Longevity for Men: The Male-Specific Aging Timeline and What to Do About It
In the United States, men's life expectancy at birth was 76.5 years in 2024, 4.9 years shorter than women's (CDC National Center for Health Statistics). Explanations range from biology to behaviour; this guide covers what is known about each and what men can act on.
- Women outlive men but report more illness late in life, a pattern researchers call the mortality-morbidity paradox.1 In the United States, men are more likely than women to adopt beliefs and behaviours that raise their risks and less likely to engage in behaviours linked to health and longevity.5
- Testosterone falls with age: in the Baltimore Longitudinal Study of Aging, low levels by total-testosterone criteria affected about 20% of men over 60, 30% over 70 and 50% over 80.6 The Endocrine Society recommends diagnosing low testosterone only when symptoms and signs accompany unequivocally and consistently low levels.7
- Cardiovascular disease develops 7 to 10 years later in women than in men.8 In a large US study, coronary calcium scores predicted coronary events beyond standard risk factors in all four ethnic groups studied.2
- Cancer screening follows age-based recommendations: the USPSTF advises an individual decision about PSA testing at ages 55 to 69 and recommends against it from 70, recommends against screening for testicular cancer, and recommends colorectal cancer screening from 45 to 75 (prostate, testicular and colorectal recommendations).
- Having a regular clinician and keeping up with recommended screenings are practical ways to act on the behavioural side of the gap.
A 2000 analysis noted that US men had higher death rates than women for all 15 leading causes of death, and argued that beliefs and behaviours tied to masculinity contribute to the gap.5 Biology plays a part too: in animal populations, evolutionary explanations for sex differences in lifespan include differing exposure to environmental hazards, sexual selection and patterns of parental care.1
Cardiovascular Risk Comes Earlier in Men
Cardiovascular disease develops 7 to 10 years later in women than in men.8 Coronary calcium scans can show plaque before symptoms: in the MESA study of 6,722 adults without heart disease, a calcium score of 101 to 300 went with 7.7 times the risk of a coronary event compared with no calcium, each doubling of the score raised the risk of a major coronary event by 15% to 35%, and the score added predictive information beyond standard risk factors in all four ethnic groups.2 Whether a scan is worthwhile for you depends on your overall risk, so it is a question to discuss with a clinician.
The American Heart Association's Life's Essential 8 brings the main cardiovascular measures, from blood pressure, cholesterol and blood sugar to activity, sleep and smoking, into one score; you can calculate yours with our Life's Essential 8 calculator.
Testosterone and Age
In the Baltimore Longitudinal Study of Aging, total testosterone and the free testosterone index both declined with age in healthy men, and by total-testosterone criteria, low levels affected about 20% of men over 60, 30% over 70 and 50% over 80.6 Separately, a Boston study found an age-independent fall in testosterone across birth cohorts, larger than the declines usually attributed to age and not explained by smoking or obesity.3
The Endocrine Society recommends measuring fasting morning total testosterone with an accurate assay, confirming a low result with a repeat measurement, adding free testosterone when total testosterone is near the lower limit or binding proteins are altered, and evaluating the cause once deficiency is confirmed; it recommends diagnosing hypogonadism only when symptoms and signs accompany unequivocally and consistently low levels.7 In the TRAVERSE trial of 5,246 men with symptoms of hypogonadism and existing or high cardiovascular risk, testosterone was noninferior to placebo for major cardiovascular events, while atrial fibrillation, acute kidney injury and pulmonary embolism were more common with testosterone.9
Prostate Health: The Male-Specific Cancer Challenge
PSA testing has limited specificity for prostate cancer, and refinements such as PSA density and PSA velocity have been studied as adjuncts.4 The USPSTF recommends that men aged 55 to 69 make an individual decision about PSA screening after discussing its potential benefits and harms with a clinician, and recommends against PSA screening from age 70; the recommendation is being updated (USPSTF).
The Healthcare Engagement Intervention
Practical steps for the behavioural side of the gap include establishing care with a primary care clinician before problems arise and keeping up with the screenings recommended for your age, such as colorectal cancer screening from 45 (USPSTF).
Put this research into practice: What Should I Test Next? · Build Your Longevity Protocol
References
- 1Austad SN, Fischer KE. "Sex Differences in Lifespan." Cell Metab. 2016;23(6):1022-1033. PubMed · DOI
- 2Detrano R, et al. "Coronary calcium as a predictor of coronary events in four racial or ethnic groups." N Engl J Med. 2008;358(13):1336-45. PubMed · DOI
- 3Travison TG, et al. "A population-level decline in serum testosterone levels in American men." J Clin Endocrinol Metab. 2007;92(1):196-202. PubMed · DOI
- 4Loeb S, Catalona WJ. "Prostate-specific antigen in clinical practice." Cancer Lett. 2007;249(1):30-9. PubMed · DOI
- 5Courtenay WH. "Constructions of masculinity and their influence on men's well-being: a theory of gender and health." Soc Sci Med. 2000;50(10):1385-401. PubMed · DOI
- 6Harman SM, et al. "Longitudinal effects of aging on serum total and free testosterone levels in healthy men. Baltimore Longitudinal Study of Aging." J Clin Endocrinol Metab. 2001;86(2):724-31. PubMed · DOI
- 7Bhasin S, et al. "Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline." J Clin Endocrinol Metab. 2018;103(5):1715-1744. PubMed · DOI
- 8Maas AH, Appelman YE. "Gender differences in coronary heart disease." Neth Heart J. 2010;18(12):598-602. PubMed · DOI
- 9Lincoff AM, et al. "Cardiovascular Safety of Testosterone-Replacement Therapy." N Engl J Med. 2023;389(2):107-117. PubMed · DOI
