Men's Health: An Overview

Last updated 1 Jun 2026 · Men's Health

📋 Key Information Summary

📋

Heart disease, lung cancer, suicide, and road-traffic injuries remain the leading causes of death in Australian males across most age groups; suicide is the leading cause of death in men aged 15–44 years (AIHW 2023).
Australian men die on average 4.1 years earlier than women, with a life expectancy of 81.3 years versus 85.4 years (ABS 2023).
Androgen deficiency (total testosterone <8 nmol/L or 8–12 nmol/L with symptoms) requires confirmation with an early-morning fasting sample and repeat testing before initiating treatment.
First-line testosterone replacement is testosterone undecanoate oral (Andriol®) 160–240 mg/day with food, or intramuscular testosterone undecanoate (Reandron 1000®) 1000 mg every 10–14 weeks — PBS Authority Required for confirmed pathological hypogonadism.
Prostate-specific antigen (PSA) and digital rectal examination (DRE) must be checked before and during testosterone therapy; testosterone is contraindicated in known prostate or breast carcinoma.
Male osteoporosis accounts for approximately 30% of all fragility fractures in Australia; vertebral fractures in men carry a one-year mortality rate of up to 20%, exceeding that in women.
DEXA (MBS item 12320) is recommended for men ≥70 years, or ≥50 years with clinical risk factors (glucocorticoid use, hypogonadism, alcohol excess, prior fragility fracture).
First-line pharmacotherapy for male osteoporosis is alendronate 70 mg PO weekly (PBS authority required); zoledronic acid 5 mg IV annually is an alternative for intolerance or non-response.
X-linked conditions including haemophilia A (factor VIII deficiency), haemophilia B (factor IX deficiency), Duchenne and Becker muscular dystrophies, red-green colour vision deficiency, and G6PD deficiency predominantly affect males and require early recognition and genetic counselling.
Carrier testing and prenatal genetic counselling should be offered to at-risk families for all X-linked conditions; referral to a clinical genetics service is available through state-based Genetic Health Services.
Aboriginal and Torres Strait Islander males have a life expectancy 8.6 years lower than non-Indigenous males; culturally safe, longitudinal primary care engagement is essential to address the burden of chronic disease, mental health, and injury.

Introduction & Australian Epidemiology

Men's health encompasses a broad range of conditions that disproportionately or exclusively affect males across the lifespan. In Australian general practice, men present less frequently than women — on average 30% fewer consultations per year — yet experience higher rates of premature mortality, chronic disease burden, and preventable hospitalisation (AIHW 2023).

The Australian Institute of Health and Welfare (AIHW) reports that males account for 51% of the population but 62% of all deaths. Life expectancy at birth for Australian males is 81.3 years compared with 85.4 years for females (ABS 2023). This gap is driven by cardiovascular disease, cancers (particularly lung, colorectal, and prostate), suicide and self-harm, chronic respiratory disease, and road-traffic injuries.

Key modifiable risk factors include smoking (11.6% of Australian males smoke daily), harmful alcohol consumption (25% exceeding lifetime risk guidelines), physical inactivity (55% not meeting guidelines), overweight and obesity (75% of males with BMI ≥25), and poor mental health help-seeking behaviour (National Men's Health Strategy 2020–2030).

This article provides an overview of four core men's health topics relevant to Australian primary care: causes of death by age group, androgen deficiency, male osteoporosis, and sex-linked inherited disorders.

Main Causes of Death by Age Group — Australian Males

Understanding the leading causes of death at each life stage is essential for targeted preventive health in general practice. The AIHW Burden of Disease and Causes of Death reports provide the most current Australian data.

Age Group	Rank 1	Rank 2	Rank 3	Key GP Action
0–14 years	Congenital anomalies	Perinatal conditions	Accidents / injury	Newborn screening, child health checks, injury prevention
15–24 years	Suicide & self-harm	Road-traffic injury	Drug-related death	Mental health screening (PHQ-9, K10), HEdS brief intervention
25–44 years	Suicide & self-harm	Drug-related death	Ischaemic heart disease	CVD risk assessment (MBS item 701, 703, 705–707), mental health care plans
45–64 years	Ischaemic heart disease	Lung cancer	Suicide & self-harm	Absolute CVD risk (Framingham), lung cancer screening eligibility, bowel screening
65–74 years	Ischaemic heart disease	Lung cancer	COPD	Smoking cessation, lipid management, spirometry, National Bowel Cancer Screening
≥75 years	Ischaemic heart disease	Dementia / Alzheimer's	Cerebrovascular disease	Stroke risk (CHA₂DS₂-VASc), frailty screening, advance care planning

⚠️

Suicide is the leading cause of death in Australian men aged 15–44. Men account for approximately 75% of all suicides in Australia. Low rates of help-seeking mean GPs are often the first and only clinical contact. Always screen with the PHQ-9, ask directly about suicidal ideation, and develop a safety plan. Refer to crisis services (Lifeline 13 11 14, Beyond Blue 1300 22 4636) as indicated.

