Why Men Die First: How to Lengthen Your Lifespan

"This clearly written book, with its informative coverage of the male perspective on gender-specific medicine--and ironically written by a female physician--is a good purchase for public libraries and consumer health collections" --Library Journal "A vital and rewarding book...a fascinating as well as practical look at how men are both made (by biology) and shaped (by culture). Readers will be engaged and amazed by the discoveries and insights that modern medicine now possesses about the mysteries of gender. Dr. Legato has a gift for narrative and an ability to see into the human heart." --Diane Salvatore, Editor in Chief, Ladies’ Home Journal "Marianne Legato, who has devoted her career to studying the differences between the sexes, believes that the premature death of men is the most important--and neglected--health issue of our time. She has written a book for every man who wants to live longer and for the women and families who love them. Dr. Legato has started a much needed conversation we should all be having about how we can improve the health and longevity of men, who--at all ages--die before women."--Dr. Mehmet Oz, author of You: The Owner's Manual

It is a universal fact that men die before women. But the causes of this have long remained unexplored. In this trailblazing book, Dr. Marianne Legato--an expert in gender specific health--examines the reasons behind men's fragility and explains what they need to do to live longer.

A bestselling author and Professor of Medicine at Columbia University, Dr. Legato shows how the forces of culture and biology conspire against male mortality. Drawing on the latest research and narrated through the lives of her patients, she delves into problems that both men and women care about-- from why the male fetus is at greater risk, to why boys have a hard time adjusting to school, to how elevated levels of the stress hormone cortisol make men more prone to aggression and why they are more likely to die from cardiac arrest or cancer and even depression.

Why Men Die First offers specific advice on what men can do to live better, including

* how on-one time with young boys reduces anixiety and attention deficit problems

* lifestyle changes that can prevent cardiovascular disease and osteoporosis

* why young men take on high risk endeavors and how to decrease the stress

* how to cope with mid life depression and feelings of emasculation and uselessness

* how testosterone shots can mitigate the unpleasant symptoms of aging

Dr. Legato brings the possibility of both mental and physical wellbeing to men in this compelling and inspiring book. A superstar physician, celebrated annually in New York Magazine's Best Doctors Issue, Dr. Legato is well poised to take on this urgent topic with her unimpeachable authority and natural warmth.

Legato, a physician and one of the founders of gender specific medicine, provides a broad-brush look at the relative fragility of men who "at every point of their lives die an average of seven years earlier than women." Much of the book will be familiar to anyone who read John Gray's Men are from Mars, Women are from Venus (or, indeed, Legato's own Why Men Never Remember and Women Never Forget), emphasizing the debatable notions that men and boys are aggressive where most women are team players, and that women value "the ambiance of the workplace and their relationship with other workers" over attaining power within a corporate structure. She breaks newer ground when she examines the genetics; the Y chromosome, she contends, may be more vulnerable to mutation, leading her to ponder whether "men have a future," or might disappear in 125,000 years (on the other hand, it may be that "the Y drives evolution"). Later chapters look at depression, diseases, sports and work as they relate to men. Though a well-sourced overview, Legato's attempt to give readers a "new view of men" suffers from a lack of fresh perspective.
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It is a universal fact that men die before women. But the causes of this have long remained unexplored. In this trailblazing book, Dr. Marianne Legato--an expert in gender specific health--examines the reasons behind men's fragility and explains what they need to do to live longer.

A bestselling author and Professor of Medicine at Columbia University, Dr. Legato shows how the forces of culture and biology conspire against male mortality. Drawing on the latest research and narrated through the lives of her patients, she delves into problems that both men and women care about-- from why the male fetus is at greater risk, to why boys have a hard time adjusting to school, to how elevated levels of the stress hormone cortisol make men more prone to aggression and why they are more likely to die from cardiac arrest or cancer and even depression.

