Evidence points to the negative impact of hegemonic masculinity on men's health-related behavior, with American men making 134.5 million fewer physician visits per year than women. Twenty-five percent of men aged 45 to 60 do not have a personal physician, increasing their risk of death from heart disease. Men between 25 and 65 are four times more likely to die from cardiovascular disease than women, and are more likely to be diagnosed with a terminal illness because of their reluctance to see a doctor. Reasons cited for not seeing a physician include fear, denial, embarrassment, a dislike of situations out of their control and the belief that visiting a doctor is not worth the time or cost.