In short: Men report sick less often than women – and that is precisely the problem. Sickness absence statistics only capture those who report sick, not those who work while ill or do not go to the doctor at all. This article shows where the real costs arise, what role hormonal health plays, and which metrics you can use to demonstrate the benefits of a men’s health program in your company.
When management discusses absenteeism, there is usually a table on the table: sickness absence in percent, days absent per person, distribution by diagnosis group. This table is useful – but for male employees, it only tells half the story. This is because it measures behavior, not a state of health. Those who come to work despite symptoms do not appear in it. Those who ignore their symptoms for years either. And those who eventually do call in sick often end up out for a long time.
This pattern is well documented in men. It makes men’s health a topic that does not belong in the category of “a well-intentioned additional offer,” but rather in the business analysis.
What absenteeism statistics show – and what they conceal
Let’s start with the reliable figures. The Techniker Krankenkasse Health Report 2025 analyzes sickness absence data from around 5.95 million employees – approximately 16.6 percent of all employees subject to social security contributions in Germany. For the reporting year 2024, it shows 19.1 days absent per employee. Broken down by gender: women have 21.3 days absent and a sickness absence rate of 5.82 percent, men have 17.2 days absent and 4.72 percent (Techniker Krankenkasse, 2025).
A similar picture is shown by the BGF Institute’s Women and Men’s Health Report 2025, which is based on data from around 1.5 million AOK Rheinland/Hamburg insured persons. There, the sickness absence rate for men in 2024 was 6.88 percent compared to 7.34 percent for women. More revealing than the sickness absence rate itself is another metric in this report: the sickness absence rate, i.e., the proportion of insured persons with at least one period of sickness absence in the year. It is 67.0 percent for women, only 60.2 percent for men (BGF Institute, 2025).
Around four out of ten men do not report sick even once in an entire year. This could mean that they were healthy. It could also mean that they worked while ill.
A second finding from the same data is relevant for risk assessment: the average duration of absence differs little between the genders – 10.5 days for men, 10.8 for women. Men therefore do not miss work for shorter periods; they miss work less often. When it does catch them, it lasts just as long. And with the diagnosis groups, the picture is partially reversed: in the 40- to 49-year-old age group, men have significantly higher values for days absent due to cardiovascular diseases than women.
This is the first indication of where the real cost risk lies with male employees: not in the frequency of short absences, but in a few, albeit severe and costly, events in midlife.
Presenteeism: the part of the calculation that is not in any statistic
The technical term for “going to work while ill” is presenteeism. An analysis by the Chair of Health Management at the University of Erlangen-Nuremberg summarizes the findings for Germany: in representative surveys from 2003 and 2007, around two-thirds of employees stated that they had worked despite illness in the previous year; about one-third did so against express medical advice (Amler, Docter & Schöffski, 2016).
From an employer’s perspective, presenteeism is doubly problematic. First, productivity is reduced without this becoming visible anywhere – the person is present, the ticket remains open, and the mistake still happens. Second, failing to seek treatment often prolongs the subsequent absence. The delayed illness becomes a long-term one.
To put the magnitude into perspective: the Federal Institute for Occupational Safety and Health estimated the production loss costs due to sickness absence in Germany for the year 2014 at around 57 billion euros and the loss of gross value added at around 90 billion euros – and these figures only capture reported absences, not the productivity loss of those present (Amler et al., 2016).
For your company, this means: the sickness absence rate of your male workforce is not a success metric. A low value can be a good sign. It can also mean that part of the burden has not yet become visible.
The blind spot: hormonal health in midlife
Between 40 and 55, something happens to many men that is difficult to capture in a diagnosis. Energy declines, concentration becomes more fragmented, sleep worsens, mood flattens, and recovery after exercise takes longer. Most attribute this to age, their job, or their children. Part of it has a measurable hormonal component.
The European Male Ageing Study, published in the New England Journal of Medicine, examined 3,369 men between 40 and 79 years of age at eight European centers and defined evidence-based criteria for so-called age-related hypogonadism for the first time: at least three sexual symptoms in combination with total testosterone below 11 nmol/l and free testosterone below 220 pmol/l (Wu et al., 2010). This strict definition captures the pronounced full clinical picture. A biochemically low value without this complete symptom pattern is significantly more common – depending on the cutoff value used and the population studied, the figures vary considerably.
The picture becomes clearer when looking at risk groups that are represented in every workforce. A review article in Andrology describes obesity as one of the strongest modifiable risk factors for low testosterone levels; accompanying type 2 diabetes further suppresses the hormonal regulatory axis. Crucial from a corporate perspective: this suppression is functional and therefore fundamentally reversible – weight loss and the treatment of accompanying conditions can reverse it (Grossmann, Ng Tang Fui & Cheung, 2019). For men with type 2 diabetes, the literature reports prevalence rates of up to 50 percent (Farrell, Deshmukh & Baghaie, 2008), which is why several professional societies recommend screening this group (Tamler & Deveney, 2010).
