Men’s Health Network: Healthy Aging for Men and Those Who Love Them

Show Notes

Why do men have shorter life expectancies than women? And what can men do to improve their health as they age? Ana Tomšić, Vice-President of Men’s Health Network, and Dr. Sal Giorgianni, Senior Science Advisor at Men’s Health Network, talk about how men can pursue healthy aging and how the COVID-19 pandemic has impacted men’s health.

Episode Transcript

Sue Peschin:

Hello, and welcome to This is Growing Old, a podcast from the Alliance for Aging Research. I’m Sue Peschin, President and CEO of the Alliance for Aging Research. Thank you so much for tuning in today. We hope you’ve been enjoying the podcast so far. I’ve really enjoyed my conversations with the guests we’ve had on This is Growing Old. Be sure to listen to our previous episodes to listen to these conversations. On today’s episode, we’re going to be talking about men’s health, but that doesn’t mean that this conversation will only be relevant for men.

Sue Peschin:

In fact, today’s episode is for everyone, for men and for those that love them. Our guests today are Ana Tomsic, Vice President of Men’s Health Network and Dr. Sal Giorgianni, Senior Science Advisor with the Men’s Health Network. Ana and Dr. Sal, thank you so much for joining us today. My first question is actually for both of you. So since the COVID-19 pandemic began, there’s been a very steep drop off in medical visits for chronic conditions. And it seems to be slow going getting people to go back for needed checkups and elective surgeries. And in fact, I saw the CDC and also the Washington Post just did a study on non-COVID deaths related to these issues. So how can we ensure that underlying medical conditions are being addressed as the pandemic continues?

Dr. Sal Giorgianni:

One of the dilemmas is in general, men don’t go to the doctor as often as women do. And they tend to go to the doctor even later on in a disease process than women do. And that makes for a difficult situation. I think one of the most important things to come out of the COVID-19 scenario is the advent of telehealth. If men are reluctant to get out, particularly the older ones over 65 or 70 or 90, or they can’t get out, I think finding a provider who makes telehealth services available is an extremely good option. I think telehealth and finding providers who provide telehealth services is extremely important. The other is just this recognition that while we are so enmeshed in this virus, these other conditions march on. Ignoring it, which men tend to do unfortunately, I’m one of them, symptoms and signs until it’s kind of too late, is not going to make the problem go away. It’s just going to make it more difficult to treat.

Sue Peschin:

Dr. Sal, I was wondering, we know that the death rate among men is higher than it is among women with COVID-19. And I was wondering if, what you’re talking about and men are sort of slow in going to the doctor and admitting something’s going on with them. Is that contributing? Are there other factors at play? What do we know to this point?

Dr. Sal Giorgianni:

That’s an amazingly important question for guys. And those are things that I think help an awful lot, both in catching it and getting sicker from it. We don’t know exactly the reason why, but it has something to do with the overall resilience of men and their ability to fight infections in the first place, which seems to be a little bit lower than in women. It may be that they have COVID-19 as attacks the body through these receptor sites, the ACE—angiotensin converting enzyme—receptor sites. And men seem to have more of those key target tissues of women.

Dr. Sal Giorgianni:

When you look at nine of the 10 of the leading causes of mortality and morbidity sickness and death in the United States, men continue to lead in nine out of those 10. And for most of those—cardiovascular, diabetes, weight management, preliminary conditions—men are at higher risk. So not managing those underlying contributing health causes can also put men at much greater risk of not only contracting the condition, but also not doing as well when you get the condition. So again, going back to your first question, which was really important. Should men take care of their underlying conditions? Absolutely. Because we’re not out of the woods yet. We still have to fall and the winter to get through.

Sue Peschin:

Really good information. Thank you. I want to talk a bit about kind of the basics with regard to men’s health. And I think you mentioned a couple of them, but I’m wondering for our audience, what are the most common health concerns for men, including maybe one or two that people might not know about?

