Introduction

Men are the weaker sex. I don't say this to be glib; I say it because it's a fact. I know what you're probably thinking. Men are stronger. They have bigger muscles. They have more power. And they make more money, too. You're right about all that, of course. But it's not really that simple. The truth is that at every age and stage of life, the male of our species is less healthy and more vulnerable than females. They begin life as more fragile beings, then compound it with an attraction to risk, an aversion to self-care, and an arsenal of unhealthy habits. Consider:

• For every 100 females, 120 males are conceived, but the males are far less likely to survive. By the time of birth, that ratio has changed: 105 boys are born for every 100 girls.

• Boys are more likely than girls to die from nearly every cause imaginable, from sudden infant death syndrome (SIDS) to drowning, from suffocation to car accidents. They're more likely to be injured in falls, and even to be bitten by dogs!

• Teenage boys are three times as likely as girls to die of any cause. They're twice as likely to be killed in a crash, and nearly five times as likely to be murdered or to take their own lives. And although it's uncommon, teenage boys are also more likely to die from cancer, heart disease, birth defects, asthma, and flu.

• In young adulthood -- through the twenties and thirties -- this mortality gap grows, so that men now die at nearly four times the rate of women. As a result, women begin to outnumber men for the first time at age thirty-six. Men are almost three times as likely to die in a car crash, almost five times as likely to commit suicide, and four times as likely to be murdered. They're also more likely to die of heart disease, AIDS (acquired immune deficiency syndrome), diabetes, and liver disease (thanks to their much higher rates of alcohol consumption). They're even three times more likely to be poisoned. Young women die more often from only one cause -- cancer -- but men will soon catch up.

• At age forty-two, heart disease becomes the leading killer of men. Overall, men have twice as many heart attacks as women and are nearly twice as likely to die from heart disease. And from the age of fifty on, men are more likely to die of cancer as well, along with every other leading cause of death.

• Men are more likely to be killed on the job. Between 1980 and 1997, nearly 104,000 American workers were killed at work and more than 90 percent were men. That's because men do the most hazardous jobs, making up over 98 percent of firefighters, coal miners, loggers, and truck drivers.

• These problems are compounded by men's lack of attention to their own health care. Recent surveys show that one man in three has no regular doctor to go to. And one third of men say they would not go to a doctor even if they were experiencing severe chest pains or shortness of breath -- two of the most common signs of a heart attack.

• The end result is a glaring longevity gap. Men die, on average, about five and a half years younger than women. Among people over eighty-five, there are only thirty-nine men to every one hundred women. By age one hundred, there is only one man for every five women.

But what does this have to do with us -- women? Why should we care -- and what should we do -- about men's health? On a political or societal level, these are thorny questions, but on a personal level, the answers are obvious: We care about the health of males because we are married to them, we are raising them, we have brothers and fathers, and we love them. And we want them to live long, healthy lives.

We know that as women, we do a lot to make that happen. We take our boys to the pediatrician and stay up with them when they're sick. We make sure our husbands and boyfriends go to the doctor; we remind them to take their medications. We try to make sure that everyone eats right. In doing all this, we take on a role we never really asked for -- medical manager for our family. We do it because we love them. Indeed, we love them, in part, for many of the same characteristics that make it hard for them to admit illness or look after themselves -- their strength, their physicality, their maleness. We do it because we're observant and often see them struggling with a problem long before they admit it to themselves or anyone else. And we do it because their health affects us -- our physical and mental health, our strength, the very quality of our lives.

For the most part, we're happy to do these things, yet it's hard not to be exasperated sometimes by the lack of attention our men give to their health and their bodies. We want them to be healthy, and we want them to change. We want them to become more aware and more responsible about their health. And most of all, we want our sons and grandsons to grow up with a different attitude toward health care.

I haven't always thought much about this. But in recent years, changes in my own life have led me to reflect on these issues. Let me tell you a bit about my own story.

I am a physician and the medical and health correspondent for a major network morning news show. I came to CBS News in 1995 to cover women's health, the hot new topic in medical news. Newspapers and networks began to cover this beat, launching columns and segments, working to hook the female audience.

Women's health was finally getting the attention it deserved. After years of lobbying by women's health advocates, the government and the research community were finally listening. Large medical studies of women were under way, and researchers were finally looking at the important physiological differences between men and women. I didn't cover men's health back then and didn't think a whole lot about it.

