Men face specific health challenges that differ in prevalence, presentation, and outcomes compared to women. This guide covers cardiovascular disease (the leading cause of death in men), androgenetic alopecia, gynecomastia, inguinal hernias, and testicular cancer.
Cardiovascular Disease in Men
Cardiovascular disease is the leading cause of death in men, accounting for 25% of all male deaths. The lifetime risk after age 40 is 1 in 2. Men present with heart disease 7-10 years earlier than women. The average age of first heart attack is 65.
Risk Factors
Hypertension (blood pressure over 130/80) affects 50% of men over 45 and doubles the risk of heart disease. Hyperlipidemia (LDL over 130) affects 35% of men. Diabetes affects 12% of men (20% after age 60) and increases cardiovascular risk 2-4 fold. Smoking persists in 14% of men. Obesity (BMI over 30) affects 35% of men. Low testosterone is an emerging risk factor.
Heart Attack Symptoms in Men
The classic symptom is chest pain or pressure (reported in 80% of men), often radiating to the left arm, jaw, or back. Associated symptoms include shortness of breath, diaphoresis (sweating), nausea, and vomiting. Atypical symptoms such as indigestion or heartburn are less common in men than in women but do occur.
Prevention
The ASCVD risk calculator (Pooled Cohort Equations) estimates 10-year risk for men aged 40-75 and guides statin decisions. Blood pressure should be screened every 1-2 years. A lipid panel is obtained every 4-6 years starting at age 20, or earlier if risk factors are present. Aspirin for primary prevention is considered for men aged 40-59 with a 10-year risk over 10% and no bleeding risk (USPSTF 2022: C recommendation). Statins are recommended for men aged 40-75 with a 10-year risk over 7.5-10% and at least one risk factor. Lifestyle prevention is powerful: a Mediterranean diet reduces cardiovascular events by 30% (PREDIMED trial), exercise of 150 minutes per week of moderate activity reduces cardiovascular mortality by 25%, and smoking cessation reduces risk to near that of a non-smoker after 15 years.
Male Pattern Baldness
Androgenetic alopecia affects most men to some degree by age 50. It is driven by genetics and dihydrotestosterone (DHT). The androgen receptor gene (AR) on the X chromosome is a major contributor, but multiple other genes (HDAC9, EDA2R, WNT10A) are involved.
The Norwood-Hamilton scale classifies progression from stage I (minimal recession) through stage VII (only a horseshoe-shaped fringe remaining). DHT binds to androgen receptors on dermal papilla cells in the frontal and vertex scalp, miniaturizing hair follicles. Occipital follicles are usually resistant.
Treatment
Minoxidil (Rogaine) 5% foam or 2% solution is available over the counter. It prolongs the anagen (growth) phase and produces moderate regrowth or slowed loss in 40-60% of users. It is applied once daily (5% foam) or twice daily (2% solution). Results take 4-12 months. Scalp irritation and unwanted facial hair are potential side effects.
Finasteride (Propecia) 1 mg daily is a prescription 5-alpha-reductase type II inhibitor that reduces DHT by 60-70%. It maintains or improves hair density in 60-80% of men. Results take 6-12 months. Side effects include decreased libido (2-5%), ED (1-3%), and decreased ejaculate volume. A small number of men report persistent sexual side effects after stopping the medication. Dutasteride (Avodart) 0.5 mg inhibits both type I and II 5-alpha-reductase, reducing DHT by over 90%, but is used off-label for hair loss.
Low-level laser therapy and platelet-rich plasma provide mild to moderate improvement. Hair transplant (FUT or FUE) is the definitive treatment, transferring DHT-resistant follicles from the occipital scalp to bald areas.
Gynecomastia
Gynecomastia is benign proliferation of male breast glandular tissue (firm, subareolar mass over 0.5 cm diameter). It affects 30-60% of adolescent boys (peak age 14-15) and 50-70% of older men (peak age 50-70). It is distinguished from pseudogynecomastia (adipose tissue only, soft, no discrete mass) by palpation.
Causes
Physiologic gynecomastia is most common: neonatal (maternal estrogens), pubertal (transient testosterone/estradiol imbalance), and aging (increased aromatase activity). Pharmacologic causes include spironolactone, H2 blockers (cimetidine), antiandrogens (bicalutamide, flutamide), finasteride, GnRH agonists, anabolic steroids, alcohol, marijuana, opioids, calcium channel blockers, amiodarone, HAART, and tricyclic antidepressants. Pathologic causes include primary hypogonadism, hyperprolactinemia, hyperthyroidism, liver disease (cirrhosis), kidney disease (dialysis), testicular tumors, adrenal tumors, and obesity.
Evaluation
History should focus on onset, progression, medications, drugs, and symptoms of hypogonadism or testicular pain. Physical examination should distinguish glandular from fatty tissue, assess size and tenderness, and include testicular, thyroid, and liver examination. Laboratory testing includes testosterone, LH, FSH, hCG, estradiol, prolactin, TSH, LFTs, and creatinine. Mammography and biopsy are reserved for suspicious features: unilateral, eccentric, hard, fixed mass, skin changes, or bloody nipple discharge (which may indicate male breast cancer).
