This episode of Longevity by Design discusses men’s physical and mental health. The following topics are discussed: depression, anxiety, suicide, substance abuse, risk-taking, divorce, domestic violence, and more. This episode is intended to raise awareness of the warning signs of mental health disorders that men, in particular, may face. The subject matter may be distressing or triggering for some individuals. Please proceed with caution if you continue to read this article.
In this episode, Dr. Gil Blander welcomes guest John Oliffe, a renowned expert on men's mental health. Dr. Blander and Dr. Oliffe discuss the intricacies and challenges regarding mental health faced by men in today's world, and how when left unaddressed, can threaten men’s longevity. They delve into the complexities of modern masculinity and how traditional expectations impact men's emotional well-being. Throughout the conversation, Dr. Oliffe shares insight into health disparities faced by men and the stigmas men face. Dr. Oliffe shares actionable prevention strategies for men and offers valuable advice like establishing daily routines, gaining awareness of emotional health, and prioritizing meaningful relationships and connections. And while this episode discusses men’s mental health—people of all sexes can benefit from learning more about how men’s mental health impacts longevity.
About Dr. John Oliffe
Dr. John Oliffe is the founder and lead investigator of the University of British Columbia Men’s Health Research program. Dr. Oliffe is also a professor and Tier 1 Canada Research Chair in Men’s Health Promotion. His research focuses on how masculinities influence men’s health behaviors and illness management, and the impact masculinities have on partners, families, and overall quality of life. Findings drawn from his research offer guidance to clinicians for men’s health promotion and care for the psychosocial effects of prostate cancer care, male depression, suicidality, and smoking cessation.
Why do women have a longer life expectancy than men?
Did you know that men in the US have a life expectancy of 74.5 years, while women have a life expectancy of 80.2 years? To begin this episode, Dr. Blander and Dr. Oliffe dive into the key factors that contribute to the nearly six-year gap in life expectancy between males and females.
Researchers find that the primary contributors to the life expectancy gap between men and women are cardiovascular disease, suicide, motor vehicle accidents, and liver failure linked to alcohol use. Dr. Oliffe is quick to note that many of these factors can either be prevented or modified through targeted interventions. Dr. Oliffe's research program identifies effective interventions to spark meaningful behavior change to address these primary contributors. Although not all of these causes are solely influenced by social factors, there are pivotal moments for intervention that can positively impact men's lives.
Diseases impact men at an earlier age than women
Cardiovascular disease is the current leading cause of death in men and women in the US and globally, and diabetes clocks in at number seven. Men experience cardiovascular disease and diabetes at an earlier age than women, on average, according to Dr. Oliffe, contributing to their shorter life expectancy compared to women.
This early onset of cardiovascular disease in men leads to more years spent in poor health, increasing their risk of complications and ultimately impacting their life expectancy. Understanding these gender-specific differences in disease occurrence is the first step in addressing men’s life expectancy. And this awareness allows for the development of targeted interventions and health-promoting strategies.
Gender roles and healthcare
Dr. Oliffe shares thought-provoking statistics on how social constructs and normalized gender roles contribute to the ways in which men participate in healthcare.
Compared to women, men often delay seeking medical care, and avoid preventative care altogether, notes Dr. Oliffe. Men are oftentimes not making decisions on health and medical care for their families. Whether it's the influence of a mother to a son or a wife to a husband in a heterosexual relationship, women tend to take on the primary caregiver role for their families. Dr. Oliffe shows that the men’s reduced role in family caregiving shapes how men perceive and interact with the healthcare system.
Men strive to portray themselves as invincible, robust, and resilient. Dr. Oliffe explains that many men don’t seek care unless they are experiencing pain or dysfunction, while women are more likely to seek preventative care. This disparity in how men approach seeking help in comparison to women has significant implications for their life expectancy. The reluctance of men to seek medical assistance and their preference to downplay or dismiss their physical symptoms can lead to delayed diagnosis, progression of illnesses, and poor health outcomes. Dr. Oliffe argues that addressing the factors preventing men from taking a proactive approach to healthcare is essential in narrowing the life expectancy gap and ensuring better overall well-being for men.