Cardiovascular Disease

Ischaemic heart disease is the leading single cause of death in Australian males from age 45 onwards. The National Vascular Disease Prevention Alliance (NVDPA) Absolute Cardiovascular Disease Risk (CVD) Calculator should be used for all men ≥45 years (or ≥30 years for Aboriginal and Torres Strait Islander men). Assessment includes fasting lipids, blood pressure, HbA1c, eGFR, smoking status, and family history (MBS Health Assessment items 701, 703, 705–707).

Cancer

Prostate cancer is the most commonly diagnosed cancer in Australian males (estimated 25,000 new cases in 2023), while lung cancer remains the leading cause of cancer death. Colorectal cancer is the second most common cancer in men; the National Bowel Cancer Screening Program (NBCSP) provides free faecal immunochemical testing (FIT) biennially to Australians aged 50–74. Lung cancer screening with low-dose CT (LDCT) is recommended for high-risk individuals aged 50–74 with ≥20 pack-year smoking history (Cancer Council Australia 2023).

Chronic Respiratory Disease

COPD is the fifth leading cause of death in Australian men. Spirometry is essential for diagnosis in symptomatic patients or those with significant smoking history (≥10 pack-years). Management follows COPD-X guidelines with smoking cessation as the single most effective intervention.

Preventive Health Interventions in General Practice

Opportunistic screening

Offer 45–49 year health checks, 75+ health assessments, and Aboriginal and Torres Strait Islander health checks (MBS items 715) to engage men in care.

Absolute CVD risk assessment

Use the NVDPA calculator for all men ≥45 (≥30 for ATSI). Consider lipid-lowering therapy at ≥5% absolute 5-year risk per current PBS criteria.

Cancer screening

Bowel screening (50–74), skin checks (clinical examination), prostate cancer discussion (PSA shared decision-making from age 50, or 40 with family history).

Mental health and alcohol

Use AUDIT-C for alcohol screening. Establish GP Mental Health Treatment Plans (MBS items 2715, 2717) for men with depression or anxiety.

Androgen Deficiency

Definition and Epidemiology

Androgen deficiency (hypogonadism) is defined biochemically as a sustained reduction in serum testosterone below the normal reference range, associated with characteristic symptoms and signs. The Endocrine Society of Australia and the Australasian chapter of Sexual Health Medicine define androgen deficiency as a total testosterone consistently <8 nmol/L, or 8–12 nmol/L with elevated sex hormone-binding globulin (SHBG) and symptoms consistent with hypogonadism. Prevalence in Australian men aged 40–80 years is estimated at 6–12%, increasing with age, obesity, type 2 diabetes, and chronic illness.

Aetiology

Category	Examples	Typical FSH/LH
Primary (hypergonadotropic)	Klinefelter syndrome (47,XXY), bilateral orchitis, testicular torsion, chemotherapy/radiotherapy, cryptorchidism	↑↑ FSH, ↑↑ LH
Secondary (hypogonadotropic)	Kallmann syndrome, pituitary adenoma, hyperprolactinaemia, chronic opioid use, haemochromatosis, obesity-related hypogonadism	↓ or inappropriately normal FSH/LH
Late-onset / age-related	Combined testicular and hypothalamic-pituitary decline; multifactorial with comorbid obesity, T2DM, metabolic syndrome	Variable

Clinical Presentation

Symptoms are often insidious and non-specific, contributing to under-diagnosis. Key features include:

Sexual: Reduced libido, erectile dysfunction, reduced frequency of morning erections
Physical: Fatigue, decreased muscle mass and strength, increased visceral adiposity, reduced body hair, gynaecomastia, hot flushes
Psychological: Low mood, irritability, poor concentration, reduced motivation
Reproductive: Infertility, small testes (volume <15 mL on Prader orchidometry)

Diagnostic Approach

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Diagnosis requires BOTH biochemical confirmation AND clinical symptoms. A low testosterone in an asymptomatic patient does not warrant treatment.

Measure total testosterone

Early morning (08:00–10:00), fasting sample. Avoid sampling during acute illness.

Confirm with repeat

If total testosterone <12 nmol/L, repeat with LH, FSH, SHBG, prolactin, and calculated free testosterone.

Identify cause

If confirmed low: LH/FSH differentiate primary from secondary. Consider pituitary MRI if secondary hypogonadism. Check iron studies (haemochromatosis), karyotype if clinically indicated.

Exclude contraindications

PSA and DRE before treatment. Contraindicated in prostate or breast carcinoma, untreated severe OSA, uncontrolled heart failure, polycythaemia (Hct >0.54).

Investigations

Essential Total testosterone (fasting, early AM) Repeat if abnormal. Medicare rebate available.

