Evidence that weight-loss drugs like Novo Nordisk’s Wegovy and Eli Lilly’s Zepbound can cut heart disease risk, treat sleep apnea and address other health issues may help convince more men to use them, five doctors who prescribe the medicines regularly told Reuters.

Men prefer to shed extra pounds with diet and exercise changes before reaching for drugs, if they address their weight at all, doctors and three healthcare industry analysts said in interviews.

Women are far less hesitant to seek a physician’s help with weight loss and management, they said.

The “typical weight management program is female predominant in our clinic. It’s almost two out of three patients are women, and that’s pretty much common across the country,” said Dr. Robert Kushner, obesity medicine researcher at Northwestern’s Feinberg School of Medicine.

Female patients accounted for at least 78% of total prescriptions for Wegovy and 76% or more total prescriptions for Zepbound between January and March, according to U.S. data from IQVIA.

Yet obesity rates remain similar for both men and women at 43% and 42%, respectively, according to U.S. government data.

“This chronic disease does not discriminate by gender,” a Lilly spokesperson said in a statement to Reuters. Novo declined to comment on the gender subject.

U.S. regulators approved Wegovy for lowering heart risks in March. Lilly’s Zepbound has improved sleep apnea symptoms in trials, and analysts expect it to be approved for that indication by early next year.

The drugs, from a class of medicines that also treat type 2 diabetes called GLP-1 agonists, are also being considered to cut the risk or progression of kidney disease and for alcohol abuse, among other health issues. Such new uses could shift the gender balance, doctors said.

Kushner said in his practice male patients were showing more interest in these medications, both of which are taken as weekly injections, in light of data showing their wider health benefits.

Some patients think “when you have multiple benefits, there’s more value,” said Dr. Audrey Wells, sleep medicine advisor at CPAP.com. “It’s more legitimate as a health treatment, not just a cosmetic treatment.”

Other physicians suggested that some men may be more open to weight-loss drugs based on recommendations from women in their lives taking the medicines.

“The woman may be the one that initiates the idea or thought process of going on a GLP-1 (for weight loss), but the man closely follows,” said Dr. Fatima Cody Stanford, an obesity medicine specialist at Massachusetts General Hospital.

Yet Barclays pharmaceutical industry analyst Emily Field sees the market for such drugs – estimated to reach $150 billion in the coming decade – still primarily involving women, as they tend to be the ones “who seek treatment” for weight.

‘Stereotypes around masculinity’

Doctors and analysts attributed the gender difference in part to social and cultural expectations that give men a pass on weighing more.

Clinical trials that tested Wegovy and Zepbound for weight loss primarily enrolled women. Lilly’s sleep apnea trial and Novo’s heart disease study both recruited more than 70% male patients, the drugmakers have said.

Two analysts said this could be reflective of disease prevalence rather than gender bias. Data from the U.S. Centers for Disease Control and Prevention shows that men are more likely to report having heart disease and are also disproportionately affected by obstructive sleep apnea.

Women become equally at risk for these conditions once they reach perimenopause, around age 45.

“In general men, especially before middle age, are not as experienced in going to the doctor… I think it’s in line with some generalizations about stereotypes around masculinity,” Wells said.

Representatives from American College of Cardiology (ACC) and American College of Endocrinology (ACE) noted the gender discrepancies when GLP-1 drugs are used for weight loss.

However, both ACE’s Dr. Scott Isaacs and Dr. Pamela Douglas from ACC pointed to a more balanced use between genders when the treatments are prescribed for diabetes, for which they were initially approved.

Miami-based Dr. Jonathan Fialkow of Baptist Health said since men have more muscle mass than women, they typically see evidence of exercise efforts sooner. This also leads to a sense of greater control over changes in their weight, he said.

“A lot more guys especially are nervous about trying medicated solutions to things,” said Alex, a 28-year old from North Carolina who has been taking Wegovy for four months but preferred not to provide his full name.

“To them I’ll reply that this ain’t pill popping,” he said. “If taking one shot a week can … give you 10 years of extra time with your kids, most guys, I think, would take it.”

—Bhanvi Satija and Sriparna Roy, Reuters