Men's mental health
Mental health encompasses emotional, psychological, and social well-being, influencing our thoughts, feelings, actions, and stress management.  And mental health impacts physical health as it shapes our emotional resilience, cognitive function, and ability to cope with life's challenges. Moreover, mental health influences healthspan, as depression raises the risk of various physical conditions like diabetes, heart disease, and stroke.  Understanding mental health helps prioritize preventative strategies to improve mental well-being, ultimately leading to better physical health.
During this discussion, Dr. Oliffe explains why the conversation surrounding men's mental health holds significant importance. Official statistics on men's mental health fall short in fully capturing the reality and needs of men, primarily because men often hesitate to seek support for their emotional well-being. Men might be hesitant to ask for mental health help due to stigmas, masculine ideals, being estranged from the healthcare system, and decreased awareness of their emotions.
In fact, mental health disorders in men are severely underreported. Despite men being diagnosed with depression at only half the rate of women, their suicide rate is four times higher. Dr. Oliffe suggests that the current statistic that 10-15% of men are impacted by mental illness may not accurately reflect the true percentage of affected men. Underrepresentation of men’s mental health disorders affects subsequent intervention and treatment protocols, perpetuating the cycle of poor mental health for men.
Unpacking masculinities and how they shape men's health
Masculinities encompass the societal constructs of what it means to be a man. How do men internalize and embody these ideals? Where do these constructs originate? In many cases, they are learned through interactions with parents, friends, and societal influences that shape our understanding of manhood.
Dr. Oliffe discusses how young men often adopt certain ideals in their quest to prove their masculinity during their formative years. Young men embrace strength, stoicism, and self-reliance. And as men align themselves more closely with these masculine norms, they tend to display fewer emotions as they associate emotional expression with a deviation from traditional masculinity. Consistently hiding or concealing problems can make men reluctant to seek the help they need.
It is essential to challenge and broaden these rigid categories of masculinity to create a more inclusive and mentally-healthy environment for everyone. Recognizing the diversity and variations in what it means to be a man today can alleviate the pressure to conform to narrow definitions of masculinity. By embracing a more expansive understanding of manhood, we can promote healthier attitudes toward seeking support and foster discussions about emotions and overall well-being.
Internalizing versus externalizing emotions
Digging deeper into the complexities of how men experience mental health, Dr. Oliffe explains the idea of internalization versus externalization. He highlights that men have a tendency to internalize their emotions and feelings. “When there's a transition or unfavorable life event—like divorce, retirement, or job loss—the feelings that accompany the transition are unexpected. Men tend to look internally for a remedy to deal with the emotions they're feeling,” he explains. He elaborates that one of the ways of concealing a problem is to self-isolate and unfortunately, men are particularly adept at distancing themselves from others.
Externalization is a defense mechanism in which an individual attributes their own thoughts and feelings to the outside world, independent of their own experiences. Externalization of feelings is a commonality amongst individuals experiencing depression. Generic screening tools for depression don’t characterize depressive symptoms accurately for men, as they experience depression differently than women. “We see guys who show up with substance issues, anger, irritability, over involvement in sports and work, and risk-taking. When something is going wrong internally for a male, we commonly see ways they externalize this behavior. All this to say depression is showing up quite differently in a lot of men than what a generic screening tool like the PHQ-9 would pick up as depression.” Thoughtful and professional consultations with men allow clinicians to gain a deeper understanding of their mental health status and can prevent the development of long-term destructive behaviors.
The relationship between stress and mental health
The aspects of our lives that worry us can also stimulate us to be productive. Many men—and people in general—work out of discontent or worry, yet it drives them towards success. In moderate doses, this model can be successful without causing harm.
That said, the term "stress" can mask depression among men. He notes that men often dismiss or downplay their emotions by attributing them to stress, when in reality, they may be experiencing depression. Dr. Oliffe advises to be aware of conversations in which men consistently note high stress levels.