Essential LH, FSH, SHBG, prolactin To classify primary vs secondary hypogonadism

Essential PSA and DRE Before initiating testosterone therapy

Available Calculated free testosterone Useful when SHBG abnormal (obesity, liver disease, ageing)

Available Iron studies, ferritin Exclude haemochromatosis as cause of secondary hypogonadism

Available FBC (haematocrit) Baseline before treatment; monitor for polycythaemia

Specialist Pituitary MRI If secondary hypogonadism with elevated prolactin or other pituitary hormone abnormality

Specialist Karyotype If Klinefelter syndrome suspected (tall stature, small firm testes, gynaecomastia)

Testosterone Replacement Therapy

Treatment is indicated only in men with confirmed pathological hypogonadism — not for age-related decline in the absence of symptoms or for the treatment of erectile dysfunction when testosterone levels are normal.

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Testosterone undecanoate (oral)

Andriol® · Testocaps · Oral androgen

Adult dose 120–160 mg PO daily in divided doses with food (initial); maintenance 40–120 mg/day

Renal adjustment No specific adjustment; use with caution in fluid retention

Hepatic adjustment Contraindicated in severe hepatic impairment

PBS status 🔶 PBS Authority Required — for documented pathological hypogonadism

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Testosterone undecanoate (IM)

Reandron 1000® · Intramuscular depot androgen

Adult dose 1000 mg IM gluteal, then repeat at 6 weeks, then every 10–14 weeks

Renal adjustment No specific adjustment

Hepatic adjustment Use with caution

PBS status 🔶 PBS Authority Required — for documented pathological hypogonadism

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Testosterone (transdermal gel)

Testogel® 1% · Topical androgen

Adult dose 50 mg (5 g gel) applied to shoulders/upper arms daily; titrate 25–100 mg/day based on levels

Paediatric dose Not indicated in paediatric males

Key caution Risk of transfer to women and children via skin contact. Cover application site; wash hands thoroughly.

PBS status 🔶 PBS Authority Required

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Testosterone monitoring protocol: Check testosterone level (mid-cycle for injections), haematocrit, PSA, and lipids at 3–6 months after initiation, then annually. Discontinue if Hct >0.54, PSA rises >1.4 ng/mL above baseline within 12 months, or if prostate cancer is diagnosed.

When to Refer

Suspected secondary hypogonadism requiring pituitary evaluation
Klinefelter syndrome or other genetic aetiology
Young men (<40 years) with infertility — testosterone therapy suppresses spermatogenesis; referral to reproductive endocrinology for alternatives (clomiphene, gonadotrophins)
Persistent symptoms despite adequate testosterone replacement

Osteoporosis in Men

Australian Burden

Osteoporosis is under-recognised in men. Approximately 30% of all fragility fractures in Australia occur in males, yet only 10–20% of men with a hip fracture receive investigation or treatment for osteoporosis (Osteoporosis Australia 2023). One-year mortality following hip fracture is higher in men (33%) than women (20%). An estimated 400,000 Australian men have osteoporosis, and a further 1.5 million have osteopenia (ABS National Health Survey).

Aetiology

Male osteoporosis is classified as:

Primary: Age-related bone loss (senile osteoporosis) and idiopathic (rare, typically <50 years)
Secondary: Accounts for 40–60% of cases. Common causes include hypogonadism, glucocorticoid excess (iatrogenic or Cushing's), alcohol excess (>4 standard drinks/day), hypogonadism, chronic liver or kidney disease, hyperparathyroidism, coeliac disease, androgen deprivation therapy for prostate cancer, and smoking

⚠️

Always exclude secondary causes in male osteoporosis. Investigations should include serum calcium, phosphate, ALP, 25-hydroxyvitamin D, PTH, testosterone (early AM, fasting), TSH, coeliac serology (tTG-IgA), liver function, eGFR, serum and urine protein electrophoresis, FBC, and a 24-hour urinary calcium.

Risk Assessment

DEXA (bone densitometry) is indicated for all men ≥70 years (MBS item 12320). For men aged 50–69 years, DEXA is indicated if one or more clinical risk factors are present:

Prior fragility fracture (minimal trauma fracture from standing height or less)
Current or prolonged glucocorticoid use (≥3 months of prednisolone ≥5 mg/day equivalent)
Hypogonadism (confirmed or on testosterone therapy)
Hypogonadism secondary to androgen deprivation therapy
Chronic alcohol excess, rheumatoid arthritis, untreated hyperthyroidism, chronic liver or kidney disease, coeliac disease, primary hyperparathyroidism
Parental hip fracture history
BMI <19 kg/m² or significant weight loss

The FRAX® tool (Fracture Risk Assessment Tool) can be used without DEXA for initial risk stratification in men aged 40–90 years, incorporating clinical risk factors to estimate 10-year probability of major osteoporotic fracture and hip fracture.

