Men's Health: from pediatrician to urologist, efforts to make men's health more preventive

The puberty period is a key element in human health. In addition to all the changes that occur in the body, this phase directly influences people's relationship with health care.

For women, the arrival of menarche (first menstrual period) generally marks the transition from appointments with pediatricians to follow-up with gynecologists. In contrast, in men, the absence of a marked transition event does not stimulate a sense of frequent self-care with their own health.

According to statistics from the Brazilian Society of Urology (SBU), girls attend doctors' offices 2.5 times more than boys. Culturally, this lack of encouragement for medical follow-up during adolescence ends up harming the male audience in the long term. As a result, the men's health landscape presents specific characteristics, such as the diagnosis of diseases at more advanced stages.

As highlighted Daniel Zylbersztejn, urologist at Hospital Israelita Albert Einstein, specialized in infertility and coordinator of Adolescent Urology at SBU, and coordinator of Fleury Fertility: “Men are still very reactive in relation to health care.”

And Zylbersztejn continues to state that “generally, he only seeks help when faced with a problem. There is no regular prevention culture, although campaigns like Blue November bring a temporary increase in awareness. On these occasions, the man may end up looking for a urologist, who, ideally, should look beyond prostate cancer and assess health more broadly.”

As a consequence of an under-encouraged habit among young people in Brazil, 62% of men only see a doctor when a symptom becomes unbearable, according to data from the Side by Side by Side for Life Institute.

In addition, in non-urgent situations, 70% of men only seek medical assistance under pressure from their wives or children, according to the findings of the São Paulo Reference Center for Men's Health.

This scenario has driven a new strategy: placing urologists at the same level of relevance as gynecologists in women's health.

The beginning of the human journey in the health system

In the ideal world, the one who would accompany most boys during adolescence, ensuring that they did not lose the habit of going to the doctor, would be the hebiatrician — a pediatrician who specializes in adolescence. However, Brazil has only 200 of these professionals, according to the newspaper's findings State of Minas.

The low popularity of these specialists especially impacts the male audience. “Unlike women, who started going to the gynecologist at a young age, men leave the pediatrician and become 'loose'”, says Eduardo Miranda, urologist and coordinator of the Department of Andrology, Reproduction and Sexual Medicine of the Brazilian Society of Urology.

With that in mind, SBU has been running the campaign for six years #VemProUro, which seeks to guide teenagers on topics such as sexuality, drugs, and contraception.

From adolescence to adulthood

Back to the importance of thinking about the health of young men, there are conditions that could be prevented. For example, have you ever heard of varicocele? It is the leading cause of male infertility.

Also known as “testicular varicose veins,” the condition refers to the abnormal dilation of the testicular veins. In general, It appears in adolescence and can be treated. However, with the low frequency of boys attending offices, many end up being affected by pain and infertility— it is estimated that for every 100 men, at least 20 will have challenges with infertility. Commonly resolved with surgery, some cases of varicocele can be treated non-invasively, especially if discovered early and followed up regularly.

In addition, the SBU points out that from 2019 to June 2024, varicocele was the reason for more than 6 thousand visits and 13 thousand hospitalizations in the Unified Health System (SUS).

Among other issues that could be resolved with more rigorous monitoring starting in adolescence, there are also topics such as guidelines for the use of condoms against unwanted pregnancy and sexually transmitted infections (STIs).

According to data from the Brazilian Institute of Geography and Statistics (IBGE) - published in 2022, but referring to the years 2009 to 2019 -, 62.8% Of school-age boys they didn't use a condom in the last sexual intercourse.

In this sense, in addition to the risk of acquiring other common STIs, concern increases when we consider that the vaccination against HPV (Human Papillomavirus) was able to cover only 36% of boys aged 9 to 14, according to the Butantan Institute. Despite the common risks for both genders, there are more than 100 types of infections by HPV, 14 of which have carcinogenic potential.

