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Testosterone and trauma

By Paul Middleton - posted Monday, 18 June 2012

National Men’s Health Week kicked off on Monday last week to draw attention to the role of our environment on men’s health. With so many men and boys engaging in risky behaviour, there are some very good reasons for young men to stop and think about the way their behaviour impacts their future lives.

Australia ranks sixth in the world for life expectancy, with men reaching an average age of 78.9 and women 83.6. Yet, buried within this positive sounding statistic are valuable lessons about men, risk, youth and the way lives can be shattered by the combination of all three.

Trauma is the biggest killer of people under the age of 45, usually from devastating injury to the brain and spinal cord or catastrophic bleeding. As an emergency specialist I see the end result of trauma on a daily basis, and it is all too often paired with tragedy when young men are brought into Emergency Departments.


Data from the NSW Institute of Trauma and Injury Management shows that there has been a slight reduction in the number of deaths and injuries over the past few years however this reduction obscures some disturbing facts. The real cost of trauma is not only measured in the number of deaths but in the number of young Australians, particularly young men, who are sentenced to a lifetime of permanent disability. Among young drivers, injuries outnumber deaths almost 100 to 1.  

The Lifetime Care and Support Authority of NSW reported that three quarters of adults injured in motor vehicle accidents sustained a traumatic brain injury and a quarter sustained a spinal cord injury. The most common age groups to be injured in 2011 were males aged 16-25 years.

But it’s not only motor vehicle accidents that are decimating men, particularly those in the prime of their lives. Young men are at a greater risk than any other age groups of experiencing violence. In a 2005 survey, 12% of people aged 18-24 years reported being physically assaulted by a man during the last 12 months. The proportion of men aged 18-24 years who reported physical assault by another male was almost five times as high as the rate for men aged over 25, and of these, most reported being attacked by a stranger, most frequently at licensed premises by a perpetrator who had been drinking alcohol or taking drugs. Just over one-third said that they had been drinking or taking drugs themselves.

Alcohol is another factor that cannot be ignored when discussing risky behaviour among young males. Swimming whilst under the influence of alcohol has increased, according to the 2010 National Drug Strategy, and almost 10% of all accidental spinal cord injuries in Australia are caused by diving or jumping into water and surfing. Three-quarters of such accidents happen to people under the age of 35 and all of the victims are male.

This litany of statistics points to the question whether there is something about being male that makes us so prone to harm, and National Men’s Week is an appropriate time to look into this.

It could be argued that being male, or at least being masculine, may have a damaging impact on men's health and their likelihood of seeking healthcare. In the US, men make 134.5 million fewer physician visits than women each year and a quarter of the men aged 45 to 60 do not have a personal doctor. Reasons men give for not having annual check-ups and not visiting their doctor include fear, denial, embarrassment, and a dislike of situations out of their control. It has been shown that even if health problems were likely to have negative consequences if ignored, many men still delayed seeking medical help.


The conclusion that can be drawn from this is that the combination of youth, with its agenda of discovery and experimentation, and being male, with its fixation on bravado behaviour, often form a destructive and self-reinforcing combination.

The difference between the risk factors, however, is that although being young and inexperienced will often lead to misjudgement and inaccurate estimation of risk and consequences, being stereotypically male may not be so easy to alter. While car advertisements still feature leggy models hopping into high-powered coupes driven by craggy outlaw types, and young boys obsess about driving a fat-tyred Holdens round a racetrack, we are still a very long way from reducing risky behaviour in particular, the impact of testosterone on trauma. This week is an opportunity for men, particularly young men, to reassess their behaviours and think about whether they can avoid meeting me at the thorny end of their adventures in ED.

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About the Author

Associate Professor Paul Middleton is a specialist in emergency medicine. He is Chair of the NSW branch of the Australian Resuscitation Council and works as a Visiting Medical Officer in Emergency Departments of major hospitals in NSW and ACT.

He is Director of the Australian Institute for Clinical Education which teaches doctors and nurses how to treat serious illness and injury. He is the author of What To Do When Your Child Gets Sick, published by Allen and Unwin.

Other articles by this Author

All articles by Paul Middleton

Creative Commons LicenseThis work is licensed under a Creative Commons License.

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