After Shehan Karunaratne noticed a lump on his testicle, the 26-year-old went to the doctor – but only mentioned the pain going up his leg. The general practitioner recommended physiotherapy.

A year later, when he returned coughing up blood, he received a diagnosis of stage 4 testicular cancer which had spread to his lungs, grown on the nerves down his back, around his hip and down his legs.

His younger brother, Roshan, remembers that the conversation in which Shehan revealed the diagnosis came in the form of an apology: “I’m so sorry, I’ve got cancer.”

Roshan says his older brother avoided being honest about his symptoms because of the fear it was cancer and hoping to protect his family and friends, but it was in fact transparency that would have saved them the grief that came with his death in November 2016.

The survival rate of testicular cancer is exceptionally high if detected early – 97 out 100 Australian men will live over five years after their diagnosis. “Even today that’s the hardest thing because if he had told the doctor at the time and removed the lump he would have been totally fine,” Roshan says.

Shehan is among the two in every five Australian men – more than 37,000 Australian men every year – who die too young, mostly due to conditions which could have been prevented, according to a new report released by the charity Movember this week.

The Real Face of Men’s Health report reveals that the stereotype that men are more likely to delay seeking help is not the whole picture but only a reflection of the larger structural issues at play impeding men’s connection with the health system and contributing towards their premature deaths before 75 years of age.

Dr Zac Seidler, the co-lead author of the report and the global director of research at Movember, says that some of the most common preventable causes of death among men, such as coronary heart disease, lung cancer and stroke, “all require an ongoing relationship with the health system”.

The report says that women’s relationship with the health system is often established earlier due to their reproductive and sexual health needs, such as getting a prescription for birth control in adolescence, and remains ongoing because women suffer from higher rates of non-fatal illnesses throughout their lives.

Men, by contrast, are less likely to have a trusting relationship with a health professional, and as a result, miss out on the health literacy (knowing when, where and how to get help) and preventive health advice that comes with that relationship, the report says.

Seidler emphasises the importance of the “door handle response” where often a patient will come in to see a health professional about one issue but will mention another important issue or symptom as they are about to leave.

The top five leading causes of years of life lost in men – coronary heart disease, lung cancer, self-harm/suicide, chronic obstructive pulmonary disease, and stroke – are largely avoidable through lifestyle and behaviour change, screening and earlier diagnosis and treatment. The findings of new research commissioned for the report estimate that Australia spent approximately $10.7bn in 2023 alone on treating avoidable cases of those five conditions.

The report includes a nationally representative survey of 1,658 men, among whom almost two in every three (63%) felt that gender stereotypes affected their own behaviours and experiences in healthcare settings, particularly the need for men to show strength, self-reliance and “tough it out”.

Emotional, vulnerable communication required for conversations around mental and physical health “is not the modus operandi for men, it’s just not how we’re socialised”, Seidler says.

He says in addition to breaking down the stereotypes of masculinity that male patients themselves hold, healthcare workers need to be more aware of the gender biases they and their patients are influenced by as part of creating a gender responsive health system.

The report acknowledges “we follow in the footsteps of, and owe a huge debt to, women and LGBTQIA+ health advocates who have shown the importance of an approach that takes full account of sex and gender”.

Dr Sue Haupt, a senior research fellow at the Centre for Sex and Gender Equity in Health and Medicine, led by The George Institute for Global Health, the Australian Human Rights Institute at UNSW and Deakin University, says “we share with Movember a vision for health equity, which means looking after everyone regardless of sex or gender, and not losing sight of evidence that men and boys also suffer disparities in many areas that need targeted strategies”.

“Movember’s report shines a desperately needed spotlight on fragilities in masculinity that have too long been hidden,” Haupt says.

The report also highlights the health disparities between different groups of men, with those who are Aboriginal and Torres Strait Islander, from culturally and linguistically diverse backgrounds, socioeconomically disadvantaged and living in rural and remote areas, among those who are disproportionately affected by poor health.

The report analyses the difference in premature mortality rates between electorates and finds the Lingiari electorate, covering 95% of the Northern Territory, has the highest premature mortality rates of men anywhere in Australia. They are three-and-a-half times more likely to die prematurely than men living in Bradfield, in inner metropolitan Sydney, where men have the longest life expectancy of any electorate.

Premature death was in general three-and-a-half times higher in rural electorates than inner city ones, while rates in the 10 electorates with the highest proportions of Indigenous men were almost double that of the electorates with the lowest proportions of Indigenous men.

Roshan Karunaratne believes changing the narrative is vital so that men understand the best way they can support their loved ones is not suffering in silence but actually being transparent around health issues.

“There’s strength in being vulnerable,” he says.