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Porsche serves on the advisory board of the Men's Health Network, a Washington-based advocacy group lobbying for the Office of Men's Health. First introduced in Congress in 2001 and again in 2003, the Men's Health Act aims to create a national Office of Men's Health within the Department of Health and Human Services. This new health department, modeled on the Office of Women's Health, would promote men's health screenings and research on male-specific diseases.

People have misconceptions about men's health issues, said Porsche, associate dean for nursing research and evaluation at Louisiana State University in Baton Rouge. Although many research studies use men as test subjects, few are actually about men's health, he said.

"You don't hear anyone talking about men's access to health care," he said. Yet in reality, men are less likely than women to have health care access. Men are seen as the perpetrators of violence, Porsche said, yet they are more apt than women to be the victims of violence. Although breast cancer afflicts only a small percentage of men, they are more likely to die from it because there is less breast tissue for the cancer to spread.

Porsche has a long list of male health issues that need more research, including studies on how men express pain and depression. He'd like to see the goals of a national men's health agenda go beyond the obvious male health problems of testicular and prostate cancer. The life-expectancy gap, early detection of disease, healthy eating and the economic effects of men's health are some of the themes that need to be explored.

"The men's health movement is struggling like the women's health movement was a few decades ago," Porsche said.

Recruiting men

One way to win the struggle is to bring more men into the nursing profession.

"We're the role models," Porsche said. "We know how the system works."

Will Courtenay, Ph.D., LCSW, of the department of psychiatry at Harvard Medical School and the University of California, San Francisco, Medical School, founded Men's Health Consulting in Berkeley, Calif., to train health professionals in effective ways to make the system work for men.

Courtenay has identified six aspects of men's behavior that affect their health outcomes: health-promoting behavior, risk-taking behavior, physical abuse and violence, social support, behavioral responses to stress and health care use.

Courtenay, who is also the editor of The International Journal of Men's Health, has reviewed hundreds of studies dealing with male-specific health factors. Some of the research focuses on male behavior.

For example, researchers have found that men and boys are less likely than women to have a support system in times of illness or high stress. Men without a support system are two to three times more likely to die from illness than those who can count on family and friends. At the same time, men are more likely to deny illness and to use avoidance props, such as drugs and alcohol, to cope with illness.

Other studies turned up some differences in the way that health care providers treat men and women. Although men are more likely to engage in high-risk behaviors than women and less likely to embrace healthy lifestyle behaviors, they receive less advice from doctors during checkups than women. They're also less likely to be taught how to perform self-examinations for testicular cancer compared to women, who receive this instruction about breast cancer. One study that Courtenay reviewed showed that only 29 percent of doctors taught self-exam procedures to men, compared to 86 percent who provided instruction to women for performing breast self-exams.

Courtenay has developed a best-practices strategy for improving communication between clinicians and male patients. A key part of that strategy is for doctors and nurses to humanize the care experience. Men need to know that asking for help, admitting pain and expressing emotions are natural human behaviors.

Man to man

Although no one says female nurses cannot care for male patients effectively, at times, a man-to-man approach works best.

"We know that men interact differently in front of male clinicians than they do with a female," Courtenay said. "Men are less likely to admit pain to a woman clinician." Although it may seem sexist, he said, some men tend to assign more authority to male clinicians.