There comes a point in which stress stops being helpful and impairs one’s functional abilities. “It’s normal to worry and experience low doses of anxiety—sometimes it provides the edge needed to drive productivity. When this anxiety becomes overwhelming, freezing you to the point that you can't move forward with the day-to-day, that's when we want to start intervening,” offers Dr. Oliffe. He says intervention might be as simple as turning off the media and just slowing down, or it might be more complex and require therapy. There are so many collateral issues that are worth unpacking—distressed relationships, job insecurity, financial matters, and more broadly, uncertainty in life. It is important to think systematically about mental health, and realize it is acceptable to ask for help.
Breaking down the biological and societal aspects of mental health
Research shows that men’s testosterone levels are correlated with mental health outcomes. In fact, both high and low testosterone levels are linked to depression in men. Low levels of testosterone may manifest as feelings of being down, a lack of energy, and a general sense of flatness, which can resemble symptoms of depression. And not only are low testosterone levels correlated with depression, but certain disease risks as well. Low testosterone levels in men have been associated with increased cardiovascular disease risk. Further, low testosterone in men may increase men’s risk of developing metabolic syndrome and type 2 diabetes. 
On the other hand, high levels of testosterone may present as aggression, anger, and mood dysfunction, all of which can be symptoms of depression. Testosterone dysfunction can be modified through lifestyle changes.
Dr. Oliffe acknowledges that this research provides insight into the biological mechanisms that contribute to mental health disorders. However, he emphasizes that mental health is a complex and multifaceted issue influenced by various factors. Biological dysfunctions related to testosterone levels can interact with social constructs, life events, and other factors, leading to more significant mental health challenges.
For more information on the relationship between testosterone and overall health, please refer to these articles:
Social determinants of mental health
Social determinants play a prominent role in mental health outcomes. Individuals facing socioeconomic disadvantages are more likely to experience higher levels of stress, limited access to mental health services, and reduced opportunities for self-care and well-being. Health inequities play a critical role in mental well-being, as they can exacerbate existing disparities and impact individuals' access to resources and support systems.
In addition to masculine ideals discouraging men from seeking therapy due to fears of being perceived as weak or unmanly, social determinants of health can also influence men's rate of seeking therapy. For example, systemic factors such as inadequate access to mental health resources, cost concerns, and lack of representation of men's mental health issues in healthcare settings further contribute to lower rates of help-seeking in men. Addressing these social determinants is crucial in creating an environment that encourages and supports men in seeking therapy for their mental well-being.
How exercise promotes mental health
Exercise is key for mental health—both physiologically and socially, especially when men participate in activities that they enjoy. Not only does exercise offer numerous physiological benefits for mental health, it fosters connection. “From a social and from a physiological point of view, exercise can be really helpful for boosting mood, slowing things down, having a bit of self time to contemplate the day, and so forth,” says Dr. Oliffe. He also points to how building exercise into a routine can actually play to many masculine ideals around muscle and physical fitness—allowing men to be more self-reliant and strong. This gives men the chance to improve their physical health and mental health, while simultaneously fostering the sense of empowerment and resilience they desire.
Other lifestyle habits to promote mental health
There are many other lifestyle habits that men can adopt to protect their mental health. Dr. Oliffe names a few:
- Slowing down and reflecting: Everything can feel quick and disposable these days—like news feeds and online activity. Taking a bit of time out of your day to slow down can go a long way in terms of mental health.
- Strong social connections: Being in healthy relationships, both intimate partners and more widely with friends and family, is a pillar of mental health. Support systems play a large role in how one handles their emotions.
- Avoiding triggers: If aspects of your life trigger negativity, Dr. Oliffe advises to avoid them at all costs. Deconstructing triggers with the help of a professional can help better understand emotions as well.
Top tip to improve mental health
Dr. Oliffe’s top tip for improving mental health is to exercise, reflect, and slow down. He shares the value of his daily routine of going for a morning run, in which the most noteworthy aspect is the walk back home. He explains that walking home after finishing a run offers time to reflect and slow down, both of which are critical for mental wellbeing.
For mental health resources and information, please visit: