It makes perfect sense that there are some health conditions that favor one sex over another. Men and women have different genes, anatomy and predominating hormones. These variances not only influence what symptoms we experience and how we react to treatments, but also our susceptibility to disease in the first place. There are some conditions so closely aligned with women that both doctors and patients overlook them as possible diagnoses in men– But there are two note-worthy diseases increasingly crossing gender lines to strike men.
Breast cancer in men
Breast cancer occurs in women because they have breast tissue. Men have breast tissue too, just much less of it. While less than 1% of breast cancers occur in men, the incidence is on the rise. So the same advice doctors give women– investigate any changes that occur in breast tissue, should also be extended to men.
Why men too?
We know that high estrogen and low testosterone levels play a major role in male breast cancer because men who have abnormalities involving the testicles and problems with fertility are at higher risk for the disease. Like some breast cancers in women, estrogen seems to be a major player. Breast tumors in women can be estrogen-receptor positive, meaning they have receptors on the surface of the cells that have a particular fondness for estrogen. When estrogen locks into these receptors, they can fuel the growth of certain types of breast cancers. The same mechanism is also at work in men, whose tumors tend to be mostly estrogen-receptor positive. Another mechanism for breast cancer in men is buried inside of genes. It turns out that men are not exempt from inheriting (or passing down to their children) breast cancer susceptibility genes such as BRCA1 and BRCA2, a factor in many breast cancers that run in families.
What raises the risk in men?
- Klinefelter’s Syndrome – A genetic disease where men have an extra X (female) chromosome causes higher estrogen and lower testosterone levels.
- Liver Cirrhosis- Since the liver is involved with the metabolism of sex hormones, damage (via infection or alcohol use) increases estrogen levels.
- Overweight – Fat cells convert male sex hormones into estrogen so being overweight and inactive can increase estrogen.
- Genetic – Men who have female family members who have the breast cancer gene, particularly if they test postive for BRCA or other breast cancer susceptibility genes, are at much higher risk.
- Radiation exposure -Radiation treatments received for other conditions can produce changes to breast cells if the rays are required to go through the chest.
Men can perform monthly breast self-exams to check for any lumps or changes breast tissue. This is done more easily in the shower where you can harness the slippery soapy surface to traverse the breast area. Use a lawn-mowing pattern to make sure all surfaces, including the underarms, are examined.
Here’s what men should look for:
- Lumps, bumps or swelling in the breast or underarms
- Nipple retraction, puckering or indentation
- Bleeding or discharge from the nipple
- Redness, scaling or itching of the skin
Like women, there are some benign, non-cancerous conditions that can be taken for male breast cancer, such as gynecomastia, a condition that causes breast enlargement. The diagnostic tools and treatments available to women are also available to men. Breast cancer in men is diagnosed using mammography, ultrasound and biopsy. Treatments include surgery, radiation therapy and chemotherapy.
Lupus also favors women disproportionately (9:1 female to male), but it is certainly not exclusive; Lupus is an autoimmune disease that produces symptoms throughout the body. Autoimmune diseases develop when the body’s natural immune system charged with fighting off invaders such as viruses and bacteria, mistakes healthy tissue as foreign and mounts an attack. Antibodies, which are the immune cells at the center of the attack, are somehow given faulty instructions. In the case of lupus, these rogue self-attacking antibodies (autoantibodies) attack cells in the joints, skin, kidneys, lungs, heart, blood vessels and blood. The cause is unknown but certain environmental experiences and medical conditions seem to trigger the disease in genetically susceptible people.
Why men too?
Sex-related differences in genes and hormones are also likely at work to explain the disparity between the sexes in lupus, but the picture is fuzzier than for breast cancer. Men with lupus don’t have abnormal levels of hormones such as estrogen or testosterone. While it is not yet clear what’s at play, men with lupus may metabolize estrogen differently, making them more prone to the disease.
What raises the risk in men?
The factors that raise the risk in men are the same as those in women.
- Ultraviolet rays from the sun or other sources
- Certain medications particularly sun-sensitive antibiotics
- Recreational drugs
- Bacterial or viral infection such a as cold or flu
- Emotional or bodily stress such as pregnancy, surgery or trauma
What Should Men Do?
Although men experience similar symptoms, they are less likely to report them to their doctor which delays diagnosis and risks more long-term damage to organs. The auto-antibodies that cause widespread inflammation and damage throughout the body produce symptoms that depend on where the attack takes place. Although lupus may not be the most logical explanation for many of these symptoms, it makes sense to not dismiss them based on gender, especially since men tend to get harder hit then women.
Here are some of the more common symptoms of lupus in both men and women:
- Joint swelling and pain
- Muscle weakness
- Extreme fatigue
- Unexplained fever
- Butterfly-shaped red rash across the bridge of the nose and cheeks
- Chest pain upon deep breathing
- Hair loss
- Sun sensitivity
- Leg swelling
- Eye puffiness
- Mouth sores
- Swollen glands
Although there is no single test to confirm a diagnosis, a combination of many blood tests and biopsy of affected tissue can point a finger to lupus. Steroids are the mainstay of treatments but there are other effective strategies depending on where in the body the attacks take place. Treatments focus on reducing flare-ups, inflammation and pain.
For an appointment or consultation with Dr. Gary Bellman, please contact the office or call 818-912-1899