Warning signs men should never ignore in their 40s, 50s and 60s. Photo / Getty Images
With the average middle-aged man reluctant to visit their GP, medical experts share the key symptoms to watch out for.
For the average middle-aged man, nothing short of a severed limb or full-blown cardiac arrest would convince them to see the doctor, something that will be highly familiar to concerned wives up and down the country.
This reluctance has been captured in a new survey from AXA Global Healthcare which showed that while 88% would fix a car issue within a week, only 47% would seek to act as swiftly in response to a health problem.
For NHS North London GP Dr Semiya Aziz, who also runs the private GP service Say GP, this is an issue which she encounters on a weekly basis. She says there tend to be three main reasons for this hesitancy – embarrassment, a mistaken sense of being invincible, and sometimes a suppressed fear of a sinister diagnosis.
“Men will not come and see a GP,” she says. “They’re often coaxed into it by their wives or partners, and when I ask why they presented so late with their symptoms, they often tell me, they’re fearful they will be given a death sentence, and avoidance was the easier option. Ignorance is bliss.”
Unfortunately, however, in the case of many diseases, early symptoms being ignored can lead to much worse outcomes. For example, one study concluded that warning signs may have been missed in one in six heart attack deaths, with men known to be markedly more vulnerable to cardiovascular disease.
So what are some of the key symptoms men should look out for in their forties, fifties and sixties?
We might think of the developing blotches on our skin as an inevitable, if annoying, aspect of ageing, but in some cases, they can represent a sign of either pre-diabetes or Type 2 diabetes.
“Look out for increasing numbers of skin tags around the neck, the armpit or in the groin area,” says Dr John van Bockxmeer, a primary care physician at Columbia University.
According to van Bockxmeer, these tags can often be accompanied by a neck rash which appears as a thickening of the skin, and dark, velvety patches, sometimes mistaken for dirt or bruising. This is known medically as acanthosis nigricans and is a common sign of insulin resistance.
Another tell-tale sign is the sudden appearance of a dark patchy pigmentation on the legs. “Sometimes people come to see me and they’re like, ‘I’ve got these rashes,’ and we have to step back a little and say, ‘No, it’s no eczema, it’s actually your sugar levels,’” he says. Get to the doctor, fast.
The penis is often referred to as a window to a man’s state of health, and while most men with erectile dysfunction are concerned about their testosterone levels, it’s more likely to reflect either elevated blood sugar levels damaging the fragile nerves in the penis, or a decline in the health of their arteries.
“For most men who experience midlife erectile dysfunction, this is a result of poor blood flow to the penis due to narrowing of the blood vessels,” says Steve Garnett, a consultant urologist at Benenden Hospital. “This is the same process that causes narrowing of the arteries in the heart, and it tends to precede heart problems by about 10 years.”
Garnett advises men to seek medical attention if it’s persistent, and interfering with their personal life, as cholesterol tests and analysis of the levels of blood fats should be carried out as soon as possible.
According to estimates, 85% of sleep apnea cases – where breathing repeatedly stops and starts during sleep – in the UK go undiagnosed, predominantly among middle-aged men, who are two to three times more vulnerable than women to developing the condition. “We do see a spike in this age group because of an increase in fat deposition in the upper airway, and their neural reflexes becoming more lax which affects the [airway] muscle tone,” says Ryan Cheong, a consultant ENT and specialist sleep surgeon at University College London Hospitals (UCLH).
Key warning signs include daytime fatigue, such as repeatedly feeling the urge to nod off at work or persistent low energy levels, or constantly waking with a dry mouth in the morning. “If your partner witnesses you gasping and choking while trying to draw breath at night, that’s also a very strong telltale sign that you may have obstructive sleep apnea,” says Cheong.
Because sleep apnea is associated with normal chronic diseases including stroke, heart failure, hypertension, Type 2 diabetes and even dementia, Cheong says it’s vital to try and catch it early. Men suspected of having the condition can be referred by their GP to a sleep clinic who will provide them with a home-based device for measuring their blood oxygen levels at night, which can lead to a diagnosis.