Pharmacological Management

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Alendronate

Fosamax® · Fosamax Plus® (with cholecalciferol) · Bisphosphonate

Adult dose 70 mg PO once weekly, on empty stomach with 200 mL water, 30 min before food/other medications, remain upright for 30 min

Renal adjustment Contraindicated if eGFR <35 mL/min

Duration Reassess at 3–5 years; consider drug holiday if fracture risk reassessed as lower

PBS status 🔶 PBS Authority Required — for established osteoporosis with prior minimal trauma fracture OR T-score ≤−3.0 at hip or spine

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Zoledronic acid

Aclasta® · IV bisphosphonate

Adult dose 5 mg IV infusion over ≥15 minutes, once yearly

Renal adjustment Contraindicated if eGFR <35 mL/min

Duration 3–5 years then reassess; possible drug holiday

PBS status 🔶 PBS Authority Required — when oral bisphosphonates not tolerated or contraindicated

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Denosumab

Prolia® · RANKL inhibitor

Adult dose 60 mg SC every 6 months

Renal adjustment Safe in renal impairment (no renal excretion); however, monitor calcium

Key caution Must not be discontinued without transition to a bisphosphonate — rapid bone loss and rebound vertebral fractures may occur

PBS status 🔶 PBS Authority Required — when bisphosphonates contraindicated, not tolerated, or eGFR <35 mL/min

Non-Pharmacological Measures

Calcium: Dietary target 1000–1300 mg/day; supplements only if dietary intake inadequate
Vitamin D: Maintain serum 25(OH)D ≥50 nmol/L. Cholecalciferol 1000–2000 IU daily as supplement; higher loading doses may be required for deficiency (<25 nmol/L)
Exercise: Weight-bearing and resistance exercise for ≥30 minutes on most days; progressive resistance training improves BMD and reduces fall risk
Smoking cessation and alcohol moderation
Fall prevention: Home hazard assessment, balance training, review of medications contributing to falls (sedatives, antihypertensives)

Sex-Linked Inherited Disorders

Sex-linked (X-linked) disorders are caused by mutations on the X chromosome. Because males have only one X chromosome (46,XY), a single pathogenic allele is sufficient to cause disease. Females (46,XX) are usually carriers, though variable X-inactivation (lyonisation) can produce mild or occasionally significant clinical features in carriers. The following conditions are most relevant to Australian primary care.

Haemophilia A and B

Feature	Haemophilia A	Haemophilia B
Deficient factor	Factor VIII (FVIII)	Factor IX (FIX)
Incidence	~1 in 5,000 male births	~1 in 30,000 male births
Gene location	Xq28	Xq27
Severity grading	Severe (<1% FVIII activity), Moderate (1–5%), Mild (5–40%)	Same severity grading by FIX level
Presentation	Severe: spontaneous joint/muscle bleeds from infancy; Mild: prolonged bleeding post-surgery/trauma	Similar but generally milder phenotype
Diagnosis	Prolonged aPTT, normal PT/INR; low FVIII activity	Prolonged aPTT; low FIX activity
Treatment	Factor VIII replacement (recombinant preferred); emicizumab for prophylaxis	Factor IX replacement (recombinant preferred)
Haemophilia treatment centres	All Australian states have a Haemophilia Treatment Centre (Australian Haemophilia Centre Directors' Organisation — AHCDO)

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Carrier testing: Females at risk of being carriers should be offered factor level testing and/or genetic testing. Prenatal diagnosis via chorionic villus sampling (CVS) or amniocentesis is available through Genetic Health Services Australia. Carrier females may have low enough factor levels to bleed during surgery or childbirth and should be managed in consultation with a haemophilia centre.

Duchenne and Becker Muscular Dystrophy

Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD) are X-linked recessive disorders caused by mutations in the DMD gene (Xp21.2), encoding dystrophin.

Feature	Duchenne (DMD)	Becker (BMD)
Incidence	~1 in 3,500 male births	~1 in 18,000 male births
Mutation type	Frameshift (out-of-frame deletions/duplications); absent dystrophin	In-frame deletions; reduced or partially functional dystrophin
Onset	2–5 years: delayed walking, Gowers' sign, waddling gait, calf pseudohypertrophy	Variable; may present in childhood or adulthood
Ambulation loss	Usually by age 10–12 years	May retain ambulation into adulthood
Cardiac involvement	Dilated cardiomyopathy universal by teenage years	Cardiomyopathy in 50–70%; may be presenting feature
Diagnosis	CK markedly elevated (10–100× normal); genetic testing (MLPA); muscle biopsy if genetic testing inconclusive	CK elevated; genetic testing confirms
Management	Multidisciplinary: corticosteroids (prednisolone 0.75 mg/kg/day or deflazacort), cardiac monitoring, respiratory support, physiotherapy, orthopaedic management. Referral to neuromuscular clinic.	Cardiac surveillance (echo + MRI from diagnosis), physiotherapy, genetic counselling

⚠️

Newborn screening for DMD: While not yet part of the national Newborn Bloodspot Screening Programme, pilot programmes are being evaluated. Early diagnosis enables timely corticosteroid initiation, cardiac surveillance, and access to emerging gene therapies. Newborn screening for DMD has been implemented in some international programmes (e.g., New York State, USA). Australian families at risk should be referred to Genetic Health Services and neuromuscular clinics.

