Reality check for men's health

Most people's grandmothers outlive their grandfathers, and 85 percent of centenarians are women. Behavior patterns contribute. Eighty percent of Americans who have a serious drug addiction are men; more than 80 percent of drunk drivers are men; during young adulthood, the peak age for homicide, suicide and accidental death, three men die for every woman.

However, Daniel Kruger, a research fellow at the University of Michigan who has done extensive studies on mortality rates, notes that behavior isn't the only factor in men's shorter life span; there are contributing genetic and physiologic differences.

Just as in many other species, he says, human "males are built for competition and females for longevity." Physiologically, the male hormone testosterone builds muscle mass, while the female hormone estrogen boosts the immune system and increases the level of HDL, the "good" cholesterol.

Tom Perls, founder of the New England Centenarian Study at Boston University, estimates that about 30 percent of the male-female disparity in longevity is due to biological differences, and 70 percent to social and cultural factors.

Primary to those particular factors is that women are known to tune in more to their health care. Women visit the doctor more often than men, and nearly twice as often for preventive care, according to a 2001 study by the Centers for Disease Control and Prevention.

The government's Agency for Healthcare Research and Quality is trying to get men more interested in their health. An ad campaign ( www.ahrq.gov/realmen) promotes the idea of getting regular checkups.

But if you're already geared up and just need a little extra help, read on for an age-by-age breakdown on what men should do at various ages to maintain their health.
What to do in your ...

20s:

Arrange for a complete physical every five years, which should include:

• Cholesterol profile

• Blood pressure check

• Testicular cancer screening (Young men should also perform monthly self-exams.)

• Waist measurement and height and weight measurements to calculate your body mass index, or BMI

• Complete blood count, a blood-sugar test and urinalysis

• Adult-type tetanus-pertussis-diphtheria booster (and follow up every 10 years)

• Dental visit every six to 12 months

30s:

Sign up for complete physicals, which should repeat the tests conducted in your 20s, but every three years instead of every five. At 35 you can stop testicular exams.

40s:

Get a complete physical every two years.

Also:

• Schedule a baseline EKG at 40 and repeat it periodically.

• Take a fasting blood sugar test at 45, then every three years.

• Start skin cancer screening, with additional exams by a dermatologist for men at high risk.

50s:

It's time to make your complete physical an annual event. Your regular health-care schedule should from now on include these four important additions:

• Colon cancer screening, which should take one of four approaches: Annual fecal occult blood testing (FOBT) with colonoscopy if a positive test; FOBT plus sigmoidoscopy every five years; colonoscopy every 10 years; double-contrast barium enema every five to 10 years.

• Prostate cancer screening. The physician should discuss the pros and cons of annual PSA blood tests and digital rectal exams.

• Eye exams by a specialist

• Annual flu shot

60s:

In addition to maintaining the pattern established in your 50s, ask your doctor about a shingles shot. Also, get the pneumonia vaccine. At 65, men who have ever smoked should get an abdominal aortic ultrasound.

70s and beyond:

From here on out, you can keep doing what you've been doing. After all, you've made it this far.

Better still, when you hit age 75, you can delete prostate cancer screening from your checklist.

And if some of this sounds a little familiar, it's probably because you've heard it before. One of the challenges of primary care, according to Harvey B. Simon, who compiled this information, is persuading men to get regular physicals. Simon should know. He is an associate professor of medicine at Harvard Medical School and the editor of Harvard Men's Health Watch.

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