Treatment
Mild, recent-onset gynecomastia (under 2 cm, less than 6 months) is managed with reassurance and addressing the underlying cause — removing the offending medication or treating the underlying condition. Moderate gynecomastia (over 3 cm, tender, persistent beyond 6-12 months) may be treated with tamoxifen 20 mg daily or raloxifene 60 mg daily if within 6-12 months of onset. Severe or chronic gynecomastia (over 12 months, fibrotic) requires surgical reduction (subcutaneous mastectomy with liposuction) — fibrosis makes medical therapy ineffective.
Hernias
Inguinal hernias are the most common hernia type in men, with a lifetime risk of 27%. An indirect inguinal hernia passes through the internal inguinal ring into the inguinal canal (may extend into the scrotum). A direct inguinal hernia passes through Hesselbach triangle (medial to the inferior epigastric vessels) and is more common in older men. Femoral hernias pass through the femoral canal below the inguinal ligament and are less common in men. Other hernias include umbilical, incisional (10-20% after abdominal surgery), and hiatal.
Risk factors include increased intra-abdominal pressure (heavy lifting, chronic cough, constipation, obesity, BPH/straining) and smoking (impaired connective tissue). Presentation is a bulge or lump in the groin that may or may not be reducible, with a dull ache or heavy sensation that worsens with standing or straining.
Complications
Incarceration occurs when hernia contents cannot be reduced — this causes pain and nausea and is urgent. Strangulation occurs when the blood supply to incarcerated contents is compromised, causing severe pain, vomiting, and peritonitis — this is a surgical emergency requiring immediate intervention.
Repair
The Lichtenstein tension-free open repair using polypropylene mesh is the gold standard with a 1-3% recurrence rate. It can be performed under local anesthesia. Laparoscopic repair (TEP or TAPP) offers faster recovery and less postoperative pain but requires general anesthesia and has a steeper learning curve. Robotic TAPP provides enhanced dexterity at higher cost. Watchful waiting is appropriate for asymptomatic or minimally symptomatic hernias, especially in men with comorbidities — the risk of incarceration is approximately 1-2% per year.
Testicular Cancer
Testicular cancer is the most common cancer in men aged 15-35, with a lifetime risk of 1 in 250. The cure rate exceeds 95% across all stages combined. The median age at diagnosis is 33. Incidence is 6 per 100,000 and increasing.
Risk factors include cryptorchidism (2-8 fold increase, even after orchiopexy), family history (4-10 fold), personal history (25-fold risk of contralateral testicular cancer), Klinefelter syndrome, testicular atrophy, and infertility.
Histology
Germ cell tumors account for 95% of testicular cancers. Seminoma (45-55%) peaks at age 30-45 and may elevate hCG. Non-seminomatous germ cell tumors (45-55%) include embryonal carcinoma, yolk sac tumor, choriocarcinoma, teratoma, and mixed types — they peak at age 20-35 and may elevate AFP, hCG, or LDH.
Diagnosis and Staging
Testicular ultrasound distinguishes an intratesticular mass (likely cancer) from an extratesticular mass (likely benign). Serum tumor markers (AFP, hCG, LDH) are measured at baseline for diagnosis and monitoring. CT of the chest, abdomen, and pelvis stages the disease. Radical inguinal orchiectomy is both the definitive diagnosis and the first step in treatment — trans-scrotal biopsy or orchiectomy is contraindicated (alters lymphatic drainage patterns).
Treatment
Stage I seminoma is treated with orchiectomy plus surveillance (preferred), single-dose carboplatin, or radiation. Stage I non-seminoma is treated with orchiectomy plus surveillance (preferred), RPLND, or chemotherapy. Stage IS (persistent marker elevation) requires chemotherapy: BEP (bleomycin, etoposide, cisplatin) for 3 cycles or EP for 4 cycles. Stage II and III disease requires chemotherapy (BEP or EP) with post-chemotherapy RPLND for residual masses.
Follow-up and Fertility
Follow-up is intensive: years 1-2 every 2-3 months, year 3 every 3-4 months, years 4-5 every 6 months, then annually. Assessments include physical exam, tumor markers, and CT scans. Late effects of treatment include secondary malignancy, cardiovascular disease, neuropathy, nephrotoxicity, hypogonadism, and infertility. All men with testicular cancer should be offered sperm banking before treatment.
Summary
The leading health concerns for men include: cardiovascular disease (the number one killer, largely preventable through lifestyle and risk factor management), male pattern baldness (treatable with minoxidil and finasteride), gynecomastia (requires distinguishing from male breast cancer), inguinal hernia (common, repaired electively with low recurrence), and testicular cancer (highly curable, detected early through monthly self-examination). Regular preventive care and awareness of these conditions improve outcomes.