Ana Tomsic:

There are many conditions that men and women need to be aware of. Cardiovascular health, mental health, respiratory health, but important to men are issues that are specific to men. And that is prostate cancer. And men need to know to go to the doctor. Once they get into their fifties, sixties for a prostate exam. There are two different types of prostate tests. There’s the PSA blood test, which measures the level of PSA in your blood. And then there is the digital rectal exam, which is the exam where you have to go into the office and a doctor will insert a finger into the rectum to test your prostate, to see if there’s anything abnormal about it. So for that, we recommend that men go… First, they know their family history because that’s important. If a man knows that his father, his brother, his uncle, grandfather had it, then they should go at an earlier age to go get screened.

Ana Tomsic:

We recommend that men go starting at the age of 50 to go get a regular PSA test. African American men, men with exposure to Agent Orange and men with a family history should start even earlier than that around 40 just to make sure that they know what their PSA levels are. In addition to that, testicular cancer is something that men need to be watching out for, from a young age. So young boys from the ages of 15 to 35 can do testicular self exams in the shower to see are there any lumps similar to how women can do self breast exams. Mental health is a big focus for us and what a lot of men have contacted us that they’re interested in because they don’t feel like there is a lot of support for them. Men don’t usually talk about their feelings and their emotions. And so for them, when they hold it in, it can kind of build up. So mental health is also a big concern and things that we want to make sure that men are really focusing on.

Dr. Sal Giorgianni:

If I could add a couple of things to that that may not be so obvious. Breast cancer. It’s true. Men do get breast cancer. It’s very small percentage, but just as it’s prudent to do testicular exams, it’s also important particularly as they get older. And sometimes to take medications that can increase the size of the breast and medications for high blood pressure, for example, or antidepressants and some other hormonal medications, they can increase the tissue receptivity and the breast tissue in a guy. So making sure that you don’t feel anything unusual and lumps in particular. Ask your wife and she’ll tell you how all that is done. The other is vaccinations, particularly now as we’re moving into flu season. And then hopefully the pharmaceutical industry will come up with some effective vaccine. There are still a range of vaccines that are age appropriate for the guys beyond flu.

Dr. Sal Giorgianni:

So herpes, shingles vaccine is very important. Maybe tetanus depending on what you’re doing. So there is a range of vaccines that older guys still need to help maintain wellness. And help fight these ancillary infections and secondary infections that may be around. The other thing I wanted to talk about is GI cancer. If there’s any changes in bowel habits, in stools, be alert to little signs of blood in the stool. You might need a single RSP, just like prostate cancer. You need to know your family history. You need to go in for these things.

Dr. Sal Giorgianni:

It’s not the most pleasant thing, but so getting colorectal cancer can be deadly and that’s a lot less pleasant than having a sigmoidoscopy or colonoscopy. The other is relative to COVID. One of the very unusual symptoms that we see that could alert you to the fact that you have COVID-19 infection, Coronavirus, is loss of taste and loss of smell. There’s a lot in the press about that. Guys can be very sensitive to that as well as women, but be alert to that. And then rash, particularly in the palms of the hands, the bottoms of your feet. It doesn’t occur so often in older persons, but that could be another soft sign and not so obvious sign that you might have COVID-19.

Sue Peschin:

Great information. Thank you both. I wanted to touch on something that I think Dr. Sal you… Actually both of you mentioned at certain points, which are sort of different recommendations for African American men. And wanted to just ask a question about the role of health disparities, of racism, certainly of violence as well, and the impact on men of color. And was wondering if you both could speak to that.

Ana Tomsic:

So when you’re looking at health disparities, we need to see what the environment is around us. So when you have some people who live in rural areas that don’t have access to healthcare, that don’t have a medical facility right in their neighborhood, and they have to drive an hour or more to see a doctor they’re less likely to want to go for a small ailment that they may have. So in the South, and we’ve done a lot of work in the South, they have a high prevalence of diabetes and high cholesterol, heart conditions. And so we try to come in and look at what the environment is like. And before having a program, just to discuss, okay, we want to go to say Memphis and do a program here. What is the neighborhood that we’re looking to do a program in or an event at, what are they really looking for?