In this regard, men are more susceptible to recurrent infections and to have the condition progressing to cancer, since without the vaccine the male body has only 8% of the chance of producing antibodies against the virus, as indicated by a study published in the magazine Papillomavirus Research. On the other hand, with vaccination it is possible to maintain an antibody production for more than 10 years.

Adult men's health

However, what happens to adult men who already have well-established harmful habits?

In these cases, joint work with the other specialties is necessary. As Daniel Zylbersztejn puts it: “because a man is reactive, he seeks out a doctor related to the specific problem. For example, with lower back pain, he seeks an orthopedist. However, many of these specialists are not prepared to realize the need for preventive tests, such as the assessment of blood glucose or blood pressure, so this is an opportunity for doctors to guide and refer the patient for general examinations.”

In addition, the most practical way to improve the male health landscape is through the sum of efforts. In addition to the possibility of going through general practitioners and family doctors, urology now wants to expand its role.

“The urologist must broaden their vision, as gynecologists do with women, and act as the reference doctor for men's health. This includes evaluating metabolic, cardiovascular, and hormonal aspects and even referring them to other specialists when necessary. The global vision is fundamental, especially in a society where humans have not developed a culture of preventive care at an early age”, defends Zylbersztejn.

Culture and diagnoses

Regarding the male health landscape, “there was a change, with the aging of the population”, says Eduardo Miranda. “Today, cancer and cardiovascular diseases they are the leading causes of death, with cancer becoming increasingly common, especially among men”, he added.

Miranda also points out that “the Blue November campaign, which began as a prevention of prostate cancer, now also emphasizes men's health. For younger men, issues such as diabetes, hypertension, cholesterol and sexual health are more worrying”. A portrait of this is the life expectancy of men, which is currently 7.2 years lower than that of women, according to the Ministry of Health.

In this sense, it's not always just about getting a diagnosis. That's because, although each person reacts in a unique way, “men tend to minimize health problems, ignoring signs until it's late. I work a lot with sexual dysfunctions and I see that many men prefer to pretend that everything is fine out of shame. They focus on their responsibilities and put themselves in the background, which makes it difficult to recognize a problem”, Eduardo points out.

The issue goes against the great taboo of men's health: the rectal exam. Although it lasts about 8 seconds, many men still avoid going to the office in fear and embarrassment of the exam.

But the good news is that, in Daniel Zylbersztejn's view, “acceptance has improved with increased awareness. Many men understand that the test is essential, especially since there are types of prostate cancer that are not detected by PSA (Prostate Specific Antigen). Rectal touch is quick and can be decisive in identifying early changes”, reiterates the Fleury Fertility coordinator.

The Future of Men's Health

For the future, what needs to be done is a lot of work focusing on Awareness-raising. Through it, it would be possible to achieve a second goal for urologists: to make the specialty more consultative and less dependent on surgery. “This requires urologists to take a more comprehensive view of men's health, following trends such as less invasive treatments and advances in personalized medicine,” adds Daniel.

Although this breadth of analysis is, in theory, assigned to general practitioners, pediatricians, and family physicians, reproductive organ specialists of each gender increasingly embrace this additional responsibility. Not ideal, but in gynecology this has been done for many years. Now, urology is following the example and is on its way to becoming the 'official' medical specialty for men.

In this sense, the “Blue November” campaign, officially integrated into the Brazilian calendar in 2011, thanks to the efforts of the Institute Side by Side for Life, has encouraged the male public to think about their health as a whole. Thus, the behavior of Brazilian men in relation to health has improved - although still far from ideal.

As an example, it is worth considering some data. According to YahooFinance's analysis, the men's health market is worth around U$1.27 trillion and is expected to reach U$2.57 trillion by 2029. This is an annual growth of 12.44%, a scenario influenced by the Covid-19 pandemic and its effects on health awareness.

Finally, among other influencing factors, it is also possible to mention the rise of monitoring devices of health - such as smartphones, smartwatches and smartrings -, as well as the expansion of services of telemedicine, increased demand for supplements and other products associated with nutrition, in addition to social networks.