Why Men Die First offers specific advice on what men can do to live better, including

* how on-one time with young boys reduces anxiety and attention deficit problems

* lifestyle changes that can prevent cardiovascular disease and osteoporosis

* why young men take on high risk endeavors and how to decrease the stress

* how to cope with mid life depression and feelings of emasculation and uselessness

* how testosterone shots can mitigate the unpleasant symptoms of aging

Dr. Legato brings the possibility of both mental and physical wellbeing to men in this compelling and inspiring book. A superstar physician, celebrated annually in New York Magazine's Best Doctors Issue, Dr. Legato is well poised to take on this urgent topic with her unimpeachable authority and natural warmth.

Q&A: WHY THIS BOOK IS ESSENTIAL FOR MEN AND THE WOMEN WHO LOVE THEM:

Q: Dr. Legato, thirty years ago men in our culture looked at a visit to the doctor as a sign of weakness. How would you describe men's attitude about their health today?
A: Men continue to neglect their health; they visit the doctor infrequently, usually only when a serious health crisis compels them to do so and usually only at the urging of their wives. Many resist medication for their illnesses; one diabetic patient waited until he had almost 50% of his main arteries blocked before he agreed to take medication. Coronary artery disease, the chief cause of premature death in throughout the world, begins in men by about the age of 35 and, once they have it, generally ends their lives before they are 65. Eighty percent of coronary artery disease can be prevented simply by cultivating an optimal life style.

Men are under tremendous stress; they often have dangerous and demanding jobs, but seldom talk about the problems they face in the workplace, much less at home. Depression is widespread, under diagnosed, and underestimated. In men, it promotes isolation, excess drinking, overeating and behavior that can seriously disrupt their relationships with others.

Q: Whom do you see as the audience for your book?
A: My book is not simply a health manual; it contains little known information about the unique vulnerabilities of men from the time they are conceived until the end of their lives. My own 35 year old son read the chapter intended for his age group and found the information fascinating; he discussed it at length with his friends and asked me to send him the rest of the book as I finished it. I also expect women who want their men to have better health (and health habits) to buy the book and apply the material in it to the care of the men in their lives. It is well known that women make virtually all of the health care decisions for everyone in their family.

Q: What advice do you have for men in their 50s who are starting to think about their mortality?
A: Good health begins with an in depth assessment of their health with internist. A complete history, meticulous physical examination, a comprehensive panel of laboratory testing, assessment of their cardiovascular system with carotid doppler and stress echocardiogram, and any other testing that seems relevant to their particular needs. Most men have never had anything more than brief visits to a physician to take care of acute crises. Good health care should begin when a child leaves his pediatrician; he should sign up in his 20's for a yearly examination with an internist.

A program should be designed for every man that addresses his particular nutritional needs including vitamins and other appropriate supplements, builds in regular and age-appropriate exercise, and where necessary, includes counseling to address issues of stress and/or depression. It is very common for a patient to claim he "knows everything there is to know about nutrition", but for the overweight male, a skilled nutritionist is an essential collaborator in building a healthy life style. It is also very common for men to resist talking to a professional about the issues in their lives that trouble them. Men often believe that time alone and/or vacations at appropriate intervals are time wasted, but they can be life-saving.

Q. What advice do you have for the families of these men about how to keep them on the planet longer?
A: A good start is to sit down with the man in your life and ask him to make a visit to a good internist to assess his baseline health-to make a list of what hurts him. It's essential to plan a program for a healthy lifestyle. Often men feel that any attention, particularly if it involves their frailties, is a sign of weakness, and resist going to the doctor until the first real crisis.

Q: What is the one single most important lesson that you want men to take away from this book?
I would like men to know more about their bodies: their particular vulnerabilities and unique strengths. In particular, I want them to know how to avoid premature aging and the deterioration that occurs as they enter the latter decades of their lives. We are so good at curing disease that we are prolonging the life span for both sexes; the important thing is to make those extra years vital and as pain free as possible. I want them to know that good health depends on regular, sensible attention to each person's particular needs. A sensible lifestyle can prevent many diseases, particularly the ones that are most debilitating and eventually lead to premature death like hypertension, diabetes, and cardiovascular disease. Risk taking doesn't end with adolescence; in many men's lives, avoidance and denial take a very heavy toll.

