A Woman's Guide to Your Man's Health

Last Editorial Review: 7/8/2005

WebMD Live Events Transcript

Women make most of the health care decisions, including those for the guys in their life. Wouldn't it help if we understood male health issues better? CBS health correspondent Emily Senay, MD, author of "From Boys to Men: A Woman's Guide to the Health of Husbands, Partners, Sons, Fathers, and Brothers" was our guest on June 16, 2005. 

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Welcome to WebMD Live, Dr. Senay. Thank you for joining us today. We are talking today about women caring for the males in their lives. Why is it that most health care decisions and actions are made by women? We make sure they get to the doctor, we remind them to take their meds, we try to get them to eat right. Are men that disconnected from their bodies? What is going on?

SENAY:
It's a wide open question, but I think there are specific reasons why we have this particular relationship surrounding health care within the family.

Men and women are socialized differently. And while so much of our relationship between the sexes has been explored, everything from child care to cleaning the house to dividing up chores -- the so-called 50/50 relationship that many couples have -- for some reason caring for the health or thinking about the health of the family is what the women still do. It's sort of the final frontier of the evolution of the relationship between men and women. Women continue to be the health care czar within the family, and many times they do not even realize the profound role they play in the family's health. Women are nurturers by nature and I think despite years of hearing that men and women are equal, there are differences between how men and women approach life. I believe that this is one of the areas where women continue to play a traditional role, though they may not acknowledge they're doing it and they also get little credit for caring for the health of the family.

MODERATOR:
Let's start by looking at how we raise our sons. As mothers, we have a great influence on our sons. What can we do to help them grow up with a better attitude towards their own health? So much of our societal attitude towards boys involves "boys will be boys" -- hell bent for action. There is almost a sort of badge awarded to boys who get injuries. It's not healthy.

SENAY:
You're absolutely right, there is a double standard. They've studied this and explored the way mothers and fathers react when children take risks. For example, if a boy and a girl are doing the equivalent thing of walking along a high wall or some other risky behavior, studies have found that the language parents use is very different if it's a boy compared to a girl. They're much more likely to issue words of caution to little girls and not to little boys. The expectation that boys are tougher, stronger, more capable is a tacit one, but when people begin to explore these things for themselves, they often find this double standard.

We do need to be more conscious about the messages we send our children, but particularly our sons, about respect for caring for their bodies, and making sure we don't send divergent messages on risk taking. In other words, we want to be equal in our language with our sons and daughters. This is a very important message, not only for mothers, but for fathers. Fathers model behavior for their sons and whatever Dad is doing sons are learning and will likely do the same.

"Boys are more vulnerable than girls to illness, disease, and even death, during in utero, at the time of birth and throughout infancy and childhood."

MODERATOR:
This isn't a political concern; it is a health issue for our sons.

SENAY:
That's right. This is not a political message, it's not intended to be radical. It's a simple fact that when you look at unintentional injury and violence, our sons are at an astronomically greater risk than our daughters. We have to respond to that data and frankly, I'm mystified that we haven't been more responsive to the data. It is so clear that being a boy is the biggest risk factor for death from unintentional injury for our adolescents, teens, and even into our 20s.

MODERATOR:
The attitudes reflected in the culture of sports can be dangerous for boys as well.

SENAY:
Yes. It's a pervasive message. No one is suggesting to take all risk away from children or to turn boys into girls. You can try that, but it will never work. The message is to equalize, if you will, our concern about risk for boys and create a more equal message between boys and girls.

Boys want to take care of themselves. The idea that boys don't talk, don't emote and are unconcerned about their health is an idea that I don't believe is true. Boys want to talk, they are concerned about their health, we just need to give them a forum and an entree into that discussion, so that they're comfortable with the language of caring for themselves and thinking about their health, rather than forcing boys to adopt a macho or risk-taking attitude that I don't think is essential necessarily to the male character.

MODERATOR:
Aside from injuries, are boys subject to more medical problems than girls?

SENAY:
It's interesting, we think of boys as the stronger, sturdier, tougher sex. I certainly had that feeling when my son was born, but when you look at the reality, it's really the opposite.

