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Pharmacies: a lifeline for men

The pandemic has highlighted gender inequalities in health. Studies have shown that men are twice as likely to die from Covid-19 – three-quarters of those who die in intensive care being men. Men also continue to have a much higher rate of dying from suicide than women, with three to four times the risk. It remains to be seen whether that will further increase because of the devastation to lives and reduced access to mental health services during the pandemic.

Set in the heart of local communities, pharmacies can provide a lifeline to their male customers. “More than any other health outlet, pharmacies are uniquely placed to get health messages to men,” says Jim Pollard of the Men’s Health Forum. “Addressing men effectively could make a big difference to men’s health and your bottom line. Look at cancers that affect both men and women. Men are at twice the risk of dying – much the same ratio as for Covid-19. And we know that the risk of cancer, like Covid-19, can be reduced dramatically with a few simple behaviour changes.”

Numark OTC business development executive Cathy Crossthwaite adds: “As the new pharmacy contract is trying to drive pharmacies as the first port of call for customer health, pharmacies can try to target men who don’t like to visit their GP. With pharmacy, men have the option of browsing first, or visiting without having made an appointment, yet can still speak to someone about their health needs.”

Amo Sohal, Alphega member at Kitsons Pharmacy in Worcester, says: “It’s important men make use of our services to preventatively manage their health. Pharmacies need to create environments that support the ability of men to access healthcare efficiently, and provide services to treat them effectively.”

Men and Covid-19

We know that men are twice as likely to die from Covid-19 as women, and that men account for 62 per cent of Covid deaths in the under 85s. There are a range of biological as well as behavioural and lifestyle reasons for the increased risk:

  • Hormone differences. Women have a stronger immune system, thanks to oestrogen and prolactin, whereas testosterone is immunosuppressive
  • Coronavirus enters cells via the angiotensin converting enzyme 2 receptor, which is more highly expressed in men
  • Pre-existing chronic diseases – cardiovascular, respiratory, diabetes, hypertension - are an important risk factor for those with severe Covid disease. A higher proportion of men are affected by these conditions
  • Smoking and drinking increase the risk of respiratory and heart disease. On average in the UK, men drink five times as much alcohol as women
  • Men could be at increased risk because they tend to wash their hands less frequently
  • Men are more reluctant to seek help for health issues and more likely to downplay severity. A YouGov survey at the start of the pandemic found that 24 per cent of men believed Covid-19 was ‘just like flu’ compared to only 16 per cent of women. They were also less likely to believe government advice about taking steps to stop the virus spreading.

Male suicide facts

  • There were 6,507 suicides in the UK in 2018
  • 4,903 were men
  • The suicide rate rose by 10.9 per cent on 2017
  • Three-quarters of suicides among young people are men.

(Source: Samaritans)

How pharmacy can help

“One of the simplest things you can do is put up posters. Men are as confused about Covid-19 and what they should do as anyone else. Social distance-denying behaviour is a reflection of that,” says Jim Pollard. “Men coming in for prescriptions are a captive audience. What about the bag you put medicines in? You could give out Covid-19 information targeted at men with every prescription and sale.”

He suggests asking men if they need any other health information. “You can play an important triage role here,” he says. “There is some evidence men are more likely to see a GP on the advice of another health professional. This is doubly important at a time when there is evidence non-Covid conditions are being neglected.”

Social media is a great way to reach out to men. “If men are less likely to come to you, you need to go where they are (online) and show you know what they want and need.”

Men and mental health

In the UK and Ireland, men are three to four times more likely to die by suicide than women, while men living in deprived areas are up to 10 times more likely than men from more affluent areas, says Samaritans. In its report Preventing suicide among less well-off, middle-aged men, common themes are social disconnection and loneliness, and lack of purposeful activity, mainly through unemployment.

For the past two decades, men aged 40-59 have had the highest suicide rate in the UK. Rates rose during the 2008 recession and there are fears this may happen again post Covid-19. “We know that having a greater number of meaningful social connections can be key to reducing suicide. Relationship breakdown can heighten risk, and this seems to affect men more than women,” says a Samaritans spokesperson. “Evidence also suggests that men are more likely to self-medicate with substances to manage negative emotions – the risk of suicide is up to eight times greater when someone is abusing alcohol. Men are also less likely to seek help – either through informal routes like speaking to a friend or family member, or through formal routes, like seeing a counsellor or health professional.”

More than any other health outlet, pharmacies are uniquely placed to get health messages to men

Jim Pollard says that using the pandemic as a pretext gives pharmacists a real chance to talk to men about mental health. “There’s no reason why you shouldn’t ask someone how they are,” he says. “Ask if they’re feeling stressed, as it’s a more male-friendly way of asking about anxiety or worries.”

Samaritans has seen an increase in contacts about mental health issues among men during the pandemic. “If pharmacy staff are worried about someone and think they may benefit from seeking help, they can encourage them to call Samaritans for free on 116 123 day or night, or they can visit samaritans.org for online self-help tools and information,” says a Samaritans spokesperson.

Samaritans launched a new phase of its Real People, Real Stories campaign mid-August. This aims to reach men who are struggling to cope, and prevent them reaching crisis point. For details, visit www.samaritans.org/RealPeopleRealStories

Let’s talk about sex

An estimated 4.3 million men in the UK are affected by erection problems, and the market is valued at around £40m.

