Why men are fucked, fucked, just about totally fucked

The Weaker Sex -- by MARIANNE J. LEGATO

WHEN I say I study gender-specific medicine, most people assume I mean women's health. Patients ask me, "Do you take care of men too?"

I may be partly to blame for the confusion: in the years since the revolutionary 1985 report on women's health from the United States Public Health Service, I — along with many of my colleagues — have tried to atone for the fact that for so long the majority of diseases that afflicted both genders were studied exclusively in men.

Over the past two decades, we've radically revised how we conduct medical research and take care of our female patients. And we've made valuable discoveries about how gender helps determine vulnerability to illness and, ultimately, the timing and causes of death. But I now believe that we doctors and researchers may have focused too much on women.

What emerges when one studies male biology in a truly evenhanded way is the realization that from the moment of conception on, men are less likely to survive than women. It's not just that men take on greater risks and pursue more hazardous vocations than women. There are poorly understood — and underappreciated — vulnerabilities inherent in men's genetic and hormonal makeup. This Father's Day, we need to rededicate ourselves to deepening our knowledge of male physiology.

Men's troubles begin during the earliest days in the womb. Even though there are more male than female embryos, there are more miscarriages of male fetuses. Industrial countries are also witnessing a decline in male to female birth ratios, and we don't know why.

Some scientists have argued that the probability of a male child declines as parents (especially fathers) age. Still others have cited the prevalence of pesticides, which produce more birth defects in male children.

Even when a boy manages to be born, he's still behind the survival eight ball: he is three to four times more likely than girls to have developmental disorders like autism and dyslexia; girls learn language earlier, develop richer vocabularies and even hear better than boys. Girls demonstrate insight and judgment earlier in adolescence than boys, who are more impulsive and take more risks than their sisters. Teenage boys are more likely to commit suicide than girls and are more likely to die violent deaths before adulthood.

As adults, too, men die earlier than women. Twice as many men as women die of coronary artery disease, which manifests itself a decade earlier in men than women; when it comes to cancer, the news for men is almost as bad. Women also have more vigorous immune systems than men: of the 10 most common infections, men are more likely to have serious encounters with seven of them.

While depression is said to be twice as frequent in women as in men, I'm convinced that the diagnosis is just made more frequently in women, who show a greater willingness to discuss their symptoms and to ask for help when in distress. Once, at a dinner party, I asked a group of men whether they believed men were depressed as often as women, but were simply conditioned to be silent in the face of discomfort, sadness or fear. "Of course!" replied one man. "Why do you think we die sooner?"

Considering the relative fragility of men, it's clearly counterintuitive for us to urge them, from boyhood on, to cope bravely with adversity, to ignore discomfort, to persevere in spite of pain and to accept without question the most dangerous jobs and tasks we have to offer. Perhaps the reason many societies offer boys nutritional, educational and vocational advantages over girls is not because of chauvinism — it's because we're trying to ensure their survival.

It's possible, too, that we've simply been sexist. We've complained bitterly that until recently women's health was restricted to keeping breasts and reproductive organs optimally functional, reflecting the view that what made women valuable was their ability to conceive and bear children. But aren't we doing the same thing with men? Read the questions posed on the cover of men's magazines: how robust is your sexuality? How well-developed are your abs? The only malignancy I hear discussed with men is prostate cancer.

It's time to focus on the unique problems of men just the way we have learned to do with women. In 2004, the National Institutes of Health spent twice as much on studies done only on women as only on men. We are not devoting nearly enough money to men's health; worse yet, we may be spending those insufficient funds to answer exactly the wrong questions.

The National Institutes of Health should therefore convene a consensus conference to identify the most important threats to men's well-being and longevity and issue a request for research proposals to address them. Would an estrogen-like molecule postpone the onset of coronary artery disease in susceptible males? Are there ways to strengthen the male immune system?

Thinking about how we might correct the comparative vulnerability of men instead of concentrating on how we have historically neglected women's biology will doubtless uncover new ways to improve men's health — and ultimately, every human's ability to survive.

(Marianne J. Legato, the director of the Partnership for Women's Health at Columbia, is the author of "Why Men Never Remember and Women Never Forget.")