Men, Women, And Aging. Where Did I Leave My Keys?
“He’s making me nuts” Julia runs her hands through her short gray hair. “He follows me around the house like one of those terrible little dogs. I can’t get anything done! Was he always this dense? It seems like I have to explain everything 40 times”.
Julia is a longtime patient of mine, in for an annual checkup. Her physical health is terrific, but as I’m hearing, her mental health is something else entirely. The source of the strain: her recently retired husband. “Thirty years, two kids – we spent so much time talking about how great it would be for him to be out of the rat race, but I’m spending our retirement doing everything I can not to kill him!”
Unfortunately, Julia is hardly alone. Many people and their spouses find the golden years of their retirements a surprisingly bitter pill to swallow, and I can’t count the number of stunned patients I’ve seen, struggling to figure out why they are not happy now that they’ve gotten this long-awaited treat. Once again, I suspect that the answer lies in the significant differences between men and women – and in this case, in how they age.
As I explained to Julia, while men and women both get older and experience physical, mental, and sexual changes as a result, the process manifests itself differently – and with different timing – in both sexes. Ultimately, we become more like each other than we may have been at any other time in our lives since childhood but getting there can be rocky. The differences between us can cause a great deal of conflict – just as life is supposed to be getting much easier.
The Aging Brain
We’re living longer than we ever have before; in fact, our life spans have doubled in the past 100 years. Retirement used to signal the end of a productive life; now it’s quite literally a “third act”, filled with travel, the satisfaction of long-postponed creative impulses, new loves, and second (or third) careers. This third act will be enjoyed by record numbers. By 2050, 1/5 of the American population will be 65 or older.
With so many more happy, healthy, active older people, our conception of aging is evolving as well. The AARP was recently up in arms about an ad for a cell phone that would make it easier for the elderly to get in touch with their “doctors and grandchildren”. I teased one of my older patients about it when I saw her answering her email in my waiting room; she smiled up at me, thumbs still flying over a slender platinum handheld, and hummed, “Times, they are a-changing.”
Aging seems to be a double-edged sword. On the one hand, I don’t agonize over every reversal or disappointment the way I did when I was 20; they don’t seem to have the same intensity they used to. A missed telephone call from the man of the hour doesn’t precipitate a crisis, and if my son forgets he agreed to have dinner with me, I shrug it off, happy to see that his life is full and busy too. Things don’t seem to be as catastrophically important as they once did, either. I find I lend my daughter my favorite clothes and jewelry without even a twinge of anxiety, and a worn spot on a wonderful oriental carpet merely reminds me of how many times I have happily walked through my beloved apartment.
But that’s not all that’s changed. I have to pay attention where I put my house keys away, so I won’t spend 15 minutes looking for them the next morning. I now have to remind myself to focus on what I’m doing, so I don’t get hopelessly distracted by one of the other thousand things that I’m processing simultaneously. It’s harder for me to learn a new song at my piano, and I absolutely cannot remember the name of a novel I loved 10 years ago.
My male friends have different complaints and celebrations, but certain things are the same. Our more fixed abilities, like our vocabulary, deteriorate less than more sophisticated processes like our ability to show good judgment or the capacity to pay attention to what we’re doing. As we’ll see (and you will eventually!), the memories of both sexes are particularly susceptible to the ravages of time.
Marianne J. Legato, MD, Ph. D. (hon. c.), FACP is an internationally renowned academic, physician, author, lecturer, and pioneer in the field of gender-specific medicine. She is a Professor Emerita of Clinical Medicine at Columbia University College of Physicians & Surgeons and an Adjunct Professor of Medicine at Johns Hopkins Medical School. Dr. Legato is also the Director of the Foundation for Gender-Specific Medicine, which she founded in 2006 as a continuation of her work with The Partnership for Gender-Specific Medicine at Columbia University. She received an honorary PhD from the University of Panama in 2015 for her work on the differences between men and women.
At its core, gender-specific medicine is the science of how normal human biology differs between men and women and how the diagnosis and treatment of disease differs as a function of gender. Dr. Legato’s discoveries and those of her colleagues have led to a personalization of medicine that assists doctors worldwide in understanding the difference in normal function of men and women and in their sex-specific experiences of the same diseases.
She began her work in gender-specific medicine by authoring the first book on women and heart disease, The Female Heart: The Truth About Women and Coronary Artery Disease, which won the Blakeslee Award of the American Heart Association in 1992. Because of this research, the cardiovascular community began to include women in clinical trials affirming the fact that the risk factors, symptoms, and treatment of the same disease can be significantly different between the sexes. Convinced that the sex-specific differences in coronary artery disease were not unique, Dr. Legato began a wide-ranging survey of all medical specialties and in 2004, published the first textbook on gender-specific medicine, The Principles of Gender-Specific Medicine. The second edition appeared in 2010 and the third edition, dedicated to explaining how gender impacts biomedical investigation in the genomic era, won the PROSE Award in Clinical Medicine from the Association of American Publishers in 2018. A fourth edition is forthcoming.
She also founded the first scientific journals publishing new studies in the field, The Journal of Gender-Specific Medicine, and a newer version, Gender Medicine, both listed in the Index Medicus of the National Library of Medicine. She has founded a third peer-reviewed, open access journal, Gender and the Genome, which focuses on the impact of biological sex on technology and its effects on human life.
Dr. Legato is the author of multiple works, including: What Women Need to Know (Simon & Schuster, 1997), Eve’s Rib (Harmony Books, 2002), Why Men Never Remember and Women Never Forget (Rodale, 2005), Why Men Die First (Palgrave, 2008), The International Society for Gender Medicine: History and Highlights (Academic Press, 2017), and most recently, The Plasticity of Sex (Academic Press, 2020). Her books have been translated into 28 languages to date.
As an internationally respected authority on gender medicine, Dr. Legato has chaired symposia and made keynote addresses to world congresses in gender-specific medicine in Berlin, Israel, Italy, Japan, Panama, South Korea, Stockholm, and Vienna. In collaboration with the Menarini Foundation, she is co-chairing a symposium on epigenetics, Sex, Gender and Epigenetics: From Molecule to Bedside, to be held in Spring 2021 in Italy. She maintains one of the only gender-specific private practice in New York City, and she has earned recognition as one of the “Top Doctors in New York.”