Marianne Legato, professor of Clinical Medicine at Columbia University, talks about how males are less likely to make it through the embryonic state and more likely to develop a wealth of disorders and diseases.
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In spite of their obvious increased physical strength compared to women, men are more vulnerable biologically than women are. The vulnerability begins in the womb. Far fewer male embryos make it to delivery compared with females. Even at birth, boys are developmentally behind their sisters and are prey to developmental disabilities and respiratory problems among others in the weeks immediately after birth. This vulnerability continues during the course of their life. One of the most important health problems of men is the early onset of coronary artery disease which begins to be symptomatic in many men in the mid thirties. And those men who have coronary disease are usually dead before the age of sixty-five. I think this is one of the most compelling health problems that men face and something on which we should really be concentrating. Developmental disabilities are four to six times more frequent in males than in females. We don’t really know why this is correct but a very interesting theory has developed in which it was pointed out by some neo-natal experts. That the brains of boys are larger than those of their sisters and at the same time their metabolic rate is lower so that the demands of the bigger brain are really not met as efficiently by the low metabolic rate which doesn’t deliver enough oxygen and blood to the brain as is the case with their sisters who have smaller and probably more efficient systems of providing the brain with blood and oxygen. One of the most vulnerable periods for men, or males, is during adolescence. There is a lag time in the development in the systems in the brain that have to do with risk assessment and judgment. At the same time, the surge of testosterone makes them prone to idealistic, impulsive and risk-taking behavior so that suicide and violent death is far more common in the male adolescent than it is in the female adolescent. We really capitalize on this, sadly, by sending eighteen year olds to war. A very smart man had said to me, who was in the military, that if you ask an 18 year old to take a well-defended objective, he’ll say “when?” If you ask a thirty-year-old to take the same objective, he’ll say “how?” And if you ask a forty-year-old man, he’ll say “why?” I think there are definite steps we should be taking, and taking immediately, to ensure better and longer lives for men. In the first place, we should stop regarding them as the “stronger sex.” They’re biologically much less hardy in many ways than are women. In particular, we should be concentrating, in my opinion, on the early onset of coronary disease which takes such a terrible toll of men. And I think the American Heart Association should have a program called Go Blue for men, the way it does Go Red for women. I think heart disease in its early and devastating onset in men is one of the most important health problems that we face.

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