Red-Green Colour Vision Deficiency

The most common X-linked condition, affecting approximately 8% of Australian males of European descent and 4–5% overall. It is a benign condition but has implications for occupational requirements (e.g., defence force, aviation, electrical trades). Diagnosis is by Ishihara plates or anomaloscopy. No treatment is available. Genetic counselling is offered for carrier females.

Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency

G6PD deficiency is an X-linked enzymopathy affecting ~400 million people worldwide. Prevalence is highest in people of African, Mediterranean, Middle Eastern, and Southeast Asian descent. In Australia, it is relevant in migrants from endemic regions and in Aboriginal and Torres Strait Islander communities. Affected males are hemizygous; females may be heterozygous carriers with variable enzyme activity.

Clinical features include neonatal jaundice and acute haemolytic anaemia triggered by oxidant drugs (dapsone, primaquine, sulfonamides, rasburicase), fava beans, and infections. Diagnosis is by quantitative G6PD enzyme assay (avoid testing during acute haemolysis as reticulocytes have higher G6PD activity, producing false-normal results). Management is primarily avoidance of triggers. Australian newborn screening does not currently include G6PD, but targeted screening is recommended for at-risk populations.

Genetic Counselling and Referral

All families affected by X-linked conditions should be offered referral to a Clinical Genetics service (available in all Australian states and territories)
Carrier testing using molecular genetic analysis should be offered to at-risk female relatives
Prenatal options include CVS (11–13 weeks), amniocentesis (≥15 weeks), and preimplantation genetic testing (PGT) with IVF
Newborn screening (heel-prick) does not currently include haemophilia or DMD nationally; clinical suspicion warrants immediate referral
Genetic counsellors are available through public hospital genetics departments and privately (Human Genetics Society of Australasia — HGSA directory)

Special Populations

🧒 Paediatrics

Haemophilia: Suspect in boys with prolonged bleeding after circumcision, unexplained bruising, or haemarthrosis before ambulation. Refer to a paediatric haematologist at a Haemophilia Treatment Centre.

Duchenne MD: Gowers' sign, toe-walking, speech delay, and elevated CK on incidental testing in boys aged 2–5 should prompt urgent referral to paediatric neurology.

Testosterone: In boys with constitutional delay of growth and puberty, short-course low-dose testosterone (testosterone enanthate 50 mg IM monthly for 3–6 months) may be used under endocrine supervision to initiate puberty — not the same as treatment of pathological hypogonadism.

👴 Elderly Men

Osteoporosis: All men ≥70 years qualify for DEXA (MBS item 12320). Bisphosphonate-related osteonecrosis of the jaw (BRONJ) risk increases with age; dental review before initiation is advised.

Androgen deficiency: Late-onset hypogonadism overlaps with multimorbidity; treat modifiable contributors (obesity, diabetes, opioids) before initiating testosterone. Shared decision-making is essential.

Falls prevention: Review benzodiazepines, antihypertensives, and anticholinergics. Refer to community falls prevention programmes (e.g., Stepping On).

🫘 Renal Impairment

Bisphosphonates: Contraindicated if eGFR <35 mL/min. Denosumab is the preferred anti-resorptive agent in CKD stages 4–5 (monitor serum calcium closely — hypocalcaemia risk).

Testosterone: Use with caution; fluid retention may worsen hypertension. Monitor haematocrit and blood pressure.

🫁 Hepatic Impairment

Testosterone: Oral testosterone undecanoate (Andriol®) has lower hepatotoxicity risk than older 17α-alkylated androgens. Avoid oral testosterone in severe hepatic impairment. Transdermal or IM formulations are preferred.

Osteoporosis: Chronic liver disease is a secondary cause — investigate and manage the underlying liver condition alongside osteoporosis treatment.

🛡️ Immunocompromised

Haemophilia: Patients on emicizumab (prophylaxis for haemophilia A) should avoid live vaccines if concurrent immunosuppressive therapy is used. Coordinate with haemophilia treatment centre.

Men on androgen deprivation therapy (ADT) for prostate cancer: Have significantly accelerated bone loss (5–10% per year at the hip). DEXA at baseline and every 1–2 years during ADT. Treat with bisphosphonates or denosumab if T-score ≤−2.0 or fragility fracture occurs.

