Health: Real men don't go to the doctor

As a result, they tend to die younger. When will they accept they are the weaker sex?

Roger Kirby is haunted by the fear of dying young. A successful surgeon with a Harley Street practice, he has been more aware than most of his own mortality since his father died of a heart attack at the age of 49.

The devastation visited on the Kirby family by that premature death is still apparent. Roger was 17 at the time and he had a younger sister of seven as well as an older brother, Michael, of 22. This week the Kirby brothers - Michael is a GP - published the first clinical guide to men's health to help other families avoid their fate. The press release was headed "Big boys don't cry".

As well as echoing a family tragedy, those words encapsulate a truth about men. It is our desire to appear invulnerable that leads us to ignore early warning signs of disease, they say. Our reluctance to seek help is sending thousands of men to an early grave.

The figures are striking. Women live, on average, five years longer than men, despite the exigencies of childbearing and rearing. Men are twice as likely to die before the age of 65. Deaths from heart disease, cancer, suicide, accidents and Aids are all higher among men.

The most remarkable contrast is that between rich men and poor women. We know that the poor die younger than the rich, but the gender gap is so wide that it cancels this difference out. Women in the lowest social classes live longer than men in the highest.

So why should men be the weaker sex? It is our "rash and venturesome nature" that is to blame, according to Sir Donald Acheson. As a former Government Chief Medical Officer he took a keen interest in what was killing men more quickly than women. "Hormones" is his explanation of the gender gap.

Among younger, testosterone-fuelled men, accidents and violence are the chief cause of death, whereas in later life they are carried off by heart disease - the female hormone, oestrogen, protects against heart disease in women - and cancer (largely caused by smoking). In a foreword to the book, which is aimed at GPs, Sir Donald says: "At all stages of life from the foetus to old age, the mortality of males is higher than that of females... To reduce these differences there will need to be new health policies directed at the problems of men."

It is difficult to see what these might be. It is attitudes not policies that need to change. Only five books have previously been published on men's health, compared with 90 on women's health and 258 on children.

Roger Kirby, at 48, is now just a year younger than his father was when he died. He recalls going to school the day after his father's funeral and having to confront his friends and teachers in his grief. "I wouldn't want other people to go through that. Michael and I are both convinced we will die early."

Despite two decades of efforts to persuade men to open up emotionally, show their softer side and seek help when they need it, there has been little change, he says. As a consultant urologist, he sees men who have ignored the bloody stain in their urine for months or years, until the bladder tumour responsible is no longer operable. "We have to change the male mindset. If you look after your body it won't break down. If you respond to symptoms and get an early diagnosis, it is relatively easy to fix. If you leave it, it becomes more difficult," he says.

"Men need to believe that it isn't macho to ignore disease and to make unhealthy choices. We need a softer, less macho approach. We need to show that men are not invulnerable - on TV, in soaps."

Mr Kirby, a specialist in prostate cancer, now has an annual PSA (Prostate Specific Antigen) test to check for the disease and an annual cholesterol test as well as running regularly and eating salad. But he believes screening is appropriate only for those at high risk.

"We have to be cautious before urging everyone to have a Well Man screen. I would not advise every man to have a PSA test every year. It is a question of balance and common sense. The message is to respond early to symptoms. Don't die of ignorance, or because of embarrassment, or because you don't want to make a fuss."

All this seems unchallengeable good sense. It is when we get a diagnosis and have to decide what to do about it that the choices become more difficult. Prostate cancer is a case in point. It kills 10,000 men a year - only slightly fewer than breast cancer, at 13,000 - and deaths are rising while those from breast cancer are falling.

Early treatment - surgical removal of the prostate, a gland just below the bladder that supplies part of the seminal fluid - can cure the cancer. But in many cases the cancer is slow growing and men survive for years without surgery, only to die of something else.

The surgery itself carries a risk of side-effects. Between 50 and 60 per cent of men are rendered impotent, although in many cases this can be helped with injections or Viagra. About 20 to 30 per cent of cases are initially incontinent and 6 to 8 per cent remain slightly incontinent (they have to wear a "spot pad"); for between 2 and 3 per cent incontinence "makes their lives a misery".

These odds were presented at the launch of the book, Men's Health, as "tiny" risks. To my mind, they are uncomfortably high (other specialists quote even higher risks, of 40 per cent leaking urine after surgery) and I would want to be confident that surgery was genuinely necessary before risking them. In this context, the macho approach that says "if in doubt, whip it out" may be exactly what men don't need.

`Men's Health', edited by RS Kirby, MG Kirby and RN Farah, is published by Isis Medical Media, pounds 39.95

MEN'S HEALTH: THE FACTS

n Almost 5,000 people are injured in accidents each year, three quarters of them are men

n More than six men die from smoking for every woman. More women take up smoking but are better at giving it up

n Four times as many men commit suicide each year than women. However, women attempt suicide four times more often than men

n Sexually transmitted diseases such as syphilis are more common in men. Men make up 93 per cent of Aids cases and 88 per cent of HIV.

n Three quarters of heroin addicts and 88 per cent of drug offenders are men