What was Darryl Kile thinking the night before he died? It was widely reported that the St. Louis Cardinals pitcher had complained to his brother of shoulder pain and weakness the evening before he was found dead in his hotel room June 23, at 33. Maybe Kile believed the soreness and fatigue came from overexerting himself on the mound, and so he didn't recognize classic warning signs of the severely clogged arteries that a coroner later concluded likely had caused his death. Kile's father had died at 44 of a heart attack and stroke, and one can't help but wonder why the pitcher hadn't sought medical attention that evening. We'll never know, and second-guessing won't bring back the admired athlete, husband, and father.

Kile's death does raise anew a question that has long frustrated physicians. Why are men so reluctant to seek medical help? Doctors have known that many guys would rather clean gutters or watch synchronized swimming than schedule an office visit. In March, the journal Neurology reported that more than half of all male migraine sufferers never consult a doctor about their pain, compared to only about a quarter of female patients. A poll in 2000 by the Commonwealth Fund, a New York research group, found that American men are three times more likely than women to go a year without seeing a doctor.

In one sense, these statistics aren't difficult to understand. Cavemen, presumably, didn't sit around whining if a saber-toothed tiger chomped their leg. They had to tough it out and protect their clan or risk extinction. Some observers believe that remnants of that mentality persist today.

"It's inculcated in men that we have to be the breadwinner, have to be strong, can't acknowledge weakness," said Harold L. Pass, a psychologist at Stony Brook University Hospital in New York who specializes in male psychology. "As a result, men tend to minimize medical symptoms when they first appear."

Male foot-dragging is often fueled by embarrassment, experts say. What if there's really nothing wrong with me? I'll look like a hypochondriac, or worse, a sissy.

Pass has a friend who waited nearly 10 hours with severe chest pain before going to an emergency room because he thought it might be only heartburn. One little detail makes this story of masculine denial truly disturbing. The guy was a doctor. (He did have a mild heart attack but recovered.)

The pressure to conform to masculine stereotypes begins early. Many men were encouraged to be silent in the face of aches and maladies. If you skinned your knee and burst out crying, you risked being called a big baby, but when the same thing happened to your sister, she probably got a hug and a lollipop. Youth sports coaches often sneer at bumps and bruises, imploring youngsters to "walk it off," and get back in the game.

Playing with pain is celebrated as valorous and brave. Who will ever forget former Los Angeles Dodger Kirk Gibson hobbling off the bench with a bum knee to hit a game-winning home run in the 1988 World Series, or Willis Reed of the New York Knicks playing in the seventh game of the 1970 NBA championship on a badly injured knee?

What's more, in most families, women run the medicine show, leaving a lasting impression on little boys, insists Dr. Ian Banks, a physician in Belfast, Northern Ireland, and president of the European Men's Health Forum. Last November Banks wrote an editorial in the British Medical Journal explaining why men feel alienated from the health care system, which he calls no-man's- land.

"We brainwash our children into accepting that health is a women's issue," Banks said in a phone interview. In his own practice, he notes, little boys almost always arrive accompanied by a mom, sister, or grandmother, but rarely a male relative. As kids mature, the perception that health awareness is women's work only gets stronger. When girls reach puberty, they start seeing gynecologists for annual checkups, but there's no equivalent specialty for men.

For many men, seeing a doctor when they feel ill simply isn't an option. Even when men find their way into doctors' offices, said Banks, many find it difficult to discuss personal problems with other males, who still make up the majority of physicians in the United States. To make matters worse, he said some doctors come out of the dog-eat-dog medical school climate imbued with a macho mentality, believing -- consciously or not -- that men don't complain, that men can cope with pain. The result, Banks wrote in the journal, can be a "testosterone-driven consultation." No wonder some guys never go back. The medical profession needs to do a better job of making men feel a part of the system, but in the end, men have to take greater responsibility for their bodies. Health professionals stress it's critical to see a physician for annual checkups and health concerns. Make your own appointments and get your own prescriptions. You'll feel more in control of your care, and take action when that little voice in your head tells you something's wrong. He who hesitates is all too often lost.