Aboriginal and Torres Strait Islander Health Considerations

Aboriginal and Torres Strait Islander Health

Aboriginal and Torres Strait Islander males experience a disproportionate burden of disease and premature death across every domain covered in this article. Life expectancy for Indigenous Australian males is approximately 71.6 years — 8.6 years less than non-Indigenous males (AIHW 2023). The gap is greatest in the 35–64 age group, where chronic disease, injury, and mental health conditions converge.

Life expectancy gap

8.6 years lower than non-Indigenous males. Heart disease, diabetes, and chronic kidney disease are the largest contributors (AIHW 2023).

Cardiovascular disease

Indigenous Australians are 1.6× more likely to have cardiovascular disease. CVD risk assessment should commence at age 30 (rather than 45) using the NVDPA calculator with an Indigenous-specific risk adjustment.

Diabetes

Type 2 diabetes prevalence is 3–4× higher. Testosterone deficiency is common in the context of poorly controlled T2DM and obesity — screening should be integrated into chronic disease management.

Renal disease

End-stage kidney disease rates are 6× higher in Indigenous Australians. This impacts bisphosphonate use for osteoporosis (eGFR-dependent); denosumab may be preferred. Testosterone monitoring must include renal function.

Mental health and suicide

Indigenous males have suicide rates 2.5× higher than non-Indigenous males, with the peak in the 15–34 year age group. Social determinants — intergenerational trauma, racism, incarceration, housing, and employment — must be addressed alongside clinical care.

G6PD deficiency

Higher prevalence in Aboriginal and Torres Strait Islander communities. Ensure G6PD testing before prescribing oxidant drugs (dapsone, primaquine). Malaria prophylaxis choice may be affected.

Remote access

Specialist services (haematology, endocrinology, genetics) are concentrated in major cities. Telehealth (MBS items 99200–99215), RFDS retrieval, and Aboriginal Community Controlled Health Organisations (ACCHOs) are critical for equitable access. Long-acting injectable testosterone (Reandron) may be preferred in remote settings to reduce clinic attendance frequency.

Cultural safety

Men's health discussions require cultural sensitivity and may involve family and community Elders. Indigenous male health workers and the Close the Gap campaign framework support engagement. MBS Indigenous Health Assessment (item 715) provides a structured entry point.

📚 References

1. Australian Institute of Health and Welfare (AIHW). Deaths in Australia. Cat. no. PHE 229. Canberra: AIHW; 2023.
2. Australian Bureau of Statistics (ABS). Life Tables, 2020–2022. Cat. no. 3302.0.55.001. Canberra: ABS; 2023.
3. Australian Government Department of Health. National Men's Health Strategy 2020–2030. Canberra: Commonwealth of Australia; 2019.
4. Grossmann M, Zajac JD. Management of testosterone deficiency in men. Med J Aust. 2018;209(2):82–87.
5. Yeap BB, Grossmann M, McLachlan RI, et al. Endocrine Society of Australia position statement on male hypogonadism. Med J Aust. 2016;205(2):71–73.
6. Osteoporosis Australia. Know Your Bones — Clinical Guide to Osteoporosis in Men. Sydney: Osteoporosis Australia; 2023.
7. Australian and New Zealand Bone and Mineral Society (ANZBMS). Clinical Guideline for the Prevention and Treatment of Osteoporosis in Adults. Updated 2023.
8. Royal Australian College of General Practitioners (RACGP). Guidelines for Preventive Activities in General Practice (Red Book). 9th edn. Melbourne: RACGP; 2018 (updated 2023).
9. National Vascular Disease Prevention Alliance (NVDPA). Guidelines for the Management of Absolute Cardiovascular Disease Risk. 2012 (current calculator endorsed by RACGP, NHF, Cardiac Society ANZ).
10. Australian Haemophilia Centre Directors' Organisation (AHCDO). Guidelines for the Management of Haemophilia in Australia. 2020.
11. Birnkrant DJ, Bushby K, Bann CM, et al. Diagnosis and management of Duchenne muscular dystrophy, part 1: diagnosis, and neuromuscular, rehabilitation, endocrine, and gastrointestinal and nutritional management. Lancet Neurol. 2018;17(3):251–267.
12. Srivastava A, Santagostino E, Dougall A, et al. WFH Guidelines for the Management of Haemophilia, 3rd edition. Haemophilia. 2020;26(Suppl 6):1–158.
13. Australian Institute of Health and Welfare (AIHW). Aboriginal and Torres Strait Islander Health Performance Framework: Summary Report 2023. Canberra: AIHW; 2023.
14. Lalloo C, Osei-Bonsu E, Walwyn R. G6PD deficiency in Aboriginal and Torres Strait Islander Australians: a review for clinicians. Aust J Gen Pract. 2021;50(12):918–922.
15. Ministry of Health (NSW). Minimum Standards for Men's Health in NSW. North Sydney: NSW Ministry of Health; 2020.

for PBS scripts. Utilise ACCHS pharmacies and Remote Area Aboriginal Health Worker programs for medication supply in remote areas. Avoid initiating benzodiazepines; support holistic pain management including community-based exercise programs.

