Integrated men’s health: Androgen deficiency, cardiovascular risk, and metabolic syndrome

Contributors of Campbell-Walsh-Wein, 12th edition

Neil Fleshner, Miran Kenk, and Steven Kaplan

Overview of the problem

In almost every country, health outcomes among males are significantly inferior to those of females. Efforts to reduce gender inequality in health require a substantial adjustment in multiple facets of life. Human longevity continues to increase on a global scale with advances in medicine. On average, men throughout the world live shorter lives than women ( Fig. 15.1 ). Men also fall ill at younger ages and are more prone to chronic diseases ( Table 15.1 ). Six of the 10 most common causes of death among Americans, including heart disease, cancer, and diabetes, are more prevalent among males.

Table 15.1

Major Causes of Death, United States, 2016

From Centre for Disease Control and Prevention/National Center for Health Statistics (CDC/NCHS). National vital statistics system, mortality 2017. Atlanta: US Department of Health and Human Services, 2017..

CAUSE OF DEATH	ANNUAL NO. OF DEATHS	MALE-TO-FEMALE INCIDENCE RATIO
Heart disease	633,842	1.12
Cancer	595,930	1.11
Chronic obstructive lung disease	155,041	0.88
Accidents	146,571	1.73
Stroke	140,323	0.71
Dementia	110,561	0.44
Diabetes	79,535	1.18
Influenza or pneumonia	57,062	0.89
Nephrological conditions	49,959	1.03
Suicide	44,193	3.33

Explanation of the poorer health of men

Several factors place men at higher risk of death and disease. Men have increased exposure to physical and environmental harm in the workplace , and up to 97% of all risk fatalities are in males. Men have a propensity for risk-taking behaviors , such as alcohol use, smoking, and risky sexual practices. In addition, males experience relatively more social pressure to endorse gender stereotypes, such as independence and toughness, and may postpone or dismiss their health care needs.

Metabolic syndrome and men’s health

Metabolic syndrome is defined as a series of biochemical, physiologic, metabolic, and clinical factors that increase the individual’s risk of type 2 diabetes mellitus (T2DM), heart disease, and early mortality. Depending on the definition and population studied, the prevalence of metabolic syndrome ranges between 10% and 84% of the population. Risk factors include sedentary lifestyle, excess caloric intake, and higher socioeconomic status. Several definitions are available ( Fig. 15.2 ; Table 15.2 ).

Table 15.2

Metabolic Syndrome Definitions and Criteria

CLINICAL PARAMETER	WHO (1999)	EGIR (Balkau and Charles, 1999)	ATP III (NCEP, 2001)	AACE (Einhorn et al., 2003)	IDF (Alberti et al., 2005)
Obesity/body fat distribution	Waist/hip ratio >0.90 in men, >0.85 in women or BMI >30 kg/m ²	Waist circumference ≥94 cm in men, ≥80 cm in women	Waist circumference >102 cm in men, >88 cm in women	BMI ≥25 kg/m ²	Waist circumference ≥94 cm in men, ≥80 cm in women
Insulin resistance/ hyperglycemia	IGT, IFG, T2DM, or other evidence of insulin resistance	Hyperinsulinemia (plasma insulin >75th percentile)	Fasting glucose ≥110 mg/dL	Fasting glucose ≥110 mg/dL	Fasting glucose ≥100 mg/dL, T2DM
Triglyceridemia	≥150 mg/dL	≥177 mg/dL	≥150 mg/dL	>150 mg/dL	>150 mg/dL or on treatment
Cholesterol	HDL-C <35 mg/dL in men or <39 mg/dL in women	HDL-C<39 mg/dL	HDL-C <40 mg/dL in men; <50 mg/dL in women	HDL-C <40 mg/dL in men; <50 mg/dL in women	HDL-C <40 mg/dL in men; <50 mg/dL in women; or on treatment
Blood pressure	≥140/90 mm Hg	≥140/90 mm Hg or on treatment	>130/85 mm Hg	≥130/85 mm Hg	>130/85 mm Hg or on treatment
Other	Microalbuminuria ^a			Other features of insulin resistance ^b