As a specialist in men’s health, I have become keenly aware of what motivates men to address their main health concerns. Men’s health is important, and it deserves greater attention from both individual men and society. Yet, unfortunately, it is not always addressed or taken seriously. I still get chuckles from strangers, or second glances from people in other health care professions, when I tell them of my work in “men’s health.”

Today, there is more information than ever available to help educate men about how to be healthy. Magazine racks, blogs, talks shows, and books all preach the gospel on the importance of exercise, how to eat right, and how to lead a healthy lifestyle that will prevent major issues that men are susceptible to such as cardiovascular disease, cancer, and diabetes. Much of this information is not evidence-based or effective, and it can be full of marketing ploys.

Nonetheless, men still do not value their health as much as they should until it becomes a serious problem that they can no longer ignore. We know that men are half as likely to see their physician than women over a 2-year period. Men’s lackluster attitude toward their health is especially concerning since, according to the Center for Disease Control, 30% of Americans have high blood pressure and yet many of them are left undiagnosed until they have a heart attack or stroke. Many heart disease conditions and cancers are asymptomatic during early stages, and once a patient has symptoms, the disease process is too far advanced for doctors to manage or reverse it with treatment.

Why is this? Why do men wait until it is too late? An online survey by the Orlando Health Hospital system attempted to answer these questions and found that many men cited these top excuses for skipping the doctor: not enough time, afraid of finding out what could be wrong, and having uncomfortable body exams. The American Heart Association also cites ten key reasons why men don’t go to the doctor, including “I don’t have a doctor,” “I don’t have insurance,” and “there’s probably nothing wrong” as the top three. These answers are part of the picture. However, what lies behind these reasonable and unreasonable excuses?

Another answer to this mystery is patriarchy, which encompasses our traditional gender roles and expectations. Men are conditioned to minimize their health problems and procrastinate when it comes to taking care of their health. A man’s attitude towards his health is not to be blamed solely on that individual’s apathy, but rather on an attitude created by our entire society.

A recent pop-culture image of how patriarchy causes detrimental health outcomes in men is Sam Elliot’s character Beau Bennett in the Netflix original TV series, The Ranch. Beau is a stoic, terse, hardworking, and tough cattle rancher. In Season 1, Episode 3, he goes to the doctor after a back injury and states that he hasn’t been to the doctor for 12 years, and the doctor lets him know she will have to do a full physical exam, lab work and an X-ray to make sure Beau is in optimal health. He is diagnosed with a sprained back, high cholesterol and high blood pressure. Beau resists but eventually concedes to the doctor’s orders and is ironically put on a steak-free diet. He has to eat salads and chicken instead. The archetypal image of the stoic, rough-and-tough male is depicted in Sam Elliot’s rancher character, Beau. Hollywood characters from Beau Bennett to John Wayne have reinforced both men’s and women’s expectations about how a man is supposed to respond to his environment and himself.

Recent epigenetic research shows our community and our environment can express our healthy and unhealthy genetics. The truth is, our men are expected to suffer and “suck it up.” This feeds into our status quo of gender roles and poor psychological health. Men are expected to suppress physical and psycho-emotional pain — the same pain that, when unchecked, plays a role in heart disease and health issues later in life. This starts at a young age. In Dr. William Pollack’s book “Real Boys,” he addresses how we traditionally raise men and the toughening process that drives their true emotions underground. While many boys may appear tough, cheerful, and confident, they are in fact sad, lonely, and confused.

In some aspect, this tough approach is beneficial because it enables individuals to achieve greater heights and keep going when others would quit. However, it becomes dangerous once suppression becomes a subconscious habit. When asymptomatic disease processes begin forming and men continue to suppress physical symptoms that are red flags and warning signs from their body, this can result in severe diseases that could have been prevented with regular doctor’s visits and specific testing.

Some of the messages we ignore might be telling us to seek medical attention, rest and relax more, spend more time with family, eat less fried food, drink less alcohol, exercise more, and make sure to have our annual check-up with our doctor (for more interesting articles and discussions on this, check out our other blog posts).

At what point do men actually ask for help? If a man wants to take a few strokes off his golf game, or wants to work on his two-handed backhand, he is more than willing to seek out the expert advice of a golf or tennis pro. Yet, he is much slower to address personal health matters until they become a real problem, at which point it sometimes takes a larger investment of time and money, or could be entirely too late for medical interventions.

Men are most motivated to see a doctor when they experience medical emergencies, sexual health issues, or chronic pain. A man may wait days before seeking medical attention after an Acute Myocardial Infarction – a heart attack that could still kill you – yet the same man would drive four hours on a Friday afternoon in high-stress city traffic to get an injection of erectile dysfunction medication before the weekend. Both are serious conditions that should be addressed before they become an issue. Erectile dysfunction is often caused by diabetes, cardiovascular disease, and other lifestyle diseases that lower testosterone and damage vascular integrity. Thus, a man receiving a vasodilation drug injection into his penis is a short-term fix, but not a long-term solution.

The solution is for men to be supported to prevent the pathogenic environment that causes these issues. The overarching issue that allows these issues to become major problems is a toxic culture that will not allow men to be masculine and take care of themselves simultaneously. Our culture has created an outward facing mask of masculinity, which is falsified and fragile with no core or root in true masculinity. True masculinity is marked by endurance, strength, longevity, and health.

Our society has accomplished unfathomable achievements – bridges, skyscrapers, railroads, nuclear fusion, multinational corporations, and discovery of the human genome – with the work ethic and perseverance to push through any obstacle impeding success. However, in contrast, achieving success in health seems so difficult to obtain. Today, men have higher rates of cancers, heart disease, diabetes, and arguably lower total serum testosterone levels than their grandfathers did.

Yes, men need to remain tough and work hard. Yet, to be tough, a man must be healthy beyond big muscles and big brains. A man must also have healthy organs, healthy cellular function, and healthy whole body physiological systems – cardiovascular, endocrine, and immune system, etc. We can no longer wait for our men’s body systems to break down, but must work to prevent chronic conditions such as diabetes and heart disease by prompting change in our culture and redefining what it means to be a healthy man. A man can only be capable of service to his community, family, and loved ones when he is truly healthy.