Boys and men who enact behaviors more closely aligned with stereotypical gender norms in their social environment are less likely to report receiving diagnoses or treatment for cardiovascular disease risk factors.
This is according to a study — “Male Gender Expressivity and Diagnosis and Treatment of Cardiovascular Disease Risks in Men” by Nathaniel J. Glasser, Jacob C. Jameson, Elbert S. Huang, et al — that appeared in JAMA Network Open.
“It’s well known that male gender and male sex are associated with lower help-seeking for a range of health conditions, especially mental health and primary care. But previous studies haven’t probed further into the social processes through which male gender is iteratively created through an interplay between the individual and their surroundings,” said Glasser.
The researchers analyzed data from Add Health, a longitudinal study that collected health measurements and survey responses from more than 12,300 people at multiple points over the course of 24 years (1994-2018). They quantified Add Health participants’ male gender expressivity by identifying a subset of survey questions that were answered most differently by self-identified male versus female participants, then measuring how closely male participants’ answers to those questions matched those of their same-gendered peers.
“When we talk about gender expression, we’re not looking at anything physiologic that could be affected by the Y chromosome,” Glasser pointed out. “We’re purely focused on self-reported behaviors, preferences and beliefs, and how closely these reported behaviors and attitudes resemble those of same-gendered peers.”
Zeroing in on cardiovascular disease, the researchers compared the Add Health biological measurements with health-related survey responses to see if men with detectable risk factors like high blood pressure reported receiving diagnoses or treatment for those conditions.
The researchers found that men who showed more stereotypical gender expression were significantly less likely to report that a healthcare professional had ever told them about certain cardiovascular disease risk conditions. Even when these men did report having previously received a diagnosis, they were still less likely to report that they were taking medication to treat these conditions.
The risk factors examined in the study are all conditions that would normally be detected by screenings that are part of basic primary care. It’s unclear whether the decrease in reported diagnosis and treatment among those with higher male gender expression indicates that men aren’t going in to get screened; that they aren’t paying attention to their diagnoses even when they do get screened; or that they are simply downplaying their diagnoses when asked about them. Whatever the underlying reason, the findings highlight a missed opportunity to prevent or alleviate serious cardiovascular conditions later in life.
“Our hypothesis is that social pressures are leading to behavioral differences that impact cardiovascular risk mitigation efforts, which is concerning because it could be leading to worse long-term health outcomes,” Glasser said.
Ultimately, the researchers see the implications of this research reaching far beyond the topic of traditional masculinity.
“We’re seeing how pressures to convey identity — whether it’s rooted in gender, race, sexuality or something else — impact health behaviors,” Glasser said. “Fitting in and achieving belonging is a complicated task, and we feel strongly that increased societal sympathy, empathy and patience for others undertaking that task would be good for people’s health.”