Q: What is the one single most important thing you want to men to realize about their health?
A: Men have inherent vulnerabilities they need to face as well as strengths on which they can capitalize. Many of them die early and needlessly because of paying attention to their health only when it is seriously threatened. Most men's lives are saved by heroic interventions that would not have been necessary if they had paid appropriate attention to correcting the risk factors that kill most of them. Prevention is a life-time task, but the benefits are enormous. Improved vitality, strength, competence and a longer life are the result.

Why Men Die First:
* Men suffer from "andropause," a combination of hormone depletion and loss of physical, emotional, and sexual energy. This is a critical phase in men's life that up to now has been ignored. It accounts for many mid life crises and health problems.
* Depression: psychological distress and malaise is severely under diagnosed and under treated in men. Culturally men are taught to soldier on and grit their teeth. They are not taught to open up emotionally. Irritability, flashes of anger and violent behavior are often earmarks of serious depression in men. Internalization of professional disappointment, mental stress, and family problems all produce toxic effects on the body.
* Cardiovascular disease: Heart disease is the biggest killer of men. Most men with coronary artery disease die before they are 65. The first symptoms manifest a full two decades earlier. Yet most men do not seek medical care or think about their health until problems surface.
* Osteoporosis: usually thought of as a female problem, osteoporosis is a huge danger to the aging man. Men over 65 are more likely to die from a hip fracture than women. A quarter of all cases of osteoporosis occur in men.
* Infection: Men are much more prone to infection than women. They pick up more common viruses, more septic infections in hospitals, and more sexually transmitted diseases. Men have weaker immune systems than women because testosterone makes better breeding ground for parasites.
* Stress is a huge factor in men. They handle stress worse than women. Culturally, men are taught that stress is equal to personal drive and motivation and is necessary for success. Yet, it accounts for a sizable fraction of causes of death--from heart attack to stroke to suicide to gastrointestinal problems, such as ulcers.
* Prostate cancer is the second most common killer of men, right after lung cancer, and it peaks in men between the age of 50 and 60.

What Men Can do to Lengthen Their Lives:
* Andropause needs to be a recognized as a normal part of men's lives. The women in their lives as well as the men themselves need to step back and recognize that emotionally, physically, and psychologically, men are going to be challenged midlife. Men can conquer andropause with testosterone replacement therapy and by addressing the other symptoms.
* Depression in men has to be acknowledged and treated more. Men need to understand that emotional wellbeing frequently equals physical vigor. Talking therapy and an emphasis on downtime and relaxation needs to be a regular part of everyday life.
* Heart disease is a killer against whom men in their 60s have a strong fighting chance. Men with a history of early death in close relatives, diabetic men and men with a low blood concentration of "good" cholesterol require frequent visits observation. The good news is that by correcting lifestyle you can prevent 80% of coronary disease.
* Since osteoporosis is prevalent among older men, we need to raise awareness. Men should be taking calcium supplements at breakfast along with their wives, and having their bone density measured regularly.
* Men need to protect themselves against infection by regular observation and learning the first symptoms of infectious diseases.
* Incidents of prostate cancer can be curtailed with close observation in men between the age of 50 and 60, which is when it peaks. Dr. Legato explains the warning signs men should look out for.

Dr. Marianne J. Legato is an internationally recognized physician, author, and lecturer. Professor of Clinical Medicine at Columbia University, she is annually cited in New York Magazine's top doctors issues. She is also the author of bestselling Eve's Rib, The Female Heart, and Why Men Never Remember and Women Never Forgot, which was translated into eleven languages. She lives in New York.