One in five men die before 65 years of age and a man’s life expectancy is four years less than a woman’s. So what are the reasons behind this health inequality and how can pharmacy help to change it?

Men are, on the whole, reluctant to seek healthcare advice. This was the conclusion from a recent study by Nuffield Health, which found that almost 50 per cent of men would wait to see if a health issue goes away rather than see a doctor, and a third of men surveyed revealed they never talk about their health concerns. This is not new news.

The NPA’s ‘Ask Your Pharmacist’ campaign back in 2012 also found that men are less likely than women to take advantage of the NHS services available to them in community settings, including pharmacies. And recent research from TENA Men revealed that one in two men do not openly discuss their health, with up to 90 per cent choosing to ignore a health concern in a bid to avoid discussing their worries.

So why are men so unwilling to confront topics around their own health? Yvonne Tuckley, Numark’s learning and development manager, says that there is a perception amongst some men “that they need to ‘man up’ and not show weakness, so it is hardly surprising that they are reluctant to seek advice.”

In addition, the pharmacy environment may seem more female-friendly at first glance, with toiletries and make-up on display, and female staff members being more common, which could deter some male customers. Yvonne also points out that “men can sometimes be more reluctant to communicate their concerns than women and privacy can be important to both groups. Although private consultation rooms are available, if men don’t visit pharmacies in the first place, they won’t know that they are there”.

This could mean that health providers, including pharmacies, focus too much on women’s health and actually act as a barrier to men seeking help. Yvonne says it could be that men’s health “isn’t necessarily considered directly by the pharmacy team”. But she adds: “There are certainly ways of publicising your products and services directly to this audience. Understanding how to communicate effectively with men is an important part of training for pharmacy staff, who should be aware of privacy issues in particular.”

Superdrug’s health and wellbeing ambassador, Dr Pixie McKenna, says: “We can always do a bit better where men’s health is concerned.” She believes there may be other reasons behind this health inequality too: “In a household, the woman has always traditionally been the care giver, so historically has masterminded the care of the men in the family. As women we are also better used to sharing information about things like periods, waxing, bladder issues and sexual problems with our peers and, by default, healthcare professionals,” she comments.

“It seems to come naturally to us in part because we have so much intricate body maintenance on a day-to-day basis. Men tend to just shower, shave and spend time on the toilet. They store up their worries and are only likely to share them if really pressed,” Dr McKenna adds.

There is a perception amongst some men that they need to ‘man up’ and not show weakness, so it is hardly surprising that they are reluctant to seek advice

Room to improve

While men are reluctant to talk openly about their health concerns, they are hungry for information. Recent research from TENA Men showed the rise in the number of men looking for information on diagnosis websites (36 per cent), NHS online (43 per cent), as well as in books (13 per cent) and leaflets (30 per cent). And 29 per cent of men in the UK agree they should try harder to look after their health.

Yvonne says there is “a real opportunity for community pharmacy” to create more meaningful interactions with men. However, she suggests: “Perhaps for some, a more subtle approach would work. For example, when offering a non-gender specific service such as flu vaccinations or travel clinics, pharmacy staff have a great opportunity to discuss wider subjects. When targeting men, for instance for smoking cessation, it may be worth looking at running group sessions as well as one-to-one sessions to offer more choice to the customer.”

Ultimately, pharmacies are well placed to reach out to men because they have characteristics which are known to be appealing to them: they are accessible, informal and offer expert advice without an appointment.

This, says the NPA, can help men “do more to stay well, not just get treatment when they are sick”. The challenge is to spread the message to more men about the benefits of the free professional advice and support that’s available from pharmacies to help them maintain a healthy lifestyle.

Male motivations

So, what are the key health concerns and conditions that men should focus on and that pharmacy can target in order to provide the best support and care for the men in their local area?

Weight

In England, 14 million men are overweight or obese and are not being adequately helped by weight management programmes, according to the Men’s Health Forum.

Tam Fry, expert advisory team member for Action On Sugar, and spokesperson for the National Obesity Forum, says he thinks pharmacy could do more. “Pharmacies in general have a huge opportunity to help men as getting to see a doctor is so hard, which puts people off. However, I think they could be much more politely ‘in your face’ when it comes to talking about weight.”

“People who come in to talk about weight need to know about diabetes, cardiovascular problems and other things that come from being too fat,” says Tam, “and it also affects their would-be future children. Men like to pride themselves they are good in bed, and the majority get married and want to have children. What many don’t realise is that obesity can ruin their chances because one of the problems is it fouls up the whole of the reproductive system and they can become infertile. Without trying to shock them, positive information about the benefits of weight loss should be available to them without scaring them off.”