Then a few things changed. The first was the birth of my son Harry. I grew up with three sisters and no brothers. When I discovered that my baby would be a boy, I realized that I didn't know the first thing about them. Oh sure, I'd known boys as a child, had plenty of male friends, and, after all, married one. Still, I was seized with panic at the prospect of actually raising a baby boy. I was caught off guard about basic decisions, such as what to do about circumcision. And I was unprepared for Harry's amazing level of activity.

From early on, Harry was "all boy," and by the time he was fifteen months old, my husband and I had a saying: "No mere mortal can contain him." We had an adorable, squeezable, delicious little alpha male on our hands, one who seemed never to stop moving. I collapsed exhausted at the end of each day, while he rarely slept through the night.

When it came time to look for preschools, we started to hear about differences between boys and girls: that boys are behind, boys are more trouble, boys are a special challenge. This was usually accompanied by a sigh or a knowing shake of the head. The "boy thing" was going to be a challenge, and I realized I wanted to learn more about them.

The second event was more troubling. One afternoon my husband, Avery, called me at work complaining of a sharp pain in his upper back. Even though I told him that these were symptoms of a possible heart attack, I still had to convince him to go with me to the emergency room. Frankly, I had been waiting for this call. My husband is outwardly the picture of health. But as a physician I knew he was cheating the devil. High blood pressure, high cholesterol, prediabetes, and the diet of a teenage boy -- all were at work inside his arteries, waiting, just waiting.

Things turned out okay that day. Tests showed he did not have a heart attack. That was the good news. The bad news: Tests showed definitively he had diabetes, with very high cholesterol and high blood pressure. The doctor told him point-blank that if he wanted to prevent catastrophe, he needed to take immediate action.

He didn't. So I did. I scheduled the follow-up appointments and made sure he went. I sat in on examinations so Avery couldn't play down his health problems as he always did. I didn't do this because I'm a physician. As any woman reading this will already know, I did it because I'm a woman, and this is what women do. We take charge of health matters, we become "Dr. Mom."

In dealing with these issues, Avery was jocular, breezy, his usual self. I was perplexed and sometimes infuriated by his lack of alarm. I could not understand why he didn't do everything in his power to prevent a disaster -- read: massive heart attack. He was an Ivy League-educated lawyer who was acting like a boy.

It gnawed at me that he didn't take the whole thing more seriously. Eating a donut, he would swagger and laugh, practically taunting his body to betray him. "What are you doing?" I would screech. But then I would rationalize: "I'm overreacting. I worry too much because I'm a physician. If he were really in trouble, he would take care of himself." I did not want to be smothering or hysterical.

When I did try to start a serious discussion about his health, our conversations were, shall we say, oblique. I'd say something and get an evil look in response, a quick denial, or a long-winded rationalization. He refused to examine what was going on, and I could not break his denial. To avoid a fight I would shrug and concede, "Okay, you're probably fine."

We were getting nowhere. I love my husband and did not want to see him become ill. Plus, we had a growing family. If anything happened to him, it would devastate his son and daughters.

Around the same time, I received a letter from a viewer, a woman who wanted to know more about a prostate cancer story we had covered. By this time, I was covering general medical news on the morning show. Why, I thought, doesn't her husband ask these questions for himself? That's when it hit me: Because that's not what men do!

Most men do not take care of their bodies the way women do. They don't seek out health information, lay themselves bare to doctors, or recognize when they are on the brink of medical disaster until it's too late. But their mothers, partners, wives, sisters, and daughters do.

Reading this woman's letter, her love and concern came through in every line. I also realized that viewer letters and e-mails came mostly from women, even when the topic was men. I was not the only woman who was functioning as health advocate for the men in the family.

As I asked my women friends and coworkers about the roles they played in the health of their sons, partners, and fathers, things became clearer. Women were intimately involved in many aspects of boys' and men's health. The stories they told were funny, and sometimes sad.

One woman told me her husband refused to seek help though he was seriously depressed. A young mother wanted to know if her son was headed for trouble, because he insisted on sitting, rather than standing up to pee. Another friend, a single mom, was shocked to find pornography on her twelve-year-old son's computer. One woman told me her husband refused urgent coronary bypass surgery until after an important business meeting. Another friend's father is dying of colon cancer because, she believes, he ignored symptoms and refused to get checked.

