It begins in childhood. When a girl falls off her bicycle and hurts herself, she's attended to. Her cuts are cleaned and bandaged and her tears get wiped away. But for boys, it is usually a different story.

As Jean Bonhomme, MD, MPH, put it: When a boy is 8 years old and he skins his knee, he is told, "boys don't cry." When he's 15 years old and gets hurt playing football, he is told to "take one for the team." Then, when he's 50 years old and having chest pains, he generally ignores it, saying "it's just indigestion."

"Men are going into middle age with the lessons they learned in childhood, and I think that is a large part of what is causing the men's health crisis," Bonhomme added. The key characteristic of the health crisis is men delaying trips to their family doctor.

According to the Agency for Healthcare Research and Quality, seven of every 10 Americans who have not visited a doctor in the past five years are men. That results in only a small number of men getting screened and tested for diseases like cancer and heart disease that, if caught early, might not take such a disastrous toll.

With such an alarming number of men neglecting their annual physicals, there are several contributing factors. First of all, men, particularly African-Americans and Latinos, are less likely than women to have health insurance and to not have a regular physician.

Second, the male ego comes into play. "A lot of men see health problems as a personal failure or defeat," Bonhomme said. "We teach men to be very self-reliant. Sometimes men will recognize there is a problem with their health, but they'll try to solve it themselves and this can have disastrous results."

Despite his own work promoting men's health, Bonhomme, senior faculty at Emory University in Atlanta can personally understand why some men do not schedule appointments to get physicals: the hours such health care is available are high on the list.

"I find myself postponing health care just because I am trying to get my job done," he said. "For most people, if they want to see the doctor, they're going to have to take time from work."

Reproductive Health Needs

While women also have to rearrange their schedules to see the doctor, they have unique reasons for taking part in regular health care screenings, like yearly gynecological exams, for example. When they are seeing their specialists, women have an opportunity to report any general health concerns, Bonhomme said. "For instance, obstetricians and gynecologists may take the woman's blood pressure and pick up hypertension; or they may discover a yeast infection that isn't going away, so they'll run tests for diabetes or HIV."

For years, women have been having reproductive cancer screenings and mammograms, but there is a dearth of men doing the same for prostate and testicular cancers. And recent reports suggest men should make their reproductive health a priority.

Alarming statistics show that about one in six men in the United States will get prostate cancer, Bonhomme said. Even more alarming, he said, is the lack of knowledge the public has about cancer of the prostate, the gland surrounding a man's urethra that secretes a fluid that makes up semen. At some men's health screenings, women asked Bonhomme for prostate cancer testing.

"Some people do not even know which gender the prostate gland belongs to," he said, emphasizing there is a need for general health education as well as specific men's health education.

"For a while, the concept was that we were doing a lot of medical experimentation on men and ignoring women," he said. "Now we're starting to realize that men have reproductive health needs that need to be addressed as well."

Lending a Hand

Since men live on average five to six years less than women and African-American men have a life expectancy eight years short of their female counterparts, education about preventive health care is crucial, said Will Courtenay, PhD, LCSW, lecturer at McLean Hospital at Harvard Medical School and founder of Men's Health Consulting in Berkely, Calif.

"Studies have proven that physicians who ask, educate and counsel their patients about their health are a lot more successful at improving those patients' health, than are physicians who only do tests and examinations with patients," he told ADVANCE.

Another part of problem lies in the fact that men actually believe that they're less susceptible to disease and injury than women are, Courtenay said. "And he's not going to be ready to see a doctor or change unhealthy habits until he learns about his health and can honestly admit he's really at risk."

Men's Health Courses

Education about men's health is needed outside of the examination rooms. Some universities and colleges are beginning to introduce men's health in their curriculums, said Robert Tan, MD, a board member for Men's Health Network and associate professor of medicine at Baylor College of Medicine and associate professor of family medicine at the University of Texas at Houston.

"There needs to be more education on the whole and more research on gender-based issues," Tan said. "There are some differences in how men and women handle diseases, especially some cancers. Right now we're pretty generic when it comes to treatment, and I think with more research we'll develop gender-based treatments for some illnesses."

One area that Tan is studying where differences have been shown is the effects of testosterone on depression. "We found that men who are depressed may have low levels of the hormone. The correct treatment to handle this may be, besides the anti-depressants, that we prescribe androgen treatments, like testosterone, as well."

Tan, the author of the book, The Andropause Mystery, said low levels of testosterone are affecting anywhere from 5 to 10 million men, most of whom do not recognize they have a problem. Osteoporosis, impotence, weakness, memory loss, and depression all are symptoms of andropause and those symptoms perhaps might be reversed with testosterone supplements, he said.

Family Ties

To further open men's eyes to their health, the Men's Health Network is celebrating its 12th annual Men's Health Week from June 14-20. For the past six years, Men's Health Week events on Capitol Hill have included free screenings for prostate cancer, blood pressure, cholesterol, diabetes and body fat index measurements. In communities where no screenings are offered, men are encouraged to visit their doctors for an annual physical. If the men are unwilling to schedule such visits, family members are given free reign to nag and encourage them until they do.

Forcefulness is justified, because men's health has encompassing effects on wives and children, Bonhomme said. For example, a woman has a 40 percent chance of falling into poverty when her husband dies, and she is twice as likely to die within the months immediately following the death of her husband.

Men's lack of health attention also has some major societal impacts. "In the African-American community, it is believed that one in 50 men is HIV positive, but one in every 160 African-American women has the virus. HIV could not have attained such alarming prevalence in black women if it had not first become widespread among black men."

Marketing to Men

Although family members can be effective when it comes to persuading men to see a physician, so too can be advertisements, especially ads for conditions like erectile dysfunction medications, according to Bonhomme.

"One of the good things about the new class of drugs like Viagra, Levitra and Cialis is that men will come with a complaint of difficulty having sex, giving the doctor the opportunity to check that man for underlying conditions," he said.

In a lot of cases, Bonhomme explained, sexual problems may be one of the first signs that something is going wrong with a man's body. Taking a careful look at cases of men who have had strokes and heart attacks, physicians are finding they may have had erectile dysfunction in the years preceding those events.

Medications that target improved sexual performance tend to pique men's interest in other elements of their own well-being, Bonhomme said.

"Health care needs to be presented to men as a way to help them maintain and achieve their maximum attainment and to regain some of the things they have lost. When presented in that light, health care becomes more attractive to men."

You can reach Stacey Miller at smiller@merion.com.