Sexual health and fertility

In fact, male fertility is a huge taboo in the UK, with many men unwilling to discuss or address their fertility concerns with their partner or GP. This is according to research from Nuffield Health, in partnership with Infertility Network UK.

The survey also showed that a vast number of men are unaware of the significant impact that their lifestyle choices could have on their fertility. Infertility Network UK says that any advice that pharmacy can give around improving lifestyle – stopping smoking, for example – can have a positive effect, although if men have specific concerns they should visit their GP.

Factors that can affect sperm production include:

• Smoking and drinking – smoking over 20 cigarettes a day has been shown to reduce both sperm count and motility to a major degree, and even moderate alcohol consumption affects sperm. It takes sperm 72 days to mature and the primary focus for couples experiencing infertility should be to avoid any toxins, including alcohol, three months before trying for a baby
• Nutrition and environment – sperm need an abundance of nutrients and vitamin supplementation is an easy way to improve sperm health. Infertility Network UK says vital nutrients include zinc, which plays an essential role in the formation of new sperm and maintenance of sperm motility. Vitamins C, B12 and E are also important, as is arginine, which is needed to help with sperm production.

Testicular cancer

Each year testicular cancer affects over 2,200 men and around 60 young men will die of the disease. It most commonly affects men between the ages of 15 and 45 and, if caught at an early stage, men can expect a high cure rate, with 98 per cent surviving the disease.

Early detection with regular monthly self-checks is therefore recommended. However, new research by the male cancer charity Orchid found that over 43 per cent of young men aged 18 to 24 in the UK were worried that their masculinity could be compromised by testicular cancer. This has led to concerns that men may be put off from checking their testicles and seeking medical advice at the earliest opportunity.

The research also revealed that 18 to 24-year-olds have the least awareness amongst all age groups of the signs and symptoms of testicular cancer and how often you should check. Paradoxically, the over 55s, who are at least risk of developing testicular cancer, are those who most regularly check their testicles and possess the greatest knowledge of symptoms.

The charity stresses that men will still be able to function sexually if they catch the disease early. Male cancer nurse specialist Robert Cornes explains: “Providing that a man had two healthy testicles beforehand, the removal of one testicle for early stage testicular cancer will not usually affect a man’s sex drive or result in erectile dysfunction and he will still be able to climax and have children. It is therefore imperative that men get checked out for any testicle concerns at the earliest opportunity.”

Alcohol

Recent changes to legislation have decreased the recommended alcohol limits for men to those of women, in order to keep the risk of cancers and other diseases low. Both men and women are now advised not to regularly drink more than 14 units a week, which alcohol charity Drinkaware says is equivalent to six pints of four per cent beer, six 175ml glasses of 13 per cent wine, or 14 25ml glasses of 40 per cent spirits.

If you have a customer who is dependent on alcohol, they are increasing their risk of developing high blood pressure, stroke, coronary heart disease and liver disease. The may also develop mental health and psychological problems such as anxiety, depression and suicidal feelings, as regular heavy drinking interferes with neurotransmitters in the brain that are needed for good mental health.

Drinkaware chief medical advisor Professor Paul Wallace also points out that alcohol can have adverse effects if taken with medication. For example, he advises:

• People taking sedative drugs (e.g. diazepam/Valium) or antidepressants (e.g. fluoxetine/Prozac) should avoid alcohol altogether
• People taking long-term medication should be careful about drinking as alcohol can make some drugs less effective, meaning their conditions get worse. Examples include people taking drugs for epilepsy or diabetes, or drugs such as warfarin which thin the blood
• There are some antibiotics which simply do not mix with alcohol and drinking with these will make people sick. But for most commonly prescribed antibiotics, drinking is unlikely to cause problems so long as it is within the daily unit guidelines.

Mental health

Three-quarters of people who take their own lives are men, and male mental health has become a big concern in recent years for healthcare professionals and policy makers. As a frontline service, pharmacy has a real opportunity to spot the signs in customers early and offer advice and signposting that can make a difference.

Nikki Holmes, head of pharmacy for forensic services at Nottinghamshire Healthcare NHS Foundation Trust and president of the College of Mental Health Pharmacy, says: “I'd recommend anyone working in community pharmacy settings look at engaging with the Mental Health First Aid training. It will help you recognise and work effectively with people who are experiencing mental health issues and includes some of the ‘soft signs’ men may exhibit whereby they'll present with physical health symptoms rather than being initially open about mental health issues,” she explains.

“The Men's Health Forum website has some great information and guides on how to better engage men with respect to mental health issues and it's also definitely worth staff being aware of and being able to signpost people to men’s support networks such as Age UK’s Men in Sheds, and the Men's Sheds projects which use woodwork and other activities to support older men,” adds Nikki.