One of the biggest threats to men’s health has always been the challenge of getting them to care about it. “It’s hard to say the exact reason, but men don’t really do anything preventatively,” explains physician Frank Lipman, M.D. Through nearly 40 years of experience practicing functional medicine, he has found that men generally “are not interested in subtle changes in their body, and they traditionally wait until they have a heart attack or something serious,” Lipman says. And although he can’t point to a single catchall reason for why this is, it’s always been the case. “That’s the male way of seeing things: It’s not a problem until it’s a big problem.”

That’s not to say there haven’t been attempts to engage men to take a more proactive approach to their health and wellness. But much of this has been geared toward optimizing their performance. That’s why erectile dysfunction and low testosterone have been a major part of these efforts, because they affect men’s ability to perform in bed, at work, and on the field. As a result, these are the concerns that might get men in to see their doctors and screened for more serious risks such as heart disease and diabetes.

But now, thanks to a combination of telemedicine, wearable tech, and the mainstreaming of biohacking, doctors like Lipman have been able to spin this competitive edge into a more holistic approach to healthcare. “A lot of guys are learning that they can do a lot of health testing at home, use wearables, and do things in order to perform better,” Lipman says. Being able to track things like their sleep, exercise, and how much alcohol they’ve cut back on, and bond with other guys while competing over these progress, might be what gets them paying more attention to their minds and bodies.

“Men generally are more competitive, so if that can be spun in a positive way, then they will take more notice,” Lipman says. “Being able to measure these things at home and compare it to their friends is a positive.”

Although the overall outcome remains to be seen, Lipman sat down with Fatherly to discuss his optimism about the future of men’s health, and how we can gamify it for the better.

Over the course of your career, how have you seen men’s interest in their health change? What’s different now, and what is still the same?

Traditionally it’s been the spouse or significant other bringing men into the doctor. But there’s been a shift, and now men seem to be paying more attention to athletes and other role models for men, on Twitter and social media, talking about how when they started doing ice plunges, they started performing better. A lot of them are athletes because there’s a lot more awareness about health for them. All of that has made men more aware. Instead of their spouses getting them to care about their health, there are successful role models.

With so many men getting this information from social media, are there concerns about misinformation?

There’s always going to be some misinformation, but overall I think it’s much more positive. There’s much more good coming from it. And if it brings them into the doctor, they can do more testing, and their health can be a little bit more controlled.

What conditions are guys coming into your office worried about?

They’ve become more aware of heart disease, which usually is a disease that’s easily picked up from biomarkers. I think men are usually more concerned about performance and issues related to that, like Alzheimer’s and other cognitive issues. They’re worried about not having the energy to play basketball with their friends. They’re worried about not being able to perform as well as the younger people at work.

It seems like men aren’t that interested in worrying about diseases like cancer that could develop. Is it fair to say, when you try to get men to worry about preventative healthcare so far in the future, it may not work?

Yes, you’ve got to present it in a way that’s going to make them make changes. You can’t say, “If you don’t do this, you’re going to get heart disease.” Or, “If you don’t do this, you’re going to put on weight.” It’s more about, “If you don’t do this, you’re not going to have the energy to do the thing you want to do.

Having heart disease or a problem with your health is going to affect your penis as well, because ED is not isolated to that particular organ. Usually when someone has ED, it’s a systemic thing — it’s vascular disease all over the body. That’s a generalization, but you’ve got to scare men in a way that’s going to change the way they’re going to see things.

You mentioned biomarkers. For someone who’s new to telemedicine, wearable tech, and biohacking, what are some biomarkers they should pay attention to? Or what sort of things should they have tested?

A lot of the blood work done by doctors is not particularly helpful. Guys should be asking for an advanced lipid panel that looks at the particle size of the cholesterol molecules — that measures inflammatory markers. It’s a much more extensive test that gives us much more information about heart disease and inflammation than regular tests.

They should have their uric acid checked. They should have nutrient levels checked, which are not usually checked. For instance, they should have their Omega-3 levels checked. They should have their red blood cell magnesium checked. They should have their B-12 checked.

And then hormones; men should not only have their testosterone and free testosterone checked, they should check for estrogens as well. Too much estrogen can be a problem for men as well as women.

What are the limits to biohacking?

The biggest things that get ignored are moving your body, how you sleep, meditation or stress reduction, spending time in nature, having some purpose in life, having some connection, or being connected to family or a community. Those to me are the primary biohacks of the body.

The secondary hacks are when you want to take it to the next level. So guys who are biohacking by measuring their blood glucose and their sleep and taking all these crazy supplements, it’s all fine, and I don’t think they’re dangerous. But to me, those are secondary hacks. If you’re thinking of biohacking, you can’t ignore the primary biohacks.

Sleeping seems to be a big thing that men can track for the sake of their mental and physical health.

Poor sleep puts you at risk for almost every chronic disease from Alzheimer’s to heart disease to diabetes to obesity. So poor sleep is the first place you need to do some work, because men don’t take sleep seriously enough. Sleep is when your body is recovering and repairing. It’s when your brain cleans all the toxins out. Sleep is crucial to one’s health.

Alcohol seems similar, in that it puts men at risk for a lot of problems, but it also can be managed and tracked easily with apps. Does it work the same way?

Yes, too many people drink too much alcohol, which not only affects sleep, but it can affect so many other parts of the body and predispose you to so many problems. Three to four drinks a week isn’t a problem, but most men are drinking three to four drinks a night for three or four nights a week, and that becomes a problem. It puts a load on most organ systems, and is probably one of the primary risk factors for many of the diseases men are presenting with.

Sleep and alcohol also seem to have a large effect on men’s mental health, which has been said to be in a state of crisis. Do you believe men are facing a mental health crisis, and has it always been this way?

I’m not sure the problems with men’s mental health are a new thing. I think it’s probably more of an issue now because there’s more stress in people’s lives, whether it’s financial or otherwise. And men are starting to deal with it instead of suppressing it. Younger men are much more aware of their mental health and are in therapy, again because there have been more role models. People like Michael Phelps make a difference and help things.

I think younger men are more aware of their mental and emotional health, and it’s great that that’s shifted. But also, there is more pressure on everyone, including men, than there was 20 years ago.

And how can paying attention to physical health in the ways we’ve discussed help with mental health?

To me, mental and physical health are all one thing. Men paying more attention to their physical health will absolutely help with their mental health. I think teletherapy has made men more comfortable going to therapy from their home and that’s also helped a lot with that.

If you were to take into account all the avoidance and mental and physical health risks we’ve discussed, do you think that being a man should be considered a pre-existing condition, or a medical diagnosis in itself?

I don’t see it that way. We all have different pre-dispositions. Especially with genetic testing now, we can tell who’s more genetically predisposed to heart disease or diabetes or whatever. Certain diseases might happen more for men, but I don’t see being a man as a health risk, to be quite honest. I think it comes down to how health information is presented, and I think now it is being presented to men in a more accessible way.