Health equity is for everyone

(Note: we’d like to remind our readers that the lives and safety of women and LGBTQ+ individuals are at stake in a way that cisgender, straight men’s lives are not. We usually focus on gender bias and its specific effects on women and our healthcare system. We encourage you to read those posts, too, to understand the deep inequities that women in particular face.)

Gender bias is a negative or positive attitude towards someone based on their gender and believed gender roles. In the U.S., gender bias favors straight, cisgender men. Men are typically perceived as leaders who are strong, assertive, and physically able. Women, non-binary, and transgender people, on the other hand, are often characterized as having supporting roles to men, weak, or subversive. In healthcare settings, these biases can affect a provider’s judgment and attitude towards a patient. On a broader level, our healthcare system is biased towards men, from the way clinical research is conducted to what is taught in medical schools.

Yet, despite the partiality to cisgender, straight men, gender bias has a negative effect on their health and lifespan, too. In this post, we’ll be sharing some of the ways in which gender bias hurts men. Importantly, this isn’t about men versus women, or men versus everyone else–it’s about how labels, stereotypes, and assumptions deny us the human dignity we all deserve.

Men are socialized to believe they must be strong and powerful at all times, including at the doctor’s office.

Expectations that men must be “tough” and that vulnerability is a sign of weakness can make men reluctant to seek medical care and preventive screenings. In a 2019 survey from the Cleveland Clinic(1), 41% of men were told as children that men don’t complain about health issues, and 20% of men said that they aren’t completely honest with their doctor. Another study demonstrated a link between masculine norms and lower healthcare utilization in highly religious, straight men(2). Men’s avoidance of medical care has real consequences: it’s one of the preventable reasons why they tend to have shorter lifespans than women(3).

Healthcare providers are less likely to diagnose a man with a mental health condition like depression and anxiety.

Stereotypes about masculinity and lack of awareness in how men experience mental health symptoms can lead to these conditions to go undetected in male patients. Men are more often socialized to suppress their emotions or avoid talking about them. As a result, men’s symptoms of depression or anxiety may present differently from women’s(4). Men are also more likely to visit a medical provider when feeling physical symptoms, like chest pains, headaches, or sexual problems–all of which are also symptoms of depression. The focus on physical symptoms can make these conditions more challenging to diagnose in male patients. Men are four times more likely to die by suicide than women(5), which illustrates the need for better mental health solutions.

Gay, bisexual, and transgender men face discrimination at the doctor’s office, too.

Most forms of gender bias favor cisgender, straight men and exclude LGBTQ+ men. As a result, gay and transgender men face the negative effects of gender bias, too. For example, a healthcare provider may stereotype a gay or bisexual man and assume he has had unprotected sex or engages in high risk behaviors without asking those specific questions(6). Gay men’s healthcare might overly focus on HIV prevention and STI-related care(7), and neglect the essential primary care for their overall health and well-being.

Transgender people are in an especially fraught political climate. There’s a wave of anti-trans bills, from anti-trans sports legislation to bans on gender-affirming care. Oklahoma bill OK SB129, which was introduced earlier this year, would make it a felony to provide gender-affirming care to anyone under the age of 26. Such bills further stigmatize the healthcare needs of transgender men and women.

Identities and behaviors don’t exist in rigid categories.

We also can’t make the mistake of assuming that cisgender, straight men always behave or act a certain way. Behavior and identity are two different, fluid notions. For instance, the acronym “MSM” (men who have sex with men) started to gain traction in 1994 during the HIV/AIDS pandemic in the U.S.(8) The intent behind using “MSM” was to separate an act from a person’s identity, and reach the people who would most benefit from screenings and treatment, who might otherwise self-select out of it. During the monkeypox outbreak in 2022, institutions like the CDC emphasized the risks for MSM rather than just gay men. This was to prevent characterizing it as a “gay men’s disease.”

Along this line of recognizing the fluidity of gender and identity, cisgender, straight men may self-identify one way, and a provider may make assumptions about them. They may encounter healthcare providers who don’t ask about their choice of partners or use inclusive language. Unaware healthcare providers may mis-gender a patient’s sexual partner, or draw conclusions about their sex partners. This can embarrass patients, and make them less reluctant to share their health history with the provider.

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While gender bias would have us believe that people fall into all-or-nothing categories or definitions, human experience is rich, nuanced, and unique to every individual. Our medical institutions must recognize and honor the diverse and unique elements that make up who we are and how we exist in the world. Rigid gender roles and the biases that come with them affect the quality of our healthcare, no matter who we are. When we see health equity as not just a women’s issue, or a LGBTQ+ issue, but an issue for all, we can succeed in achieving it together. We are poised for meaningful change when everyone participates.

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Sources

1. “Cleveland Clinic Survey: Men Will Do Almost Anything to Avoid Going to the Doctor.” Cleveland Clinic, 4 Sept. 2019, www.newsroom.clevelandclinic.org/2019/09/04/cleveland-clinic-survey-men-will-do-almost-anything-to-avoid-going-to-the-doctor. Accessed 2 May 2023.
2. Novak, Joshua R., et al. “Associations Between Masculine Norms and Health-Care Utilization in Highly Religious, Heterosexual Men.” American Journal of Men’s Health, vol. 13, no. 3, SAGE Publishing, June 2019, p. 155798831985673. https://doi.org/10.1177/1557988319856739.
3. Shmerling, Robert H., MD. “Why Men Often Die Earlier Than Women.” Harvard Health, June 2020, www.health.harvard.edu/blog/why-men-often-die-earlier-than-women-201602199137.
4. “Men And Depression.” National Institute of Mental Health (NIMH), www.nimh.nih.gov/health/publications/men-and-depression.
5. Suicide Data and Statistics | Suicide | CDC. www.cdc.gov/suicide/suicide-data-statistics.html.
6. Casanova-Perez, Reggie. “Broken Down by Bias: Healthcare Biases Experienced by BIPOC and LGBTQ+ Patients.” PubMed Central (PMC), 2021, www.ncbi.nlm.nih.gov/pmc/articles/PMC8861755.
7. Ayhan, Cemile Hurrem Balik, et al. “A Systematic Review of the Discrimination Against Sexual and Gender Minority in Health Care Settings.” International Journal of Health Services, vol. 50, no. 1, SAGE Publishing, Jan. 2020, pp. 44–61. https://doi.org/10.1177/0020731419885093.
8. Ricks, JaNelle. “‘Men Who Have Sex With Men’ Originated During the HIV Pandemic to Focus on Behavior Rather Than Identity — but Not Everyone Thinks the Term Helps.” The Conversation, www.theconversation.com/men-who-have-sex-with-men-originated-during-the-hiv-pandemic-to-focus-on-behavior-rather-than-identity-but-not-everyone-thinks-the-term-helps-189619.