Men's health

Why men die younger#

In 2024, US life expectancy at birth was 76.5 years for men and 81.4 for women, a gap of 4.9 years; at 65, men could expect 18.4 more years and women 20.8. The gap had widened from 4.8 years in 2010 to 5.8 in 2021, driven by COVID-19 and by unintentional injuries, mostly drug overdoses. Heart disease remains the largest steady difference.

Men account for 72.5% of US crash deaths (2024), and many of these deaths trace back to behavior that can change, such as drinking, speeding, and unsecured firearms.

Men also use less care. In national survey data, 63.1% of men aged 18 to 29 had seen or talked to a clinician in the past year, versus 82.4% of women the same age. Among adults with a mental illness, 41.6% of men received treatment versus 56.9% of women (2022). The optimal fix is simple: a yearly visit where you review your own numbers, starting in your 20s (the optimal care model, the yearly core panel).

Heart risk starts earlier#

Earlier and more often#

In the Framingham study, a 40-year-old man's lifetime risk of coronary heart disease was 48.6%, versus 31.7% for a woman. Women develop cardiovascular disease 7 to 10 years later on average, so men need to start prevention earlier, before a heart attack becomes the first sign of disease.

Plaque is a lifetime sum of ApoB and blood pressure exposure, so the optimal plan starts early Strong:

• A lipid panel with ApoB every year from your 20s, and 4 to 12 weeks after each treatment change (how often to test), with Lp(a) once on the first panel. Aim for ApoB under about 60 mg/dL, and discuss medication if it stays above about 80 by your late 30s or 40s (when to start treatment).
• Blood pressure under 120/80, with a week of home readings every 3 months (measuring at home).
• A first coronary calcium scan around 40 if you are not already on treatment, about 5 years earlier with a strong family history, familial hypercholesterolemia, high Lp(a), diabetes, or a long smoking history. Guideline minimum: the 2026 guideline supports scanning men from 40 only when a statin decision is uncertain.

Visceral fat and the waist#

Men tend to store fat in the abdomen and around the organs, the pattern most tied to insulin resistance and heart disease, while many women store more under the skin of the hips and thighs, which carries lower cardiometabolic risk. That is why a man can have a normal BMI and still carry dangerous visceral fat.

The NHLBI flags a waist above 40 inches for men as higher risk, but the better target is a waist under half your height (waist-to-height ratio) Moderate. A body-composition DEXA every 1 to 2 years from your 30s or 40s measures visceral fat directly and gives you a trend line (body fat and visceral fat). Abdominal fat also lowers testosterone, and weight loss raises it (Hormones).

Erectile dysfunction as an early warning#

Erectile dysfunction (ED) is common: in the Massachusetts Male Aging Study, 52% of men aged 40 to 70 had some degree of it, and complete ED tripled from 5% to 15% across those ages. Erections depend on healthy small arteries, so ED is often the first sign of the same disease that causes heart attacks. In 300 men with confirmed coronary disease, 49% had ED, and in two-thirds of them ED came first, by an average of 39 months. A meta-analysis of 92,757 men linked ED to 44% more cardiovascular events, with the strongest link in younger men (heart).

The optimal approach Moderate: treat erection quality as a vital sign and mention any change at your yearly visit. New or worsening ED without an obvious cause calls for a full cardiovascular assessment (ApoB, Lp(a), blood pressure, HbA1c, and a calcium scan if you are 40 or older), a check for sleep apnea, and a testosterone workup if libido is also low. The Princeton III consensus recommends cardiovascular risk assessment for every man with ED. ED pills are effective and safe for most men, but never with nitrates; see Hormones.

Prostate health#

Urinary symptoms and BPH#

Benign prostatic hyperplasia (BPH), noncancerous growth of the prostate, affects an estimated 5% to 6% of men aged 40 to 64 and 29% to 33% of men 65 and older. It causes a weak or interrupted stream, trouble starting, dribbling, urgency, frequency, and waking at night to urinate. BPH does not turn into cancer, but the symptoms overlap, so new symptoms deserve an exam.

Treatment, from limiting evening fluids and caffeine to medicines and minimally invasive procedures, follows the AUA guideline and is summarized in prostate enlargement. One detail matters for screening: finasteride at the BPH dose lowers PSA by about 50% within six months, and the lower hair-loss dose also lowers it. Anyone reading your PSA must know you take one, and any confirmed rise on the drug needs evaluation.

An optimal PSA plan#

About 1 in 8 men will be diagnosed with prostate cancer, with an estimated 333,830 new cases and 36,320 deaths in the US in 2026. The full decision is in prostate cancer screening; the short version Moderate:

A mid-40s PSA is unusually informative: in a Swedish cohort followed for decades, 44% of prostate cancer deaths occurred in men whose PSA at 45 to 49 was in the top tenth (1.6 ng/mL or more). BRCA2 carriers face a 19% to 61% chance of prostate cancer by 80, versus about 10.6% of all men. Guideline minimum: the USPSTF leaves PSA screening to an individual decision for men 55 to 69.

Testosterone#

Testosterone falls slowly with age. In the Massachusetts Male Aging Study, total testosterone declined about 1.6% a year within the same men, and good health (no chronic illness, obesity, or heavy drinking) added 10% to 15% to levels. The common symptoms blamed on low testosterone, such as fatigue and weight gain, have many other causes.

When to test. Test if you have symptoms such as low libido, erectile problems, or loss of morning erections. The workup, detailed in diagnosis in men, is two fasting early-morning total testosterone tests, free testosterone if borderline, LH and FSH (pituitary signals that show where the problem is), a blood count, and PSA, plus a check for reversible causes such as obesity, sleep apnea, opioids, and overtraining.