Starting in the womb boys are more vulnerable to genetic abnormalities, problems in utero, prematurity, sudden infant death syndrome and ear infections -- a whole host of diseases -- and we don't know and understand the biological reason completely. Boys are more vulnerable than girls to illness, disease, and even death, during in utero, at the time of birth and throughout infancy and childhood.

MODERATOR:
Once they reach their teens, boys sometimes shut mom out of the conversation. This can be troubling since most health care will come through Mom.

SENAY:
That's absolutely right. There's a saying that a boy has his last vaccination and doesn't appear at the doctor's office again until he's had his first heart attack -- an exaggeration for sure, but there's some truth to this.

I think one of the greatest things we can do for our sons, as mothers, is to help them establish a pattern of routine medical care and comfort in seeking help when they need it, rather than waiting for small problems to become big ones. I think explaining this frankly and clearly to our sons is the best way to help sons achieve a healthy approach and a responsible approach to their own health.

It's possible that if this dialogue begins to occur in families we won't see the neglect in the younger generation of men that we have seen in some of the current older generations of men who would avoid care at all costs.

MODERATOR:
How do we get our boys to take control of their health as they become men?

SENAY:
If you can find a family physician, a pediatrician, a nurse practitioner, an internist, someone who your child can establish a relationship with, that would be wonderful. I realize that in this day and age that is often very difficult to do.

Encouraging them to seek care, discouraging them from toughing it out, telling them that taking care of your health is the most macho thing they can do -- are all messages that will help them establish their own pattern of taking care of their health.

The goal of all this is not to burden women with more responsibility for their families or the men in their lives -- the goal of the entire book was to help acknowledge the fact that women are playing this role and then guiding them through steps they can take to help change this way we have of doing business within our families so that our sons, our husbands and all the men in our lives become more responsible for their own care.

"Until something serious or scary happens, men often think they are invulnerable."

MEMBER QUESTION:
I've heard that there are doctors who specialize in adolescent medicine. Would you recommend changing to one of those specialists as my son grows? He seems put off by the little kid environment at the pediatrician. And when do I stop going into the exam room with him? I want to know what's going on, but want him to feel able to talk to the doctor about anything he may want to.

SENAY:
This is an excellent question.

Over and over again I hear that adolescents reach a point when they don't want to be in the waiting room with the little-kid stuff -- the toys, the trucks and the blocks. That's completely understandable. This is a good thing.

If you can find an adolescent specialist in your area and your son would prefer to go to an environment where there is not the little-kid stuff, do it. Many pediatricians take excellent care of adolescents. Many of them have office hours where they will see only adolescents, so it doesn't necessarily have to be someone who is board certified in adolescent medicine.

If the problem simply is the waiting room and the pediatrician or family physician is comfortable with adolescents, maybe you can work out a way for your son to be seen when there are no little kids around.

I think if you have an open, honest continuous dialogue with your son, you can talk together about whether or not you should accompany him in with the doctor. He's entitled to his privacy, and only under extreme circumstances, such as the idea that he would harm himself or others, the doctor must respect his privacy as well. So my advice would be if he's ready, let him go in on his own to talk to the doctor, because this is a very important step in learning to care for himself.

MODERATOR:
Those sons of ours grow up to be someone's boyfriend, partner or husband. Then we have the problem of dealing with grown men who don't take care of themselves.

SENAY:
I know about this problem all too well. Until something serious or scary happens, men often think they are invulnerable. Certainly my own husband had this attitude for the first nine years of our marriage. And once something does happen, they will begin to pay attention, but why should we wait for something bad to happen?

I hate nagging, I hate having to worry, but I found myself doing all that and more, when I saw my own husband was heading for trouble. My hope is that the exploration of this phenomenon that I talk about in the book will get a dialogue going so that men and women are comfortable talking frankly about the role each plays surrounding health.

MODERATOR:
My husband called me at work to tell me he was having chest pain. I insisted he call 911. He refused, but finally drove himself to the doctor's office across town from where he was at the time. He had to be rushed to the hospital via ambulance because he was having a heart attack! What amazed me was that he thought it was the right thing to call me instead of 911.