Ana Tomsic:

What do they need? How far is the nearest hospital? How far has the nearest clinic? Is it easily accessible? Do people have high insurance rates or do they not have insurance? And so it’s something that definitely affects it because if you’re not comfortable, if you have to think about whether you can afford to take time off work and then pay your copay and pay for a doctor’s visit, pay for the medication, whatever you need as compared to paying for food for your family, that’s going to be, sometimes a fairly easy decision for you. You’ll take the family over your health. And so people put their health on the back burner a little bit because of that, but we do definitely need to focus on giving access to people where there’s a lack of access.

Dr. Sal Giorgianni:

When we look at the impact of COVID on African American men, we see a disproportionate number of men getting the disease and getting sicker from it. And we think also dying from it, at least certainly disproportionate to the representation of African American men in the population. A lot of that is because when you drill down into some of the unfortunate statistics about deaths from chronic conditions, the kinds of things that make COVID much more deadly, African American men have a higher percentage of those conditions. For example, diabetes, which is more prevalent in African American men and Latino men. Hypertension, more prevalent in African American men. Pulmonary conditions, which sometimes speak to poor overall health status. American Public Health Association—Men’s Health Network work very closely with American Public Health Association—long has recognized that there are zip codes in the United States where the overall health status of individuals is significantly lower than in others.

Dr. Sal Giorgianni:

Those tend to be urban areas. And if you look at just my hometown of New York, the Bronx, which has a very high percentage of Latino and African American citizens, the rates of COVID-19 and a range of other predisposing conditions are much higher. We think those go hand in glove. So the message here is for those who work with minority men, men of color, be sensitive to these issues, try and bring them to healthcare. Telehealth is an important vehicle as well, making sure that they have health coverage, either through ACA (Affordable Care Act) or other types of health coverage. You have to look at this population as a population at higher risk for overall mortality, overall death, as well as overall susceptibility to COVID-19.

Sue Peschin:

Great. Thank you for that. Now I’m going to sort of pivot to talking about men and women. And I’ve always wondered, why is it that women live longer than men?

Dr. Sal Giorgianni:

When you go back to the 1920s, the average lifespan of men and women were essentially the same. And slowly over the decades is crept up. I’d love to know Ana’s take on it because my general view is men need to take a page out of a women’s health care playbook, and they need to take personal responsibility for their own health. Women engage in their own health. They’re engaged in primary prevention. They’re much more interested in wellness and that is something that guys, whatever their age, whether they are 20, 40, 60, or 90 have to do. I think there’s another thing that goes on is one of the areas of my specializations are media media and overall attitudes of health and wellness in society. And one of the studies that I had done that published them doing some follow-up work and how many advertisements or messages about health and wellness are directed either graphically in words or images towards boys and men.

Dr. Sal Giorgianni:

Very few. Last time I clocked it it was about 75% of media attention to health issues was focused on girls and women. And that’s unfortunate because it sends a signal early on in a guy’s life, which leads to problems with healthy aging as men get older. So, guys constantly have to fight against their inherent lack of desire to go to healthcare. Their societal view that women are in charge of health and not guys, which is totally wrong. And also the just underlying genetics of healthcare. So it’s a triple threat. At the end of the day guys just are not where they should be from mostly preventable diseases.

Ana Tomsic:

When you’re in a monogamous relationship you know what your partner feels like, what they act like normally. And women play a huge role in men’s health because they can sense that there are differences. Their personality changes suddenly or they notice that on their lower back they have this new cute little mole that was never there before that their partner never saw. So a lot of times men, you can find skin cancer on your partner or women have found testicular cancer in men. Men have found breast lumps in women because they know what their partner’s body is supposed to feel like. And they know their personalities.

Ana Tomsic:

So being around and being able to talk to them, being able to have that conversation with their partner to encourage them to go to the doctor. We always encourage that if a man is too worried to go to the doctor that his partner or any woman in his life actually can help encourage him by asking and making the appointment for him or attending the appointment with him. If he’s not comfortable with having her in the room with him with a doctor and come up with a list of questions to ask the doctor at the appointment and then review it later together.