These problems play out everywhere you look. During the war in Iraq, NBC News correspondent David Bloom did a brilliant and courageous job of covering the war live as it happened. But his cramped post in an armored vehicle was causing him pain in his legs. He complained to medics and consulted doctors by phone; they all advised him to seek medical attention. But he refused to leave the battlefield and died when a blood clot traveled to his lung. How terribly sad. For me, his death raises the question: If Bloom were a woman, would he have listened to those medics? Would he possibly be alive today?

No one, of course, can answer those questions with certainty. Yet it is clear that on matters of health, the gender divide operates as strongly as ever. Men do things that most women wouldn't, and they fail to do things that, for women, are routine. Scott Hensley covers health and medicine for The Wall Street Journal so he should, as he says, "know better." A couple of years ago, he got his cholesterol checked -- "practically against my will" -- by a nurse at a clinic he was writing about.

"My blood sugar was fine, but my total cholesterol and LDL [bad cholesterol] were through the roof," Hensley recalls. "Did I go to the doctor? Nope. Do I even have a primary-care doctor? Nope. Didn't then and still don't. Pathetic. For the past ten years, my trips to the doctor have been prompted by acute problems I couldn't ignore -- broken bones and accidents pretty much."

Men don't act this way because they are dolts or because they have a deep-seated death wish. They don't act this way because they want to burden us with undue worry about their health. They act this way because eons of evolution and centuries of cultural conditioning make it difficult for them to act otherwise. The risks they take, their visceral fear of appearing vulnerable, their preference for "gutting it out" -- all are so deeply ingrained that they're almost second nature. It's what makes them men.

As I thought about these attitudes and the issues in my own family, the idea for this book was born. I wanted to get to the bottom of what was going on in men's health, if for no other reason than to understand my own son and husband.

To get my arms around the topic was going to be a huge undertaking and one I could not do alone. So I roped my old friend Rob Waters into helping me out. As former editor of the "Men's Health" section of WebMD, a former writer for Health magazine, and a contributing editor to Psychotherapy Networker magazine, Rob immediately understood what I was trying to do. He's researched and written a lot about mental health and the psychological aspects of health. He's also a man, of course, and readily admits to falling into many of the attitudes and habits that are so typical of his sex. And perhaps most important, he too has a young son.

We spent a year doing research, identifying the major issues in the health of boys and men. We interviewed experts in each area, more than one hundred fifty in all. We asked medical societies, academies, and institutions to identify leading thinkers. And then we consulted more experts to hone our findings and make sure we provided the most cutting-edge and accurate information available. Each chapter has been read and vetted by experts in that field.

The result is a book that does three things: It outlines the conditions, illnesses, and health habits that are more common to males, offering tips for prevention and treatment. It looks at the biological, cultural, and psychological reasons behind men's health-related attitudes and practices. And it suggests ways that women can work with their sons, husbands, fathers, or any man they want to help to be healthier.

We've organized the book to follow the arc of the relationships with the men in your life: as the mother of a boy, the wife of a still-healthy man, and the partner of a man with health problems. We explain everything from circumcision to heart disease, and offer suggestions on what you can do if you think the man in your life eats the wrong foods or drinks too much alcohol. We weave in firsthand accounts to illustrate what happens between mothers and sons and husbands and wives. We avoid going through the usual litany of symptoms and tests, followed by treatments, but we suggest many excellent books and websites where you can find that sort of information and more. Always check our resource section for additional information. We offer concrete advice and information that helps you understand what's going on physically, developmentally, and emotionally with the men. We point out the areas of major risk to their health and tell how you can help. And we offer suggestions on how you can share your knowledge with your husband, along with some ideas about ways you can motivate him to take better care of himself and be a better health role model for your sons.

So this is a book about men's health issues -- for women. Many women, including some thoughtful feminist thinkers, believe that we should not have to take care of men's health, that men should bear this responsibility themselves. On one level, I agree. We ought not to have this job. It should be enough that we take care of ourselves and our children without having to be responsible for our men's medical care as well. But the reality is that we often are. Clearly, this needs to change. Men need to feel that taking care of themselves is not a mark against their masculinity. But until this happens, we are not about to abandon the men and boys we love. Why should we? How could we?

That said, let me be clear about what this book isn't. It isn't about how to be your husband's, or lover's, or even your son's caretaker. The goal is not to make men more dependent. Rather, our goal is to arm you with information and to help you educate the boys and men in your life so that they can take care of themselves.

We hope you do enjoy this book and we offer one suggestion: After you read it, leave it around someplace obvious. Maybe he'll read it, too.

Copyright © 2004 by Dr. Emily Senay