If there were a medical specialist whose practice focused on the health problems specific to men, would you choose him as your doctor as opposed to, say, an internist? If you’re like most men, probably not.

THAT’S BECAUSE you’re more likely to maneuver outside the health-care system entirely, and if you do go to a doctor it will probably be one chosen by your mother, wife or girlfriend. Interestingly, it’s the stubborn attitude that underlies such thinking that a specialty in men’s health would seek to reform.

“One issue that we’re fighting is that the genders are taught to deal with pain very differently from early childhood,” says Dr. Jean Bonhomme, a public-health specialist in Atlanta and advisor to the Men’s Health Network. “If a boy is taught at the age of 8 that he shouldn’t cry when he skins his knee, how will he respond when he’s having chest pains at 50? Men’s reluctance to ask for help clearly interferes with their ability seek health care. So a specialty in men’s health could be tailored to find ways to communicate with men to get around these cultural barriers.”

SPECIALTY IN ‘ANDROLOGY’

Bonhomme is one of a growing number of advocates of a men’s health specialty that he suggests calling “andrology.” Such a practice, he believes, would have immediate consequences for men’s well-being. “One of the things that keeps women attached to the health-care system is that they have their own health-care specialty,” he says. “Many cases of diabetes, high blood pressure and other diseases have undoubtedly been picked up during a gynecological visit.”

A routine visit to an “andrologist” would also benefit men by detecting diseases early, he says. The specialty would screen for X-chromosome-linked diseases as well as other conditions, such as hemophilia and color-blindness, that are found almost exclusively in men. If men were cycling more regularly through the health-care system, doctors would also be able to identify more psychological problems, such as depression. And, in the same manner that specialists in women’s health have been able to document cases of domestic violence, a men’s health specialist could pick up health-impacting social problems in men.

PREVENTIVE CARE

The most important benefits of a male specialty would be preventive, according to Dr. David Gremillion, a specialist in infectious diseases at the University of North Carolina School of Medicine. “The current system of health care is not well-suited to making men feel comfortable enough to step forward and do health maintenance,” he says. “It’s well-suited to handling men who have a workplace injury or caring for them once they’ve had a big heart attack. But it’s not focused on preventive care.”

Gremillion thinks a men’s health specialty is fine, but that more focused care for men needs to be incorporated into the routine clinical practice of primary care. “That way, when a man goes to a doctor because of injury or in need of a Viagra pill the doctor can initiate that process as the opportunity arises.”

That “process” involves getting men to submit to routine physicals and regular screening for male cancers, particularly prostate cancer. Long before that, says Gremillion, men should have their risk factors compiled for stroke, hypertension, diabetes and heart disease, and get advice on how to reduce them. “Such information includes doing family histories and establishing baseline profiles of a variety of physiological measurements,” he says. “And it should begin at an age when a man is feeling invincible — in his late 20s or early 30s.”    

Gremillion believes that the impetus for a men’s-health specialty must come from academics, clinicians and doctors. “We need a functional core of motivated, well-funded investigators who can help move knowledge forward,” he says. “If all questions about men’s health are diffused into the general practice setting, the information will never come together that allows a generation of new knowledge. For instance, the issue of men taking hormones in late life is totally unexplored and unless we have a focus that’s exclusively on men, those issues will never be answered as they have been for women.

“Twenty years from now we don’t want to be in the same sorry position we are now, where we are totally lacking knowledge about men’s state of affairs.”

Now would you go to a doctor who specialized in men’s health? I don’t know about you, but I would.