Ana Tomsic:

So you can see that there has been some kind of accomplishment done or that all the questions have been answered for whatever you may be concerned about. So definitely we want to try to increase the lifespan. So to get men to live as long as women do, not to decrease anything. And we’re not trying to take away from women’s health. A lot of times we get people asking questions like, well working for men’s health, you’re trying to take away from women, but it’s not like that. Men and women are together in so many different ways that they can… We want men and women to live long healthy lives together. We want it to be known that it’s more than just reproductive health. There are so much to it that men and women need each other in order to have a healthy family.

Ana Tomsic:

So one of our models is building healthy families one man at a time because women are predisposed to go to the doctor from young age, from going to a pediatrician, we automatically get put into our OB GYN and our general practitioner. And then every year or every two, three years women go and get their annual pap smears. They go and get mammograms. They get to childbirth in years and then they go to the doctor for that. And then women are sent to the pediatrician again, because they take their kids to the pediatrician. For men, once they’re done with the pediatrician, they have their general practitioner, but no one’s really reaching out to say, Hey, it’s time for this exam because there’s nothing really that they need to be going for. And then they get their phone call, Hey, you’re about 40, 50 years old, time for prostate exam. It’s time for your colonoscopy SPFT. It’s time for this and that.

Ana Tomsic:

And then guys are kind of like, what’s going on. I mean, I haven’t gone to the doctor before, so what am I supposed to do? And that’s where the woman can play a role to say, well, this is how you can handle this. So it is unfortunate that the healthcare system doesn’t really tailor to men as they do to women, but there’s ways to change that. And as Dr. Sal had mentioned earlier with telemedicine, if you don’t have a time to go to the actual doctor for an appointment, this is great opportunity to be able to do that. Take a visit from telemedicine and see your doctor and talk to them from the privacy of your own office, your own home, your car, wherever you feel comfortable doing it, where you have time.

Sue Peschin:

That’s great. This is so great. Selfishly, I have two teenage boys, so I really appreciate all this information for my husband and my dad and brother and all that. So this is incredibly useful. And I was thinking as you are going through some of the scripting for what women can do to support the men in their lives, just about the messages that I think a lot of men get, particularly if they’re in sports, the whole like shake it off. And there is a certain, I think, kind of vulnerability to going to the doctor, to looking into things, to the idea of kind of self care might be self-indulgent type of thing, and needing to kind of change that narrative to a position of strength really that taking care of yourself is something to do to keep yourself strong.

Dr. Sal Giorgianni:

Yeah, stigma for health conditions is a very large impediment for boys and men. Even in a workplace there are folks who deal with workplace health conditions. We’ll know that men are very reluctant to talk about diabetes or hypertension, things that are extremely important, as a maybe a sign of weakness. Men are very reluctant to talk about their emotional well-being. There are terrible consequences with the rates of suicide in men in America, particularly older men, is significantly up to seven or eight times as high as it is in women. It’s a national tragedy. Stigma plays a huge role and I think you’re right, that this is inculcated in the guys from very early on in age. And that’s why I think when parents and grandparents… grandads can be very important role models for their grandchildren and grandsons, granddaughters.

Dr. Sal Giorgianni:

So if one of the reasons that I think motivates individuals when they’re parents is you can do it for the kids, but let’s say, these days in particular in many communities, granddads are extremely important role model for the grandsons and granddaughters. So I think, you have to get beyond the fact that having a physical ailment, it makes you less of a guy.

Sue Peschin:

Great, I love it. So I want to actually pivot to something Dr. Sal, that you referenced, which is healthy aging and grandparents, and all of that. What steps should men be taking to pursue healthy aging?