Why not to chase numbers. If your levels are normal, testosterone will not make you healthier, and it has not been shown to extend life or improve energy or thinking. In men with true deficiency, the large TRAVERSE trial found no increase in heart attacks or strokes but more atrial fibrillation, blood clots in the lungs, and fractures (see benefits and safety). Clinics that diagnose from one test or aim for levels above the normal range add risk without proven benefit Negative. Testosterone also shuts down sperm production, covered next.

Fertility and sperm health#

Semen analysis#

A semen analysis measures volume, sperm concentration, motility (how many swim forward), and morphology (shape). The WHO's 2021 reference values, the lowest 5% among fertile men, are 16 million sperm per mL, 30% progressive motility, and 4% normal forms. These are not hard cutoffs between fertile and infertile, and results vary from sample to sample, so an abnormal result is usually repeated.

Semen quality also tracks general health. In 43,277 Danish men tested for infertility, death rates fell as sperm concentration rose up to about 40 million per mL, and with better motility and shape, an observational link. The AUA and ASRM make semen analysis part of the first evaluation of the male partner when a couple has trouble conceiving; male factors contribute in many couples, so test both partners at once (Women's health).

The optimal approach Weak: if you want children in the future, especially if you plan to wait into your late 30s or 40s, get a baseline semen analysis. Get one, and consider banking sperm, before starting testosterone. Guideline minimum: testing only after a couple has been trying without success.

Are sperm counts falling?#

The largest meta-analysis, 223 studies of samples collected from 1973 to 2018, found that average sperm concentration among men not selected for fertility fell 51.6%, with the yearly decline doubling after 2000 to 2.64% a year. The trend is contested. Counting methods and the men who volunteer for studies have changed over 45 years, and critics argue that sperm counts naturally vary across a wide, mostly healthy range. Direct surveillance of 8,320 young Danish men from 1996 to 2022 found counts stable to slightly rising (median 44 to 49 million per mL), though 36% had at least one value below WHO reference levels. The honest summary: the global trend is uncertain, and your own number is what you can act on.

What helps and what harms#

Sperm take a few months to mature, so recheck a few months after quitting smoking or losing weight, not a few weeks.

Testosterone and fertility#

Testosterone from outside the body tells the pituitary to stop sending the signals that drive sperm production, which is why it has been tested as a male contraceptive. Recovery after stopping is usually complete but slow: in 1,549 healthy men across 30 hormonal contraception studies, sperm counts took a median of 3.4 months to recover, with 67% recovered by 6 months, 90% by 12, and all by 24. The AUA advises that testosterone not be prescribed to men trying to conceive; fertility-preserving alternatives are in Hormones.

Testicular and breast cancer#

Testicular self-awareness#

Testicular cancer is uncommon but strikes young men: about 9,810 US cases and 630 deaths are expected in 2026, the average age at diagnosis is 33, and about 1 in 250 males will get it. It is usually curable, even when found from symptoms. An undescended testicle is one of the main risk factors, along with a father or brother who had it.

The USPSTF recommends against screening, including routine self-examination (grade D, 2011), because it found no evidence that screening finds curable cancers earlier. The optimal approach Weak is self-awareness rather than a formal exam: know what your testicles normally feel like, check occasionally, such as in the shower, and see a doctor within a couple of weeks for a painless lump, swelling, heaviness, or a dull ache. It costs nothing, and it matters most if you have a risk factor.

Male breast cancer#

Men get breast cancer too, rarely: about 2,670 US men will be diagnosed in 2026 and 530 will die, a lifetime risk of about 1 in 755. The main genetic risk is BRCA2: 1.8% to 7.1% of BRCA2 carriers get breast cancer by 70, versus about 0.1% of all men. Specialist guidelines summarized in a 2021 review advise a yearly clinical breast exam from 35 for male BRCA carriers and prostate screening from 40 for BRCA2 carriers. ASCO recommends genetic testing for every man with breast cancer. Report a lump, a nipple that turns inward, or discharge, and if a male relative had breast cancer, ask about genetic counseling.

Mental health and suicide#

In 2024, the US male suicide rate was nearly four times the female rate. Of 48,824 suicides that year, 38,977 were men (22.3 vs 5.6 per 100,000), and men 75 and older had the highest rate of any group, 40.1 per 100,000. Firearms were used in about 6 in 10 male suicides.

Depression in men often looks different. In a national survey, men reported more anger attacks, aggression, substance use, and risk-taking than women. When those symptoms were counted alongside classic ones such as sadness and loss of interest, men and women met depression criteria at equal rates (30.6% vs 33.3%), erasing the usual gap. Irritability, working or drinking more, and pulling away from people can be depression.

The optimal approach:

• Screen every year with the PHQ-9 and GAD-7 questionnaires, and more often in hard periods such as divorce, job loss, or retirement (screening) Moderate.
• Get help early. Therapy and medication work about equally well for depression, and combining them works better; see treatment that works Strong.
• Put time between a crisis and a firearm. Access to a gun at home is linked to about three times the odds of suicide. Store firearms locked and unloaded with ammunition separate, and during a crisis move them out of the home temporarily (firearms) Moderate.
• Watch alcohol, which worsens depression and impulsivity (alcohol), and stay connected as work ends (social connection).

Your prevention timeline#

Each row adds to the basics for everyone: strength and aerobic training, no tobacco or nicotine, little or no alcohol, good sleep, and a yearly visit (Building your care team).

Action plan#