Thursday, November 4, 2010

Movember: November Moustache Growth for Men's Health

November is a month dedicated in the past few years to men's health, marked by a campaign to raise awareness and money for diseases affecting men disproportionally involving men growing a moustache or "mo", hence "Movember". While there are formal competitions and sponsorship activities, other men are simply growing their moustache to draw attention to the month, and still others like sports figures, politicians, and other public figures are doing some combination.

Men's Physical and Mental Health

Different aspects of men's health are highlighted in different participating countries, and the Australian originators have moved to a focus on prostate cancer. Still, some highlight male depression, or men's health more globally. The BBC recently focused on a broader perspective on men's health, which I think is at the core: men's self care, and men's seeking professional care, or rather the failure of men to do both these things.

Men take less care about diet, exercise, alcohol and tobacco use than women do. They also suffer disproportionately from cardiac illness and stroke, partly due to biological factors (estrogen is protective in these illnesses) and partly due to these preventable factors. In fact men are more likely to die from the leading illnesses and have a lower life span than women in most countries.

Men are less likely to get regular checkups, are more likely to delay seeking assessment and treatment for illness, and even for injury, and more likely to engage in high risk occupations, and high risk recreational activities. Young men, who have less impulse control and less appreciation of long term consequences resulting in poorer risk assessment and judgment then either young women or older men, are most likely to suffer injury or death in a violent manner (car accidents, sporting accidents, gun accidents).

Depression in men is an important topic because it is under-diagnosed and under-treated. Although depression is less common in men than women for biological reasons, it is also more likely to be hidden, masked as irritability, anger, violence, or silence, and self-medicated with drugs and alcohol. Where men are seen to be depressed by concerned family members, they are more likely to deny it, and less likely to seek treatment. I have seen many women who are depressed as a result of living with a depressed husband who will not seek help. Sometimes the women aren't clinically depressed-yet-but looking for guidance about their husband's obvious dysphoria.

Where there is suicidal ideation, men are more likely to complete a suicide (though make fewer attempts), and to use more violent (and effective) means, like guns, knives, jumping from high buildings, carbon monoxide poisoning, or vehicular "accidents", than the more common, and usually less harmful, drug overdose. Men in middle age, especially if they have suffered a major financial reversal, and are isolated from family are more likely to be seriously suicidal. Heavy drug and alcohol use increase suicide risk.

Part of these health risks do seem related to biology, some to hard-wiring of "maleness" (male brains are distinct from female ones and that in itself predisposes to certain attitudes and behaviours). and some to seemingly universal cultural expectations that men will be more independant, more stoic, and "tougher" than women, and that there is less encouragement and less acceptance for men to express self-doubt, insecurities, emotional responses, and the need for support and help.

Cross-cultural dimensions of men's health

Men are under considerable stress in both traditional and transitioning societies. Men are still the main providers for families, whether they are living in less traditional societies or not, though more so in traditional ones, and particularly where women either are not allowed to work outside the home, or earn much less than men. This need and desire to provide for dependants, along with a strong identification by career role is what makes middle-aged men particularly vulnerable to career, financial, and to family setbacks connected to finances or to personal or family growth and strains.

Men who are feminists, or trying to be, or those who are making their way in less traditional paradigms face uncertainty about expression of their male identity, about what is acceptable to and desired by their significant female others--who may or may not know what they want, and may also struggle with how to deal with new roles--as well as other female family members, colleagues, and friends.

Involvement in bicultural settings, whether familial or societal or both, can be an extra challenge in this regard. Although my husband moves easily among cultures, and has done since early in life, I recognized that he does feel more of a strain at times than he lets on, once when we were recently arrived for a visit in Morocco. We were having breakfast with family, and another male family member asked a question. I don't remember what it was now, but my husband looked at me and the family member, and said, "I have to be careful how I answer that, I am operating in 2 systems here". I didn't much care what the answer was, but he was worried about it.

We have both experienced that, because of our respective primary cultural identities (or the one that others assume it to be), we are presumed to think or behave in a specific way by some acquaintances or even friends and family members. As an Arab Muslim my husband is always one step away from an accusation of oppressor of women; and as a Westerner and a professional I am always one step away from "battle axe" (to put it nicely)--not to mention the Arab satyr/ white slut paradigm. This is, of course, independent of our beliefs or behaviours.

More on Movember 

Movember as a celebration, or moustache statement, began in Adelaide, Australia in 1999, and the Movember Foundation was organized there in 2004. It has spread since to a number of other countries, including New Zealand, Canada, the US, the UK, Ireland, and Spain. Websites are country specific, though the content overlaps to some extent,with variation on local campaigns, and the disease specific concern.