Dr. Sal Giorgianni:

As we age, we tend to think that aches and pains come with aging, and that’s not necessarily true. The aches and pains that we perceive when we get a little older, that I perceive, I have a bad knee, a bad back, and a bad attitude, we tend to say, well, that’s just what happens when I get older, but it’s not the case. It’s just not the case. When you look at men who are very active in your seventies, eighties and nineties, they have changed their lifestyles, healthier dieting, a little bit of exercise, managing their underlying health conditions.

Dr. Sal Giorgianni:

The other is get an annual wellness visit. You’re entitled to it. So like bringing your car in for an annual checkup on all the internal parts, make sure you do that. Find a good physician, nurse practitioner, PA that understands how to treat men, that you can communicate with. If you find yourself in a position where you’re not having a good range of communications with your healthcare provider, which is a significant issue for a lot of the guys, find another one. Ask your friends who they go to, but don’t put it all off because you just don’t have that much time to get it right anymore. Healthy aging starts in your fifties and you need to take a good assessment of where you stand and not accept the fact that these aches and pains are part of a good aging process.

Sue Peschin:

Great. I’m just sort of wondering when you were both kids, what did you imagine growing older would be like?

Ana Tomsic:

I thought that it would be a lot more fun and less work. I mean, I saw my grandparents… My grandparents were alive until I was in my college years. And so, growing old, I thought that it was fun to grow old. I thought, yeah, we have to work. But, I was in school all day, so I didn’t see what my parents were doing. So I thought that it was more fun to be an adult and not have to study. I knew that people die eventually, but everybody lives to be about 90 years old or 100 years old. So I had that high expectation of things and we didn’t really have a lot of illness in my family when I was growing up. So I didn’t really think about that. We tried to eat healthy and get exercise in. So I thought that growing old would be fun.

Dr. Sal Giorgianni:

I had absolutely no clue. I was still not quite sure what aging looks like in my nineties. Oh boy. I will say though, that we really have an expectation. My expectation was the ability to be with my wife and then travel. See my kids and grandkids growing up.. Opposite to Ana’s experiences, my grandparents on my mother’s side all died very young for various conditions. My grandfather lived to be almost 99, but my grandmother on my father’s side died very young. So I had it in my head that, well, you die. You grow old and you die. But that is not the proper perspective. And I think that’s one of the reasons a lot of guys don’t see health and wellness and increased and enhanced longevity and wellness as a goal for them.

Sue Peschin:

That’s great. So I will ask both of you, what do you enjoy most about growing older now?

Ana Tomsic:

I just had a baby in January. And so now growing old, there’s just this excitement for me in watching him grow and progress and just all these new things. He just started teething. And so it’s thinking like in the future, will he need braces and what kind of smile he has. That is right now my excitement. Before my son was born, my husband and I got married and we traveled to many different places. And the idea of sharing that with my son now and our future children that really excites me to know that medical technology has advanced. So if something were to come up, if one of us were to get sick, we’re able to go to the doctor, we’re able to take care of ourselves and enjoy life and teach him that it’s important to be healthy. And in order to be able to do all these things, you have to be healthy. So that’s how it’s changed now.

Sue Peschin:

Ana and Dr. Sal, thank you so much for being on our show today. It’s been wonderful talking to both of you.

Dr. Sal Giorgianni:

Thank you for having us and the great work that you all do as well.

Sue Peschin:

Thank you.

Ana Tomsic:

Thank you very much.

Sue Peschin:

That’s all for this week’s episode. Visit www.agingresearch.org to learn more about age related conditions, diseases, and issues that impact the health of older Americans. And I’d like to close off today’s episode with an inspirational quote from Michael Jordan. One of the most influential guy athletes around, and this is one of my favorite quotes, because it’s really about not always winning and how much you learn from failure. He said, “I’ve missed than 9,000 shots in my career. I’ve lost almost 300 games. 26 times I’ve been trusted to take the game winning shot and missed. I failed over and over and over again in my life. And that’s why I succeed.” So we learn more from things that happen to us, our vulnerabilities than being strong all the time, being successful all the time. Take care of yourselves, take care of each other. Thank you all so much and have a great day.