Preventive health

Promote bone health: encourage vitamin D supplementation (1000 IU daily in deficient individuals), smoking cessation support, reduction of alcohol intake, and weight-bearing exercise. MBS Item 715 health checks provide a structured opportunity to assess bone health, screen for osteoporosis risk factors, and discuss musculoskeletal health in a culturally safe context.

Quick Reference: Differential Diagnosis at a Glance

Costovertebral dysfunction

Paracetamol ± NSAID; manual therapy

2–6 weeks

Provocable on palpation; no red flags

Thoracic compression fracture

Paracetamol; ± calcitonin; DXA + osteoporosis Rx

6–12 weeks healing

Elderly; osteoporosis; acute onset

ACS (posterior MI)

Aspirin 300 mg, GTN, heparin; urgent PCI

Time-critical

ECG, troponin; CV risk factors

Aortic dissection

IV labetalol; urgent CT aortogram; surgery (Type A)

Time-critical

Tearing pain; BP differential >20 mmHg

Vertebral osteomyelitis

IV antibiotics (vancomycin + ceftriaxone initially); ID consult

6 weeks IV antibiotics

Fever, elevated CRP, IV drug use

Biliary colic / cholecystitis

Paracetamol ± morphine; lap cholecystectomy

Surgical within 72 h (cholecystitis)

RUQ/infrascapular; post-prandial; RUQ US

📚 References

1. Briggs AM, Smith AJ, Straker LM, Bragge P. Thoracic spine pain in the general population: prevalence, incidence and associated factors in children, adolescents and adults. A systematic review. BMC Musculoskelet Disord. 2009;10:77.
2. National Health and Medical Research Council (NHMRC). Evidence-based management of acute musculoskeletal pain. Canberra: NHMRC; 2003 (updated 2020).
3. Australian Institute of Health and Welfare (AIHW). Aboriginal and Torres Strait Islander Health Performance Framework: Summary report 2023. Canberra: AIHW; 2023.
4. Deyo RA, Rainville J, Kent DL. What can the history and physical examination tell us about low back pain? JAMA. 1992;268(6):760–765.
5. Stochkendahl MJ, Kjaer P, Hartvigsen J, et al. National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. Europ Spine J. 2018;27(1):60–75.
6. Erwin WM, Jackson PC, Homonko DA. Innervation of the human costovertebral joint: implications for clinical back pain syndromes. J Manipulative Physiol Ther. 2000;23(6):395–403.
7. Royal Australian College of General Practitioners (RACGP). Guidelines for preventive activities in general practice. 9th edn. Melbourne: RACGP; 2018 (updated 2023).
8. Hirsch JA, Singh V, Falco FJE, et al. Thoracic facet joint interventions. Pain Physician. 2016;19(4):E581–E593.
9. Erwin WM, Jackson PC. The costovertebral joint: anatomy, biomechanics, and clinical significance in thoracic back pain syndromes. J Can Chiropr Assoc. 2003;47(2):112–120.
10. Strayer RJ, Gunnerson JM, Brown LH, et al. Aortic dissection: clinical features, diagnosis, and management. Aust Crit Care. 2019;32(2):144–153.
11. Ombregt L. A system of orthopaedic medicine. 3rd edn. Edinburgh: Churchill Livingstone Elsevier; 2013. Chapter 18: Thoracic spine.
12. Lin CC, Chen KH, Li DM, et al. Characteristics and outcomes of patients presenting with thoracic back pain to the emergency department. Emerg Med Australas. 2020;32(5):805–811.

for PBS-listed medicines at participating pharmacies.

Cultural safety

Engagement with Aboriginal Community Controlled Health Organisations (ACCHOs) is essential. Cultural safety training for non-Indigenous clinicians, use of Aboriginal Health Workers and Liaison Officers, and incorporation of traditional healing practices alongside Western medicine improve treatment adherence and outcomes. Avoidance of eye contact, respect for gender-sensitive examination practices, and understanding of sorry business protocols are critical elements of culturally safe care.

Medication adherence

Complex DMARD regimens with frequent monitoring requirements present adherence challenges. Long-acting depot injections (e.g., methotrexate SC) may improve adherence compared to oral regimens. Community pharmacy partnerships through the Indigenous Pharmacy Programmes improve medication management.

Specific conditions

Rheumatic heart disease (RHD) requires secondary prophylaxis with benzathine penicillin G (BPG) 1.2 MU IM every 3–4 weeks for a minimum of 10 years or until age 21 (whichever is longer). RHD registers (e.g., NT RHD Register) facilitate recall and follow-up. The Australian RHD Endgame Strategy targets elimination by 2031.

