The Fragile Male

The Fragile Male

This is a fascinating and compelling article about the innate fragility of males (Kraemer, Sebastian.British Medical Journal. 2000. 1609. Vol. 321. 1609-1612). It reviews literature from various fields and presents a number of facts that might be surprising for many readers. For instance, male mortality is greater than female mortality throughout life (from in utero till old age). Based on the review of many sources, Kraemer says that there is evidence that male embryos are more vulnerable than female ones. At the time of conception, there are more male than female embryos, but they tend to survive less to the time of birth. Apparently, perinatal brain damage, cerebral palsy and congenital deformities of genitalia and limbs are also more common in boys, as well as prematurity and stillbirth. Also, a female newborn is physiologically equivalent to a 4 to 6 week male child. It is better known that autism, hyperactivity, clumsiness, stuttering and Tourette syndrome are also more frequent in males. It is hypothesized that these conditions might be linked to an X chromosome site. Also, it appears that boys are more difficult to take care of; they tend to be more irritable, to be less rhythmic and more challenging and more sensitive than girls. Kraemer suggests that precisely the cultural expectations that boys should be more tough and stronger than girls, runs against this fragility and vulnerability. Later on in life, boys are less likely to be able to talk about their feelings and to have more aggressive behavior statistically. Girls have better literary skills and express their feelings more explicitly. Alexithymia, the inability to tak about one’s feelings is more frequent in males . When exposed to the distress of others, boys tend to be less sympathetic than girls, which has been suggested by a number of studies of exposing children to the cry of infants. More data and facts are presented in this compelling review.

Is it time for clinicians and society to change their view that boys should be stronger and tougher than girls, given those remarkable vulnerabilities?

Dr. Kraemer is a child psychiatrist at the Tavistock Clinic in London, UK