British men die four to six years younger than women on average, according to government figures (statistics for New Zealand men are similar). Alongside being more likely to have jobs in construction or the military, and having what scientists call the “biological destiny” – which results in more risk-taking behaviour – men simply don’t like going to the doctor.
A British Medical Journal report earlier this year revealed that men are 32 per cent less likely to see their GPs than women are. “The main difference between men and women is that women present earlier and get better outcomes, whereas men let things fester and get worse,” says GP Dr Niaz Khan, chief clinical officer for primary care at HCA Healthcare.
One reason for this is “macho” culture, where men dislike being seen seeking help, says Dr Eve Wijayanayagam, a GP who practises at the Sarum Road Hospital, Winchester. “It’s also because women are simply more used to tests and scans earlier in their lives, with smear tests starting in our early twenties. Most men have no reason to see the doctor until they find out something is wrong later in life, or are invited to an over-40s health check by their GP.”
And yet, men are 50 per cent more likely than women to die of heart disease, according to the Harvard Review. “Medical risks, such as poorly treated high blood pressure or unfavourable cholesterol levels, may contribute to this,” said the report. Men are also more prone to “central obesity” – visceral fat around the belly – which raises the risk of the above.
The good news – even for a doctor-shy man – is that it’s never too late. Here are the top five tests you should have.
1. Is my cholesterol too high?
Why is it particularly important for men?
Fifty-nine per cent of the UK’s total population had raised cholesterol in 2021, according to NHS digital. Although women tend to catch up later in life, among adults aged 16 to 44, men made up 53 per cent of the at-risk population.
Why is it important to check?
“High cholesterol raises the risk of heart and circulatory problems, stroke, kidney disease, and dementia,” says Dr Wijayanayagam. “Men have higher risk factors earlier in life because, statistically, they tend to drink more and be heavier smokers.” Some conditions are also hereditary, such as familial hypercholesterolemia, a genetic predisposition to high cholesterol. This may need to be treated with statin medication earlier in life.
What is the test?
“A fasting blood test gives the best picture,” says Wijayanayagam. “Results can be confusing but the easiest to understand is looking at total cholesterol, which ideally should be less than five.” Your HDL (’good’ cholesterol) should have a healthy ratio to your LDL (’bad’ cholesterol). Dr Khan says: “Men should have a target of less than three for LDL.”
If results are worrying:
Your doctor will talk to you about lifestyle choices – whether you drink excessively or smoke, as well as your diet, and how much you exercise.
“Eating well – foods like avocados and olive oil – will raise your HDL,” says Wijayanayagam. “You can lower your LDL by giving up pastries, sweets and ultra-processed food, or by taking statins.
“If lifestyle changes are ineffective, a patient has a strong family history of cardiovascular disease or has had a heart attack under 55, we will strongly recommend starting on statin medication.”
2. What’s my risk of prostate cancer?
There is a debate around the usefulness and accuracy around routine testing for prostate cancer by use of the Prostate-specific Antigen (PSA) test. PSA is a protein made only by the prostate gland. Some of it leaks into the blood, but how much depends on your age and the health of your prostate.
Why is it important to check?
Some men, for example those of African descent, are more likely to have worse outcomes with prostate cancer, so it’s important these cases are picked up early.
“Anyone over 50 should consider asking their GP for a PSA test,” says Khan. “But it’s important to see a doctor who knows how to interpret the results.”
What is the test?
A blood test. The amount of PSA in your blood is measured in nanograms of PSA per millilitre of blood (ng/ml). If you’re aged 50 to 69, raised PSA will equate to 3ng/ml or higher. That might be a sign of prostate cancer, but it can also be a sign of another condition that’s not cancer, such as a urinary tract infection.
If results are worrying:
Your doctor will monitor your condition with repeated PSA tests, and consider sending you for a biopsy if they are concerned.
“The most important thing is to keep an eye on your symptoms,” says Wijayanayagam. “How often do you pee? How easy is it to go, and is the flow good? Do you need to get up at night to go the loo?” Both doctors advise seeing your GP if you have concerns about your prostate.
3. Is my blood pressure healthy?
Why is it particularly important for men?
Around one in three adults in the UK has high blood pressure (also known as hypertension). In England, the condition affects 31 per cent of men and 26 per cent of women, according to Blood Pressure UK. Around 6 million people in the UK have high blood pressure and are unaware of it.
