Data has consistently shown that men are reluctant to seek medical care, even though they generally face higher mortality rates and shorter life expectancies than women for most causes of death.
But why are men statistically more likely than women to skip a doctor’s visit? Juan J. Andino, MD, MBA, a urologist in the Department of Urology at UCLA Health who specializes in men’s health, sexual medicine and male fertility, speaks on the topic.
Q: Studies indicate that men avoid routine health care. What are the most common reasons you encounter in your practice as to why men avoid regular checkups? How often does this include the stigma of reluctance to seek treatment?
Dr AS Andean: Most chronic diseases are “silent” before putting patients at risk. High cholesterol, high blood pressure, diabetes, obesity and infertility can all occur in daily life.
Stigma likely plays a role in the conditions I evaluate in the office and treat in the operating room. Sexual function and fertility are things that focus on personal life, and for many patients it can seem taboo to discuss them outside of the home or a relationship. This, in my opinion, is an equally important part of overall health because not only is it crucial to quality of life, but many medical and chronic health conditions can contribute to sexual dysfunction or male infertility, but if a patient has not been evaluated, he I may not know. They will not be able to resolve these issues.
Q: What are the long-term risks associated with avoiding routine health care?
Dr AS Andean: Without knowing that a health risk exists, it is impossible to begin discussing changes that may be as simple as diet and exercise recommendations. A challenge exists in that there are few guideline-based recommendations for routine health care in men, unlike women, who are established early in life with obstetrician/gynecologic physicians for checkups. health maintenance like Pap tests.
Q: How to get out of this stigma and what are the consequences?
Dr AS Andean: A component of stigma, culture and environment affects this. Many chronic diseases are initially asymptomatic, and costs to patients and reimbursement to providers do not encourage preventive care. Much of what contributes to overall health occurs outside of the health care system: if a person works three jobs and spends most of their day at work or traveling, then it can be difficult to find the time exercise and access nutritious meals.
The consequences are what we see as trends across the country: increasing rates of obesity, diabetes and chronic disease.
Q: Hispanic/Latino men appear to underutilize primary health care services. What societal or cultural factors contribute to this trend?
Dr AS Andean: This is a very complex question. A fantastic report from the Pew Research Center, published a few years ago, attempts to answer this problem.
The first, and probably most important, aspect is being underinsured or uninsured. California is leading the way in this area, recently ensuring that undocumented immigrants can also receive state-funded insurance (Medi-Cal). However, even with these insurance plans, access to care is not simple: due to low reimbursement, more and more health systems are restricting the proportion of Medi-Cal patients they can see or do not fully subscribe to this insurance. After all, if the costs of care are higher than what insurance pays you, facilities close and no patients can receive care, putting additional pressure on surrounding clinics and hospitals.
Beyond this, language barriers, limited use of interpretation services, and cultural differences in presenting or receiving information likely also contribute to problems in accessing care.
Q: How can the healthcare system better meet the needs of Hispanic/Latino patients?
Dr AS Andean: Enhanced insurance coverage is a start, whether medical, employer-sponsored, or using the California State Covered Marketplace. Once patients can access care, health systems must continue to develop best practices for language-compliant care.
UCLA Health is actively working on this -; ensuring that interpreters are offered and used when patients’ preferred language is Spanish and confirming that doctors and providers take proficiency tests if they wish to conduct a visit in a language other than English.
Finally, accessing care without going to a specific location and without taking time off work can make it possible to meet people where they are. I do a lot of telehealth because if I don’t need to do a test or procedure to make a medical recommendation, it’s much easier for patients to make an appointment and plan their health.
Q: How can breaking the stigma around sexual and reproductive health lead to better outcomes for Hispanic/Latino men?
Dr AS Andean: As a fellowship-trained urologist, I refer many men to primary care physicians because I diagnose conditions that contribute to problems with fertility and erectile function. For example, obesity and diabetes can develop for years until I saw a patient with erectile dysfunction who now requires medication for intimacy.
Machismo makes it difficult for Latino men to talk about these issues. Media reports rarely highlight the impact of age and medical conditions on sexual and reproductive health. However, by having honest conversations in the office or via telehealth, we can combat this stigma and improve our quality of life.
Q: What message do you have for men who may feel embarrassed or reluctant to seek help for health issues?
Dr AS Andean: You are not alone. Your coworkers, neighbors, and family members have experienced or will experience similar things, but they keep it to themselves. Find a doctor with whom you feel comfortable discussing these issues.
When it comes to male infertility and sexual health, such as erectile dysfunction that no longer improves with medication or penile curvature that bothers patients or partners, please contact the Men’s Clinic UCLA. I am happy to do an initial telehealth consultation to remove barriers related to work stoppage, driving and parking. I only require the following actions to be taken in person when medically necessary.
Q: How can primary care physicians and specialists work together to improve health outcomes for Hispanic/Latino men?
Dr AS Andean: By relying on each other to gain expertise and creating a network of doctors who can provide culturally and linguistically appropriate care. Most importantly, doctors and providers need to know their limitations and know when to seek help. I regularly refer patients to general practitioners or ask them to follow up regarding chronic problems impacting urological health, while communicating my recommendations to their practices. But I also rely on other urologists, endocrinologists, sleep doctors, medical radiation oncologists, interventional radiologists and doctors in reproductive endocrinology and infertility (OB/GYN specializing in female fertility) to provide the best care to patients and couples.