discussed on an interdisciplinary board to ensure optimal care for the patient. Economic factors should be disregarded for the time being. The ideal situation would be: a board where the cardiologist, the family doctor, the sports medicine doctor and the urologist sit around the table to compare notes on the well-being of their patient. A kind of counselor or coach, who ensures that these decisions and findings are then being implemented, would also be desirable. After all, in medical studies we always have wonderful compliance. But why is that? The answer is: because of controls. During a study a so-called study nurse takes care of the patient. However, “in the wild“ drugs are being prescribed without a support person who monitors their intake. In the majority of cases the patient does not contact the medical practice for five years and disappears.

MEDICA.de: Is the subject of men’s health only a German problem?

Sommer: It is particularly an important topic in industrial nations. This applies to Europe in the same way as to the US. In these countries the topic of men’s health should be more strongly adopted into everyday life, and above all get fixed in male heads, to establish better early medical care in the future.

The interview was conducted by Diana Posth and translated by Elena O’Meara.
MEDICA.de

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