SENAY:
Classic, classic.

They've actually done surveys where they look to see where people get their health information. For women, it's television, the Internet, magazines, and the doctor. For men in these surveys, they state they get most of their health information from their girlfriends, wives or mothers. That is precisely the dynamic that I was interested in exploring.

Your husband is having chest pains, likely or not a heart attack, and yet rather than calling 911, he calls you. That's classic.

MODERATOR:
At first I thought it was because I work for WebMD, but talking with girlfriends who have no involvement in health care or medicine, it happens to them too.

SENAY:
That's what I thought too, when my husband was relying on me, but asking my friends, I realized that this is an extremely common dynamic.

One of the classic areas where this dynamic plays out is with male depression. Partners see the effect of depression on their husbands, boyfriends and significant others -- the men in their lives -- and yet so often they have to struggle to get that guy into care. I have had many friends whose husbands struggled with depression and I have seen the effects the stigma of depression, particularly where men are concerned, has very negatively affected family life.

"Look for nonthreatening moments to talk about his health and for awhile, try backing off completely, especially if you've been on his case lately. Tell him you care about him, you want him around for as long as possible -- that's your goal."

MEMBER QUESTION:
My husband is like a big kid about his health. He doesn't take care of himself, yet he doesn't want me to "mother" him in this regard. How can we find a middle ground?

SENAY:
I would suggest that unless you think there's some serious acute medical problem, you continue to drop hints about taking care of his health, and hope one will sink in.

Another approach is to have a male friend, someone who he respects and who may have had a health scare, talk to him about taking care of his health.

The other thing you might want to do is when you're out at the mall or in some place where they're offering free screenings, just happen to suggest, hey, let's go check this out. One interesting study of men and women at the obstetrician's office found that when they casually screened the men for high blood pressure when they came in with their wives or partners during a routine visit, they actually found a number of guys with high blood pressure who were completely unaware they had the condition.

Don't give up on your partner. Look for nonthreatening moments to talk about his health and for awhile, try backing off completely, especially if you've been on his case lately. Tell him you care about him, you want him around for as long as possible -- that's your goal. Ask him what you can do to help him make that possible.

MEMBER QUESTION:
My husband had a major heart attack and afterwards it felt like our whole family had a heart attack. Everything is different; I feel overwhelmed and guilty and we aren't adjusting well at all. Help.

SENAY:
All the things you are describing are common, and there are solutions.

I'd like to direct you to a couple of resources that I think will help you tremendously: the Heart Mates web site ( www.heartmates.com ) ,which I reference in my book, and also the chapter exploring the postheart-attack family, which goes into detail on what to do about the common emotions and changes that happen after a spouse has had a heart attack, bypass surgery or angioplasty.

Please check out Heart Mates. This will be a tremendous resource for you.

MEMBER QUESTION:
My husband has asthma and frankly doesn't take care of himself the way he should. I keep things as clean as possible (dust can trigger attacks) but I can't get him to do all of the other things he needs to make life better, aside from just taking his medicines. He won't exercise or watch his diet. His snoring keeps me up at night. I know there are things he could do, but he doesn't and I really resent it.

SENAY:
I can't blame you at all for feeling resentment. No doubt you feel anger and frustration at your husband's indifference to his health. I imagine you're also sleep deprived, if your husband's snoring is keeping you up at night.

This is a classic problem, but I think at this point, you need to do what you must to first take care of your own health. Telling your partner that you're not getting enough rest because his snoring is keeping you up at night is one place to start.

If you have a good relationship and can comfortably tell him that his problems are impacting your relationship and you are feeling resentment, it may push him to take action.

Unfortunately, I know that many of the behaviors that you're describing can be extremely difficult to change. I talk about how to make changes as a couple in the book and recommend that you take a look at that so that you have a set of skills for helping you cope with his lack of concern.

"Very often men who are depressed have what we think of as a midlife crisis, but in fact, many of these men are probably depressed."

MEMBER QUESTION:
My husband has lost some of his sex drive. You can see his discomfort every time one of those ED ads comes on TV. How can I get him to talk to the doctor about his
sexual issues when he can't talk to me about it?