Why is it important to check?
“High blood pressure raises the risk of so many conditions, from kidney disease to stroke and heart attacks,” says Wijayanayagam. “You may have noticed that your GP seizes every opportunity to take blood pressure readings, even if you come in with toe pain. Especially with the men, as they visit so rarely.”
What is the test?
“The doctor inflates a cuff around the upper part of your arm: this measures the pressure in the arteries as the heart pumps. “I tend to take three readings as the first is often high because of ‘white coat syndrome’, where doctors make people feel anxious,” says Wijayanayagam.
A normal blood pressure reading is when the systolic pressure (upper number) is lower than 120mmHg and the diastolic pressure (lower number) is lower than 80mmHg. When these levels climb to 130mmHg or higher for systolic pressure or 80mmHg or higher for diastolic pressure, this is considered high blood pressure, or hypertension.
“If a score is high, I need to know whether it’s a one-off,” says Wijayanayagam. “If there’s cause for concern, I get the patient to test themselves at home over 14 days, once in the morning, once in the evening, to find an average.”
If results are worrying:
As with cholesterol, your doctor will talk to you about lifestyle choices. “You should not be consuming more than 6g salt in 24 hours and should aim for 150 minutes of aerobic exercise a week,” says Khan. After two sets of bad readings, your GP will ask you to return to consider hypertensive medication, such as an ACE inhibitor.
4. Should I worry about my blood sugar?
Why is it particularly important for men?
Between 2022 and 2023, both Type 1 and Type 2 diabetes were more prevalent among men than women in England, according to Statista. In this period, 56 per cent of those with Type 2 diabetes were male, compared with 44 per cent of women.
Why is it important to check?
Over time, high blood sugar levels can damage your blood vessels, leading to other problems such as coronary heart disease, kidney disease and diabetic eye disease. It’s important to know whether you have high blood sugar so that this can be controlled, reducing the risk of damage.
“People don’t take diabetes seriously, but I tell them that in 40 years they will have trouble with their eyes, kidneys and vascular system,” says Wijayanayagam.
What is the test?
The main one used these days is the non-fasting HbA1c blood test, which tests your average blood sugar levels for the past two to three months. This is different to (and more accurate than) a finger-prick test, which is a snapshot of your blood sugar levels at that moment.
If results are worrying:
If your HbA1c is more than 42 mmol/mol or fasting blood glucose is more than 11 mmol/L, your blood sugar is high (prediabetes covers the range 42 to 47; 48 and up is diabetes). Past 41 is prediabetic.
“The first step is to start with your diet,” says Wijayanayagam. “I recommend a ‘Blood Sugar Diet’ [popularised by the late Michael Mosley] to my family, as well as my patients.”
If diet proves ineffective, doctors will ask their patients to consider medication. “The first line of medication is metformin,” Wijayanayagam says. “If your diabetes is still not controlled, we will add in a second medication. If results are still not as required, we will consider insulin, which the patient has to inject into their abdomen.”
5. Do I need to be screened for bowel cancer?
Why is it particularly important for men?
Forty-four per cent of bowel cancer cases in the UK are in females, and 56 per cent are in males. In both men and women, it is the third most common cancer in the UK.
Why is it important to check?
“Screening can spot bowel cancer at an early stage, when it’s most likely to be treatable,” says Bowel Cancer UK. “Research shows that more than nine in 10 people survive bowel cancer when it’s diagnosed at the earliest stage.”
What is the test?
In the UK, testing starts at the age of 60 (in New Zealand, testing starts at 50 for Māori and Pasifika people and at 60 for non-Māori and Pasifika people). You will receive an invitation through the post, followed by a screening – or FIT – which stands for fecal immunochemical test. This will allow you to collect a small sample of poo and send it to a lab, where it is checked for tiny amounts of blood, which could be an early sign of bowel cancer. Your FIT is repeated every two years.
If results are worrying:
“You’ll be invited for a further test or a colonoscopy, where a long, thin, flexible tube with a small camera inside it is passed into your bottom. You can request sedation during the procedure,” says Wijayanayagam.
“If your test is negative, this doesn’t mean you won’t ever have bowel cancer. We need to make this procedure as normal as possible, so people keep returning for tests.”
- For more information about Men’s Health Week in New Zealand, go to menshealthweek.co.nz
