9.5.3 Male reproductive health
Life expectancy is on average 7 years shorter for men than for women; from birth through senescence, death rates are higher for males than for females (1). Potentially contributing factors are male risk-taking behaviour (accidents, homicide, smoking, alcoholism, high professional and social achievement), less use of medical care, and possibly genetic and endocrine factors. This chapter will address the potential role of sex steroids in the sex disparity in morbidity and mortality. Male and female, and androgens and oestrogens, are usually considered as being antithetical, and sex differences are usually stressed while similarities receive much less attention. However, in both sexes the decline of sex steroid production in old age is associated with osteopenia. and also with an increase in cardiovascular disease. Moreover, the pathophysiology of breast and prostate cancer might show parallels. In reproductive medicine, advances in scientific knowledge and health care have been greater in women than in men. Strategies successful for women might be utilized to promote the health of (ageing) men. It is unfortunate that sex steroids, and particularly androgens, are often perceived as potentially harmful substances rather than being valued for their potentially beneficial actions. Concerning the difference in life expectancy between men and women, an historical comparison between castrati and intact singers in the 15th to 19th centuries demonstrated that both castrati and intact singers at that time had the same life expectancy of around 64 years; this indicates that testosterone deprivation shortly before puberty did not influence longevity. More recent studies show that sociological, lifestyle and professional factors may be of more importance (2).