SENAY:
Sex can become the big elephant in the room that nobody wants to talk about. But unfortunately, or fortunately, depending on how you look at it, somebody has to start with conversation. You may want to open the conversation by saying something like, "I miss our time together. What can we do to recapture that?" Telling him you love him no matter what, that there are effective treatments and that you will go with him to the doctor to address the problem are all ways you can support his getting help for erectile dysfunction.

Do not underestimate how important sexual performance is to a man's self-esteem. In writing the book and exploring this issue, I found that some men think that people in their offices or on the street can detect their drop in sexual performance. They feel so bad about what's happening and it just colors their entire world.

Addressing this problem may help not only with the sexual performance issues, but may uncover other problems, such has heart diseases, diabetes -- hidden problems that need to be addressed, and if addressed will improve his overall health as well as his sexual performance. So jump in now.

MEMBER QUESTION:
Do men go through something like menopause? Or is male menopause a myth? Is a male midlife crisis the same thing emotionally?

SENAY:
Clearly men do not go through menopause the way women do. They do not have an abrupt -- over a year or two or three -- period where their hormones completely shift.

However, men do lose a certain amount of testosterone in a gradual decline over a many, many year period and decade period. Male testosterone is at its height during and shortly after puberty.

Nevertheless, many experts do believe that men have life-stage changes that somewhat mirror female menopause, in that men reach a time in their lives when they reflect on where they are, where they had hoped to be and where they're going, and the need to make adjustments for what their future is going to be.

Very often men who are depressed have what we think of as a midlife crisis, but in fact, many of these men are probably depressed. Testosterone treatments, despite hearing so much about this lately, really should be reserved for men who have blood levels of testosterone that are truly low.

So in my opinion, I think it's a little bit inaccurate to say that men have menopause but they clearly do go through life changes that can affect their outlook.

MEMBER QUESTION:
Men are raised not to show their emotions but they get stressed and depressed just as you talked about. What can we do to help them when they hate to admit to having any kind of emotional problems?

SENAY:
I think one of the most important messages women can give men to help them feel comfortable is to tell them that talking about these issues makes them a fuller man, and that it takes strength to admit your feelings. And that you support them, love them, and will respect them even more if they can begin to articulate what's bothering them and reach out for help.

MODERATOR:
What are the top five medical conditions we should be watching for in the men of our lives?

"I'm so glad to talk about this subject, because I think talking about it will help everybody establish a better attitude toward health."

SENAY:
The first thing adult men need to get under control -- just like adult women, really -- is weight. If you manage your weight well, you are likely reducing a variety of other troublesome risk factors for heart disease, which remain the No. 1 killer of men and women. By that I mean that if you have a normal weight you're more likely to have a normal blood pressure, normal cholesterol and other risk factors. Staying active and having a healthy diet is a good thing for everybody and it's just as important for men as for women.

The second thing is probably mental health. How is your partner feeling and doing emotionally? Obviously that will have a huge impact on your relationship and your children and overall quality of family life.

The third thing that I would suggest is that men get routine screenings for cardiovascular risk factors and cancer risk factors. So, having a good idea of their family history and then making sure that based on their own personal history they get the appropriate tests, whether it be a colonoscopy, prostate screen or cholesterol check. Whatever it is, make sure they're getting the right preventive care.

The fourth thing that I think is a big problem for men, and not much discussed, is alcohol and substance abuse, which can go hand in hand with depression. Addressing those concerns are, of course, essential.

The fifth thing, if I haven't said it, although I think I have, is an active lifestyle for the whole family.

The sixth thing is women should take care of themselves. Model the behavior they want to see in their sons, husbands, partners, and lovers, because it will be good not only for women, but for the whole family.

MODERATOR:
Dr. Senay, we are almost out of time. Before we wrap things up for today, do you have any final words for us?

SENAY:
I'm so glad to talk about this subject, because I think talking about it will help everybody establish a better attitude toward health. And frankly, ultimately may unburden women to some degree, from the role of medical manager within the family and ultimately will make the whole family healthier and happier.

MODERATOR:
Our thanks to Emily Senay, MD, for joining us today.



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