Some diseases and conditions are commonly considered to be exclusive to the domain of women. Who would ever think of men getting breast cancer, or osteoporosis for that matter? Men often think that their bodies should work like a well-oiled machine, and thus find it difficult to cope when they malfunction – even more so when they discover they are suffering from a ‘women’s disease’.
There are, in fact, several conditions commonly considered to be women’s diseases from which men can suffer, sometimes with more serious outcomes.
Breast cancer is the most common life-threatening disease for women – for every 100 Caucasian women only one man will get it. Its occurrence is more common among black men than white men, with a ratio of 70:1. Some risk factors are the same for both sexes, such as family history, excess alcohol consumption and obesity. Unique risks for men include a history of testicular conditions (such as undescended testes); liver disorders (such as cirrhosis); Klinefelter syndrome (a chromosal condition imparting more female characteristics, including breasts); Jewish ancestry and chest wall radiation exposure. Increasing age is also a risk, as men tend to be more prone between the ages of 60 and 70 years. Although breast cancer in men is much less common than in women, the survival rates for men seem lower, with development of larger and more aggressive tumours, and with more frequent spread to adjacent lymph nodes. A lack of awareness and screening with men means tumours are detected at a much later stage and are more likely to be fatal.
Here the incidence is much more common with one man for every four women suffering from osteoporosis. However, the age of onset is later for men with women experiencing rapid bone loss after menopause in their fifties while men have the same rate of bone loss only after the age of 65. This is accounted for by the decline in testosterone and oestrogen levels with increasing age. Advertising and medical screening protocols ensure that women are far more aware of the risks of developing osteoporosis than men, and bone densitometry scans may detect bone loss early. Have you heard of men requesting bone densitometry scans? Osteoporosis is usually diagnosed in men only when something major occurs, such as a fracture, and by then the disease may be far advanced. This results in twice the number of men dying from the consequences of hip fractures than women. Lifestyle factors causing osteoporosis are the same for both sexes: smoking, excess alcohol, insufficient exercise, chronic use of cortisone drugs, ethnicity and genetics. A unique risk factor for men is the testosterone-reducing drugs used to treat prostate cancer.
Men may not feel the sadness that women do when depressed, but experience instead physical pain (such as muscular and back pain) anger, frustration, discouragement, fatigue and an escape into excessive work, alcohol or drugs. They are less likely to seek help, which results in many men with depression going undiagnosed. Men generally suppress their emotions while women are far more in tune with their feelings and talk to each other, which provides a ready outlet for some frustrations before they develop into bigger problems. An alarming statistic is that more women attempt suicide, but that more men succeed at it.
Eating disorders are nine times less common among men, but have similar effects on health. Bulimia is motivated in both men and women by a need to manage their emotions. The risk factors or motives that men have for developing anorexia differ from those of women; it may be a need to lose weight for sports performance, or an elimination of certain foods to enhance health that triggers the slippery slope toward anorexia.
Andropause is a term that describes the changes that some men experience in midlife. Although menopause in women is not a disease but a stage of life, it is associated with significant hormonal changes, which can lead to emotional roller coasters, uncomfortable physical symptoms and an urge to re-evaluate life. Similarly, in men, declining testosterone levels with relatively higher oestrogen levels can cause gynaecomastia (the development of breast tissue) and osteoporosis. Some men experience emotional shifts that cause despair in the face of advancing age, and they yearn for their younger days. This need for validation may manifest in the acquisition of a sports car or a young girlfriend.
Unlike men, who seem to be protected by their long urethra, some women are plagued by re curring urinary infections (UTIs). However, the risk for men does increase with age because as the prostate enlarges so does the likelihood of developing a UTI. The symptoms of dysuria (painful urination) and frequency are similar for both sexes.
There are several auto-immune diseases (AIDs) that affect women in particular: rheumatoid arthritis, multiple sclerosis, Systemic lupus erythematosis (SLE or lupus) and thyroid disorders such as Grave’s disease and Hashimoto’s disease. The ratio is about 3:1 for rheumatoid arthritis and multiple sclerosis, but for Hashimoto’s disease and lupus the ratio is higher at 9:1. The reasons why women are more prone to these diseases than men remain unclear, but the fact that women have a larger inflammatory response and bigger hormonal fluctuations may have an influence. Men are more likely to suffer from lupus in their sixties, but if they do contract it when young the disease is likely to be more serious. The response to treatment and risk of death is similar in both sexes.
A few AIDs are as common, or more common, in men than in women. Examples of these include ankylosing spondylitis (inflammation of the joints between the vertebrae), Crohn’s disease, type 1 diabetes mellitus and psoriasis. In most cases AIDs symptoms in men are generally more severe than those found in women for similar diseases.
Fibromyalgia is a common – but difficult to diagnose and treat – syndrome manifesting in body-wide pain and tenderness in the joints, muscles, tendons, and other soft tissues as well as sleep disturbance and memory and mood issues. Although this illness is more common in women, men can get it too. A recent study¹ shows that men with fibromyalgia are less likely than women to receive a diagnosis; more research is needed to understand why this is the case.
The most common cause of death due to human papillomavirus (HPV) infection is cervical cancer in women. Infection of the penis is common in men, which can easily be transmitted to women thereby putting them at risk for developing cervical cancer. Men have an equal risk of contracting HPV, which is also linked to several cancers. Anal infection and cancer is common in all ages in gay men, whether they are HIV positive or negative. Anal and oral cancers are found in HIV positive men. HPV is also linked to genital warts and recurrent respiratory papillomatosis (the appearance of benign growths in the respiratory tract).
There are unique challenges for men who develop so-called ‘women’s diseases’. Men often tend to underplay early signs and symptoms, which leads to delayed diagnosis. In addition to this, far less screening is offered to men, resulting in delays in detection and diagnosis. Both these factors contribute to an escalation of the disease process, and more advanced disease, before treatment is initiated. Furthermore, some diseases seem to manifest more severely in men anyway.
By their very nature, men generally have more difficulty in coping with chronic disease. They are more likely to feel like a failure when something goes wrong with their body. Frustration and embarrassment at having a ‘women’s disease’ make them less likely to share with others, and they consequently miss out on peer support groups. Hopefully this brief overview will help to increase awareness and promote the treatment of these often ignored conditions in men.
- Mayo Clinic’s Fibromyalgia and Chronic Fatigue Clinic. http://www. eurekalert.org/ pub_releases/2012-12/ mc-mwf121912.php