Referral pathways

Referral through ACCHOs and Aboriginal Hospital Liaison Officers (AHLOs) improves engagement. The Specialist Outreach Assistance Programme provides funded specialist visits to remote communities. NT, WA, and QLD have specific rheumatology outreach programmes targeting Indigenous communities.

📚 References

1. Australian Institute of Health and Welfare (AIHW). Autoimmune disease in Australia. Cat. no. PHE 312. Canberra: AIHW; 2023.
2. Fraenkel L, Bathon JM, England BR, et al. 2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Care Res. 2021;73(7):924–939.
3. Fanouriakis A, Kostopoulou M, Alber K, et al. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Ann Rheum Dis. 2019;78(6):736–745.
4. Chung SA, Langford CA, Maz M, et al. 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Care Res. 2021;73(11):1583–1599.
5. Smolen JS, Landewé RBM, Bijlsma JWJ, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis. 2023;82(1):3–18.
6. Australian Technical Advisory Group on Immunisation (ATAGI). Australian Immunisation Handbook. Australian Government Department of Health; 2024. Available from: immunisationhandbook.health.gov.au.
7. Rheumatic Heart Disease Australia (RHDAustralia). The 2020 Australian guideline for prevention, diagnosis, and management of acute rheumatic fever and rheumatic heart disease. 3rd ed. Darwin: Menzies School of Health Research; 2020.
8. Pharmaceutical Benefits Scheme (PBS). PBS Schedule. Australian Government Department of Health. Available from: pbs.gov.au. Accessed 2024.
9. Agarwal S, Cunnington J, Nossent J. Autoimmune disease in Indigenous Australians: a systematic review. Int J Rheum Dis. 2021;24(12):1487–1498.
10. Pisetsky DS. Antinuclear antibody testing — misunderstood or misused? Clin Immunol. 2023;255:109717.
11. Bertsias GK, Tektonidou M, Amoura Z, et al. Joint European League Against Rheumatism and European Renal Association–European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis. Ann Rheum Dis. 2012;71(11):1771–1782.
12. Ledingham J, Deighton C; British Society for Rheumatology Standards, Audit and Guidelines Working Group. Update on the British Society for Rheumatology guidelines for prescribing TNFα blockers in adults with rheumatoid arthritis. Rheumatology. 2005;44(2):155–158.
13. National Health and Medical Research Council (NHMRC). National statement on ethical conduct in human research. Canberra: NHMRC; 2023 (updated).

for PBS-listed medicines at participating pharmacies.

Cultural safety

Medication adherence

Specific conditions

Referral pathways

📚 References

1. Australian Institute of Health and Welfare (AIHW). Autoimmune disease in Australia. Cat. no. PHE 312. Canberra: AIHW; 2023.
2. Fraenkel L, Bathon JM, England BR, et al. 2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Care Res. 2021;73(7):924–939.
3. Fanouriakis A, Kostopoulou M, Alber K, et al. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Ann Rheum Dis. 2019;78(6):736–745.
4. Chung SA, Langford CA, Maz M, et al. 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Care Res. 2021;73(11):1583–1599.
5. Smolen JS, Landewé RBM, Bijlsma JWJ, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis. 2023;82(1):3–18.
6. Australian Technical Advisory Group on Immunisation (ATAGI). Australian Immunisation Handbook. Australian Government Department of Health; 2024. Available from: immunisationhandbook.health.gov.au.
7. Rheumatic Heart Disease Australia (RHDAustralia). The 2020 Australian guideline for prevention, diagnosis, and management of acute rheumatic fever and rheumatic heart disease. 3rd ed. Darwin: Menzies School of Health Research; 2020.
8. Pharmaceutical Benefits Scheme (PBS). PBS Schedule. Australian Government Department of Health. Available from: pbs.gov.au. Accessed 2024.
9. Agarwal S, Cunnington J, Nossent J. Autoimmune disease in Indigenous Australians: a systematic review. Int J Rheum Dis. 2021;24(12):1487–1498.
10. Pisetsky DS. Antinuclear antibody testing — misunderstood or misused? Clin Immunol. 2023;255:109717.
11. Bertsias GK, Tektonidou M, Amoura Z, et al. Joint European League Against Rheumatism and European Renal Association–European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis. Ann Rheum Dis. 2012;71(11):1771–1782.
12. Ledingham J, Deighton C; British Society for Rheumatology Standards, Audit and Guidelines Working Group. Update on the British Society for Rheumatology guidelines for prescribing TNFα blockers in adults with rheumatoid arthritis. Rheumatology. 2005;44(2):155–158.
13. National Health and Medical Research Council (NHMRC). National statement on ethical conduct in human research. Canberra: NHMRC; 2023 (updated).