By Laura Freeman

Not that many generations ago, it was traditional for Scottish brides to begin weaving and sewing their burial shrouds the day after the wedding. Deaths from childbirth and related infections occurred so often it wasn’t uncommon then for men to bury two or three wives before they reached the ripe old age of 40.

Modern maternity care, antibiotics and birth control have since turned life expectancy tables upside down. Although people of both sexes are likely to live decades longer than they did a century ago, women outlive men so often that it’s fair to wonder whether women really are the weaker sex.

A child born in the US today can look forward to a life expectancy of 81 years if she is a girl, but only 77 if he is a boy. Rising life expectancy numbers have come down in recent years due to the pandemic, the opioid crisis and increasing suicide rates, but women still live significantly longer.

Why do men die earlier? Why are men at risk for so many illnesses and injuries, and why are their outcomes so often worse? Even male babies are less likely to survive infancy and 60 percent more likely to be born premature.

“It’s a combination of biology, behavior, hormones and culture,” Irfan Asif, MD, Chair of the Department of Family and Community Medicine at UAB, said.

While only women have ovarian cancer and only men get prostate cancer due to basic anatomy, there are some disorders found only in men, and many others that males are at much higher risk of developing. They are almost twice as likely to have Parkinson’s Disease; around 70 percent of Idiopathic Pulmonary Disease patients are men; and more men have ALS, alcoholism, cirrhosis, HIV, colon cancer, pancreatic cancer, kidney cancer, lung cancer and virtually all cancers not related to female reproduction. In the first year of the Covid-19 pandemic, men died at significantly higher rates than women.

“Men have diseases like Duchenne Muscular Dystrophy and Hunter syndrome,” Asif said. “They are also much more likely to have hemophilia, autism, color blindness, and to develop an abdominal aortic aneurysm, and a number of other disorders. Women have two X chromosomes. Men have only one, and if a gene on that chromosome has a mutation, there’s no backup to mitigate the risk. They also don’t have the estrogen levels that give women an extra decade of protection against the more deadly cardiovascular conditions.

“Men get more testosterone, which gives them a deeper voice, a beard and more muscle. Testosterone also makes teen boys more impulsive and aggressive several years before the judgment centers of their brain mature. That’s one reason we lose so many young men to high speed auto crashes and violence.”

The tendency of young men to take risks and to act aggressively while at the same time being in the best condition of their lives is also why societies have always depended on them to be the soldiers who fight the wars. Many young men don’t come home, and those who do bring with them memories that can affect their mental and physical health for years, assuming they live those years. Men are also between three and four times more likely to die by suicide than women.

“Work related illnesses and injuries also tend to be more common in men. More men than women have jobs that involve dangerous situations, equipment and toxic exposures. More do heavy labor in harsh conditions that take a toll on the body and long-term health,” Asif said.

In addressing the disparity in men’s health and longevity, there are some factors we can change, some we can’t, and some risks we can influence—if we can get past cultural expectation of what being manly is and get more men to take ownership of their health.

“One of the reasons we often see worse outcomes in men is that they tend to wait longer to seek help and many don’t take the time for screenings that would have detected problems earlier when they were more treatable. Some men think they have to be strong and they say they are fine when they aren’t,” Asif said.

Somehow masculinity became confused with playing when hurt, working when sick, and settling for years in a stressful job to measure up to self-expectations as a provider.

“Some men don’t treat themselves as well as they do their car,” Asif said. “Guys who would never miss an oil change say they don’t have time for a checkup. They put off prostate exams, colonoscopies and avoid seeking help with mental health issues. You don’t see them until something is really wrong or when their wives make them come in for a blood pressure check or to get a medical opinion about symptoms.”

Although men from younger generations seem to be showing more interest in a healthy lifestyle, too many still smoke, work long hours, and find it hard to come to terms with the fact that they can’t get away with eating the same way they did when they were young.

In the not too distant future, genetic screening and editing will help men overcome some of the health disadvantages they are born with. Even then, as now, the greatest opportunities to help men live longer, healthier lives will come from helping them take ownership of their bodies and become proactive about their health care.

Health care providers can help them understand they have a choice. They can treat themselves like an old jalopy just waiting to break down by the side of the road—or shine like a classic sports car, well worth the care to stay in peak condition for years.