While testicular cancer is typically perceived as a disease which presents in young men, van Bockxmeer says that there is actually a small second peak in the incidence of a particular type of the disease called seminoma around the age of 60. “Men often think, ‘I don’t need to check my testicles any more for painful lumps or swellings,’ but self-examination is still important,” he says.
A weak or interrupted urinary stream, difficulty starting to urinate, excessively frequent urination, or blood in the urine are all signs that you should see a GP. As Aziz points out, these signs can indicate an underlying disease such as prostate cancer, but men experiencing such issues should not immediately jump to that conclusion as they can also indicate an age-related condition called benign prostatic hyperplasia which is treatable.
“This general ageing and swelling of the prostate is extremely common, and less concerning from a medical perspective, but can be treated with a range of medications and procedures,” says van Bockxmeer.
Aziz points out that another reason why men should come forward is because blood in the urine can also be a sign of a urinary tract infection (UTI). “It’s important to catch UTIs sooner rather than later as they can develop into pyelonephritis which is an infection of the kidneys,” she says. “The most important thing is to go and see the doctor so they can carry out the necessary investigations and tests to ascertain the actual cause.”
While chest pains are known as the biggest red flag for cardiac problems, van Bockxmeer points out that another key sign to watch out for in midlife is shortness of breath following exercise.
“People often say, ‘It’s just because I’m not very fit, and I need to do more exercise,’ but shortness of breath can actually be a sign of underlying heart dysfunction from both an electrical and a plumbing sense,” he says.
By plumbing, van Bockxmeer means the presence of clots which can ultimately lead to a heart attack, but shortness of breath can also reflect a heart rhythm disorder called atrial fibrillation which is twice as common in men than women, while symptoms also develop a decade earlier, often impacting men in their fifties.
He says that atrial fibrillation is important to detect early as it can raise the risk of stroke in later life. “Any shortness of breath, go to your GP because we can do a couple of tests,” says van Bockxmeer. “We’ll listen to your heart for any valve or heart rate problems, and do a cholesterol test.”
If your GP is concerned, you can be referred for a Holter monitor test, a wearable device which measures your heart’s electrical rhythm over the course of a week to check for any abnormalities.
Just like skin tags, it’s easy to dismiss growing aches and pains, but van Bockxmeer says it’s particularly important not to overlook the development of back pain or pain that radiates down your leg as this can signal degeneration of the spinal discs, which can start to press on nearby nerves.
“People sometimes ignore some back pain, saying ‘I’ve just got stiffness, or I’ve just lifted something too heavy,’ but over time, those early warning signs can progress into something worse,” he says. “In a few years, they will have quite bad sciatica [pain caused by an irritated nerve in the back].”
According to van Bockxmeer, it’s important to seek medical attention, as further degeneration can be prevented through carrying out preventive stretches and core strengthening exercises.
As a consultant colorectal surgeon at UCLH, Alice Murray says that one of the common reasons why men are often reluctant to seek help for bowel issues is embarrassment. However she says it’s particularly vital to do so, as 55% of all bowel cancers are in men, while men are also more likely to die from the disease, in part because they’re more likely to present to a doctor when their illness is more advanced.
“It’s quite easy to put bowel symptoms down to something else as well,” says Murray. “You might say, ‘Oh I’ve just got some piles,’ or ‘I’m got some diarrhoea probably because I’ve had some beers or I ate a big meal,’ so you can easily ignore these symptoms or find reasons to explain it.”
Murray says the key is to look out for a change in bowel habit, whether it’s increased frequency or a change in consistency towards loose stools or constipation, which is persistent over a number of weeks. Warning signs also include bleeding – either brightly red coloured or resembling dark tar – or feeling the urge to go and not being able to. “That can be a sign of either polyps or a cancer in the rectum,” she says.
For van Bockxmeer, other key red flags include abdominal cramping, particularly on the left side of the body. “If we sense pain from a growth or a tumour, it’s more likely to be in the left side, while there are other complications like diverticulitis [inflammation of pockets called diverticula on the inside of your colon] which are typically on the left side. That’s something you’d want to explore with a colonoscopy.”
But as with all these symptoms, even if the cause ends up being benign, Murray says it’s incredibly important to get checked out just in case. “No one,” she says, “is ever going to turn you away.”