The formal moustache contests and sponsorships require registration and following rules, including starting on November 1 from a clean shave. However, I have found that celebrity ad campaigns, the moustache growing, or even the name "Movember" are  great conversation starters on men's health, and thus improve awareness generally. Hopefully that encourages men to take better care of their health, get a check up, or encourages all to contribute to funding men's health initiatives and research.

Men's health magazines are one way that knowledge is being shared and that men have encouragement and information about improving their health. Generally fitness and athletic clubs serve this function well and in an acceptable manner. There are also men's groups for a variety of psychosocial problems including unemployment, illness, divorce, widowhood, aging, depression, substance abuse, etc. Men's health is becoming more the subject of specialized studies within medicine, and professional medical journals on men's health are becoming more common.

Prostate Cancer

Age-standardised death rates from Prostate cancer by country (per 100,000 inhabitants); 
lightest yellow, less than 4, darkest red, greater than 44.

An official focus on prostate cancer and depression in men is good to increase awareness about 2 particularly taboo topics. Most countries seem to have adopted the cause of raising money for prostate cancer research as it is the "male cancer" which is responsible for the most deaths worldwide (though more men die of lung cancer). Prostate cancer is the most common cancer diagnosed in men, with lung cancer in second place; yet in terms of mortality the positions are reversed.

We, as a research team are trying to effectively be part of this balance. We will try to focus on the prostate as an important male organ -of sexual and urinary functions-and the diseases that affect the prostate gland are widely suffered by patients in the Arab and Islamic worlds and are of special importance to these men. We will attempt to utilize the latest advents in medical knowledge and technology that rapidly progressed in late years and make them within our hands reach. Another effort that will be generously spent is to stimulate our researchers to bring out their medical and research skills which will be a strong positive service to the people living in our community.

Studies conducted by researchers in Saudi Arabia consistently show lower rates of prostate cancer, throughout all regions, than in the West, including when correcting for lower screening protocols. A very good, though medical overview, of all aspects of prostate cancer in Saudi Arabia was published by Dr Hisham A. Mosli of KAU,  in the Saudi Medical Journal in 2002.

The prostate is a testosterone dependent gland of the male reproductive system which is roughly doughnut shaped, about the size of a walnut to a kiwifruit, and surrounds the urethra as it enters the bladder. The prostate is comprised of ductal glands which produce some of the 2 types of fluid which along with sperm comprise semen, and smooth muscle tissue which helps propel the semen during ejaculation. Common problems with the prostate are primarily a function of age (benign prostatic hypertrophy, ie non-cancerous enlargement) or inflammation (prostatitis). Less common is prostatitis due to bacterial infection.

Prostate cancer is primarily a cancer of elderly men, in developed countries (where life expectancies are longer, and where lifestyle factors are more carcinogenic). As it is a common cause of death in elderly men, screening for early detection is recommended in older men, and in those with a family history. Screening is by digital rectal examination (DRE) as part of a general physical examination and a blood test for Prostate Specific Antigen (PSA). The effectiveness of general screening (as opposed to screening in men with a strong family history of father and/or brothers affected, or genetic vulnerability, eg BRCA1 and BRCA2 genes) is questionable, as it tends to find anomalies that would not progress to serious cancer during the man's natural life span, and does not affect mortality rates in the general male population. PSA is good for tracking the presence and advancement of a cancer. Imaging techniques are followup tools to screening, and biopsy is necessary for a definitive diagnosis.

Non-genetic risk factors and preventive factors are the subject of ongoing research with often conflicting results. Generally it seems as if analgesics in low daily doses, eg aspirin, ibuprofen, etc, and a diet high in cruciferous vegetables (broccoli, cauliflower) and green tea, low in red meat and animal fat, and which prevents obesity are helpful. General fitness, exercise, and overall good health are important.

Symptoms of prostate cancer may be those of prostatic enlargement or inflammation, causing difficulties locally with urination (burning, frequency, nocturnal urgency, difficulty starting and stopping, blood in urine), ejaculation (pain), impotence, bladder distention, and rectal irritation. Prostate cancer that is more advanced and spread to bone, will cause bone pain in the affected areas (pelvis, ribs, spine, thigh).

As with other cancers, prognosis and treatment depend on the exact type of cancer and how aggressive it is, how far it has spread and to what extent, and the person's underlying health, along with access to diagnosis and care. Treatment includes surgery, radiation, hormone therapy, and chemotherapy based on the individual case, with surgery often being curative.

Some famous moustaches

Had you heard of Movember?
What is your impression of this campaign?
Are you growing a moustache or supporting someone who is?
What aspects of men's health do you consider the most important?
Your other thoughts, comments, impressions, experiences?

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