Masculinity may really prevent help-seeking for common risk factors.
Boys don’t cry, and they certainly don’t get themselves checked for hypertension and hyperlipidaemia, a study of thousands of young men has confirmed.
The reluctance of the boofier side of humanity to visit doctors or acknowledge physical infirmity, especially in their youth, is well known.
Previous qualitative research “suggests that boys and men experience especially strong social pressures to portray gender-congruent behaviours that emphasise dominance and deny vulnerability, including through the avoidance of preventive health care and rejection of recommended medical therapies”, write the authors of this study in JAMA Network Open.
Yet so far, no big quantitative studies have explicitly investigated the relationship between male gender expressivity (MGE, a measure “reflecting sociocultural pressures to convey male gender identity”) and the likelihood of having cardiovascular risk factors identified and managed.
This University of Chicago team used data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), which profiled a large cohort of participants from 1994-95, when they were adolescents (12-18), for 24 years. They took an all-male sample of 4230 participants, majority white and 80% privately insured.
They compared subjects’ biometric health data with MGE, a previously validated measure derived from answers to 25 questions in the Add Health survey that males and females mostly answered differently.
This metric included no physiological data, lead author Dr Nathaniel Glasser explained: “We’re purely focused on self-reported behaviours, preferences and beliefs, and how closely these reported behaviours and attitudes resemble those of same-gendered peers.”
Using three models, they found that men with higher MGE were less likely to report receiving warnings, diagnosis or treatment of CVD risk factors.
Among men with higher blood pressure (over 130 or 80mmHg), there was a clear inverse relationship between MGE and hypertension diagnosis.
Among men with higher blood sugar, there was a clear inverse relationship between MGE and diabetes diagnosis.
Among those who did report a hypertension or a diabetes diagnosis, the higher the MGE, the lower the probability of taking hypertensives or diabetes medication.
“Our hypothesis is that social pressures are leading to behavioural differences that impact cardiovascular risk mitigation efforts, which is concerning because it could be leading to worse long-term health outcomes,” Dr Glasser said.
There was no association between MGE and hyperlipidaemia; the authors hypothesise that successful marketing – nay, direct-to-consumer advertising, this being the US – of statins may have conquered the gender healthcare-seeking divide in this instance.
The authors acknowledge, among other limitations, the difficulty in their own study design of finding clear cardiovascular danger signs in what are still quite young men, the oldest being 42 – meaning there may be an even stronger signal that this data couldn’t pick up.
“By some earlier estimates, less than 25% of younger adults with borderline CVD risk levels are aware of their risk,” the authors write. While a lot of efforts are now aimed at lifting the recognition of female CVD risk, they say, which is necessary, it wouldn’t hurt to also look for ways to reduce preventable morbidity and mortality among men.
Manhood has been previously identified as “a precarious social identity, requiring continuous social proof”, they write.
Boys, please don’t prove your masculinity by having a heart attack at 55. You’ll want those years for huntin’, fishin’ and ignorin’ your emotions.
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