A study conducted for Viagra Connect found that only 4 per cent of men have sought help from a pharmacist, while 76 per cent feel too embarrassed to discuss it with one (31 per cent are too embarrassed to discuss it with anyone). “Changing this mentality to one where men are more open to discussing and seeking help is a big challenge, but once overcome, has huge benefits for men’s physical and emotional wellbeing,” says Rob Elliott, marketing director at maker Upjohn.

Until the start of lockdown, sales were skewed towards in-store. “Lockdown shifted a greater proportion of sales online and even with easing of lockdown, those online sales are being maintained,” he says.

However, Amo Sohal says erectile problems has been the biggest growth area in men’s health for Kitsons Pharmacy. “Men would rather purchase from us,” he says. “It may be more discrete online, but they understand it is safer to purchase from a pharmacy. We are seeing repeat purchases.”

Alongside TV advertising, Viagra Connect’s £8 million marketing campaign includes in-store tokens which men can pick up and take to the counter. “The tokens mean men don’t have to ask for Viagra Connect in front of other shoppers. We’ve developed training materials to help pharmacy staff feel confident and equipped to deal with anxious men who are embarrassed to talk about EPs, build trust and ultimately help them understand the potential causes and the treatment options available.”

Training resources include a CPD booklet to help staff initiate conversations and manage consultations, video e-learning modules and a consumer leaflet.

Significant opportunities

As a pharmacy only medicine, Viagra Connect has opened up a significant opportunity, believes Cathy Crossthwaite. She sees hair loss as another potential growth area. “It can start from OTC products such as shampoos to treat alopecia or Regaine to treat male pattern baldness,” she says. “These can be initial offerings to gauge customer feedback. If there is good uptake or customers seek further treatment then private PGDs to allow pharmacists to supply finasteride tablets are available.”

She advises creating a focus on healthcare, with a selection of toiletry lines to entice customers in. “Listening to the customer is especially important in men’s mental health issues as it’s a difficult conversation to start,” she says. “Point of sale is a great way to encourage conversation between healthcare professional and customer. Signpost to the pharmacy medicine bays behind the counter for sexual health and scalp treatment products not available on the shop floor.”

Amo Sohal adds this advice for improving your category: “Have more targeted public health campaigns and be proactive in targeting men with advice and support. Use social media platforms to reach your male customers.”

Prostate cancer signposting

Saheed Rashid, managing director of LDR brachytherapy specialists BXT Accelyon, outlines how to properly signpost men to seek prostate cancer guidance.

Prostate cancer is the most common cancer in UK men, with more than 47,500 diagnoses every year. The high profile stories of Stephen Fry and Bill Turnbull have prompted more men to get themselves checked for early warning signs, but more can be always done – particularly because of the trusted relationship between patients and their pharmacists.

Prostate cancer occurs mainly in older men – the average age for diagnosis is around 66. It’s more likely in men of African-Caribbean descent, and/or if a father or brother has had prostate cancer.

Different people have different symptoms. While some men have no symptoms at all, especially in the early stages, common symptoms of prostate cancer include:

  • Loss of bladder control
  • Pain in the back, hips, ribs or pelvis that doesn’t go away
  • Erectile dysfunction.

These signs may be caused by other conditions, such as adverse reactions to medicines or a prostate infection, but knowledge of symptomatology and prevalence will help pharmacy teams redirect men to their GP if there are concerns.

The prostate specific antigen (PSA) test screens for prostate cancer and is free to any well man over 50 who requests it. It’s a quick blood test that measures the level of the antigen in the blood. Typically, the higher the PSA level, the more likely a prostate problem is.

If the PSA test is abnormal, doctors may do more tests to diagnose prostate cancer, including a transrectal ultrasound, an MRI scan or a biopsy. If cancer is diagnosed, other tests will find out if the cancer cells have spread within the prostate or to other parts of the body. Survival rates tend to be much higher if the disease is caught early and hasn’t spread beyond the prostate.

It’s important for patients to be aware of all treatment options available, not just surgical removal, and their potential side effects, rather than opting for the first one discussed. Early diagnosis is key if men are to have the most options available to them. Acting on potential symptoms is therefore the vital first step.

Views from the P3pharmacy category panel

“Men are poor at accessing healthcare, so we try to reach out to as many as we can. When we do get them in, we tell them about relevant services such as weight management and stop smoking; they are often unaware of what we offer. Weight management is on the up - we offer a Lipotrim service – and men have been asking for extra support with medication since lockdown. Men ask about aches and pains; younger men also ask about supplements. Tap into the fact that men don’t come in much. Use social media to reach them instead.” Gareth Evans, Wansford Pharmacy, Peterborough

“Over the past decade interest in men’s health topics has increased considerably. We deal with mental health and erectile dysfunction queries daily, and we are only touching the surface in community pharmacy. Viagra is by far the biggest seller within men’s health. Patients are choosing to consult their community pharmacist rather than their GP. The pharmacy is an ideal setting for informal consultations.  Display units and advertising should be clear and simple; men’s health has been a taboo for many years and hidden away, but not anymore.” Selena Gill, Locum pharmacist, West Midlands

“In general, men do not come into the pharmacy themselves but send someone else.The most common queries are cold/flu symptoms, pain management, skin rashes, sexual health and vitamin/health supplements. The Viagra Connect launch changed everything. Men of all ages have been seeking advice around this and the potential underlying issues. This is a great way to discuss general health and wellbeing with male patients. We always ensure that any health promotion in the pharmacy aims at both genders.” Well Pharmacy, Hartlepool




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