Why this is relevant for employers: a testosterone deficiency is rarely the reason for a sick note. It is a reason for months of reduced productivity – and a marker for metabolic disorders that later end up in the statistics as a cardiovascular event. Your employees can read more about these connections in our article Testosterone Deficiency in Men.
What the workday itself contributes
Two factors that are directly in the company’s hands have a proven effect on the hormonal balance.
Sleep. In a controlled study, the testosterone levels of young, healthy men dropped by 10 to 15 percent after just one week of five hours of sleep per night (Leproult & Van Cauter, 2011). This is not a subtle shift, but corresponds roughly to what more than a decade of aging otherwise entails.
Shift work. A study of 754 men at an andrology outpatient clinic found significantly worse erectile function scores among night shift workers than among employees working day or evening shifts; in the presence of shift work sleep disorder, the effect was also demonstrable regardless of the shift model (Rodriguez et al., 2020). A Turkish study also found poorer sleep quality and higher rates of impaired sperm parameters among shift workers (Demirkol et al., 2021).
Neither of these are arguments against shift operations – they are indispensable in many industries. They are arguments for specifically addressing the affected groups instead of letting them drift along in the general health offer. We have described in detail how shift work affects men’s health in a separate article: Shift Work and Men’s Health.
A calculation you can perform with your own figures
Many blanket cost estimates per day absent circulate, and they are of little use because they depend heavily on the industry and qualification structure. A calculation with your own values is more reliable.
Take the number of your male employees and multiply it by 17.2 – the reference value for days absent per male employee from the TK Health Report 2025. For 200 male employees, this results in around 3,440 days absent per year. Multiply this by your average total personnel costs per workday, and you have a lower limit for direct costs.
A lower limit, therefore, because three items are still missing: the productivity losses due to presenteeism, the costs of replacement in the event of illness-related turnover, and the subsequent costs of later diagnoses. The last point particularly hits companies with a high proportion of experienced specialists in the 45-plus age group, because the expertise lost there cannot be replaced in the short term.
What prevention brings back
Research on the effectiveness of workplace health promotion is methodologically heterogeneous, but shows a consistent direction. The iga Report 3 summarizes international reviews and reports return-on-investment values between 1:2.5 and 1:10.1 for the area of absenteeism, and between 1:2.3 and 1:5.9 for healthcare costs – the upper value coming from a randomized controlled study. The underlying studies lasted an average of 3.25 years (Initiative Gesundheit und Arbeit, n.d.).
Two limitations are part of being honest. First, such ROI values are averages across very different programs; they say nothing about what your specific offer will achieve. Second, they take time – the observation period of just over three years is no coincidence. Anyone expecting amortization after twelve months will be disappointed.
What does show quickly, however, are participation rates and qualitative feedback. They are the realistic early indicators.
The tax framework: 600 euros that are rarely fully utilized
A practical point that regularly helps in the budget discussion: under § 3 No. 34 EStG, employers can spend up to 600 euros per employee and calendar year on workplace health promotion measures free of tax and social security contributions. The prerequisite is that the services meet the quality requirements of §§ 20 and 20b SGB V – i.e., they are either certified prevention courses or meet the requirements of the Prevention Guidelines as workplace health promotion measures. In addition, the services must be provided in addition to the already owed wages (Techniker Krankenkasse, n.d.).
Whether a specific measure falls under this should be clarified with your tax advisor – the distinction is demanding in detail and has shifted several times in the past.
What a realistic start looks like
The most common mistake with the topic of men’s health in the company is taking too big a first step. A complete program with diagnostics, consultation, and follow-up needs lead time, works council involvement, and a data protection concept. Getting started does not.
A three-stage sequence has proven effective: education first, then a low-threshold offer, then individual support. An interactive presentation on the central health risks for men – heart, hormones, psyche, prostate – costs little, can be implemented within a few weeks, and at the same time provides you with an initial measure of response. Only when this interest is visible is it worth building more extensive offers such as laboratory diagnostics with medical evaluation.
We have described exactly this staged approach on our page Men’s Health for Companies – from keynotes to digital learning formats and medical-assisted diagnostics.
Conclusion
In a corporate context, men’s health is not a niche topic, but a measurement problem. The metric that companies look at – sickness absence – is systematically uninformative for men because it measures reporting behavior and not the state of health. Those who view it in isolation overlook presenteeism, late diagnoses, and the hormonal and metabolic changes in midlife that begin years before the first absence.
The practical path does not begin with a program, but with visibility: address the topic, make the first step low-threshold, and measure the response before scaling. The figures for the business case are already available to you – you just need to add the items that are missing from the absenteeism table.
