A conversation with the professor of clinical medicine at Columbia University.

Marianne Legato: My name is Dr. Marianne J. Legato. I’m a professor of clinical medicine at Columbia University.

Question: Are men more prone to diseases?

Marianne Legato: 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.

Question: Are men also more prone to developmental disabilities?

Marianne Legato: 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.

Question: Is there an age where men are particularly vulnerable?

Marianne Legato: 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?”

Question: What steps should we be taking to help men lead healthier lives?

Marianne Legato: 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.

Question: Is the Y chromosome prone to mutations?

Marianne Legato: The Y chromosome is definitely unique among all the chromosomes. Over most of its extent, it can’t exchange with its partner the X chromosome to repair its deficiencies or mutations in DNA. It’s learned to repair itself in an interesting and unique way. The issues with the Y chromosome are that they are exposed to environmental toxins because they are housed outside the body in the scrotal sack. Many millions are produced every day and, therefore, mutations are far more frequent in the Y chromosome than in the X or indeed in any of the other chromosomes. So the male drives evolutionary development because of this extraordinary proliferation of mutations that are characteristic of sperm and the Y chromosome.

Question: Are men less prone to depression as women?

Marianne Legato: The generally accepted statistic is that women are twice as likely to suffer from depression as men. I don’t think this is correct. I think that the signs and symptoms of depression in men are very different than those in women. In spite of great sadness and pessimism, men tend not to communicate their distress. They go it alone as they do in so many areas of their lives and they turn to self medication sometimes with excessive TV, excessive sexual activity, or excessive drinking as symptoms of their distress.

Marianne Legato: There’s no question that depression can be fatal in both sexes including, obviously, in men. People lose their appetite. They can’t sleep. They don’t take action against threats in the environment. And I think that there’s no question that depression, which by the way also depresses the action of the immune system and makes people prone to infection, is a very serious warning that a fatal outcome is a possibility. So depression should never be underestimated.

Marianne Legato: A very interesting thing about depression was commented on, in fact, by my father who was a physician years ago. When he said that the time to be most on guard against suicide is in the partially treated, depressed patient, he pointed out that when they’re profoundly depressed, they can’t take action even to end their own lives. But as they improve, they begin to see ways to carry out their very sad objective. And I think that that’s reflected in many of the warnings on some of our antidepressants, when we start to give them, result in the suicide of patients unexpectedly. And I think it may be to this general principle that the depressed patient in treatment has to be very carefully watched because there’s this time of special vulnerability.

Recorded on: November 4, 2009