What Did You Say?
The Differences Between How We Listen and What We Hear
“You never listen to me!”
“Have you even heard a word I’ve said?”
“Men just don’t get it”
In some ways, meeting one another and getting together are the easy parts. All too often, it’s when we start really relating to one another – talking, listening, negotiating, and compromising – that the problems begin.
It seems that there is no bigger difference between men and women – and no difference that causes more friction – than the way we communicate with one another. Our difficulties in talking and listening to one another are the subject of countless books, daytime talk shows, jokes, and conversations between friends. With good reason: as all too many couples have discovered, the ability to communicate effectively can get two people through the worst parts of a relationship; without it, there is no relationship at all.
Whether you’re making love or parenting or getting older, the quality of that interaction is governed by the quality of your communication about it. Being able to talk – and perhaps more important, to listen – is positively fundamental.
Why Is It So Hard?
Men and women have so many of the same interests, and yet, I hear it over and over – from my friends, my patients, and yes, even myself: sometimes talking to the men in our lives is like banging your head against a brick wall. They don’t listen, or they’re irritated at the things we say; they don’t respond to our comments, and even when they do, they don’t say the right things. I sometimes think it’s a miracle we manage to live together as effectively as we do, given how hard it sometimes is to communicate with one another. Why the disconnect? And what can we do to repair it?
In fact, some of the difficulties that men and women have in communicating may have a biological basis. There’s considerable scientific evidence to suggest that men hear, listen to, understand, and produce speech differently than women do.
How We Hear
We are actually born with slight difference in our hearing apparatus. Newborn girls can process and interpret sounds better than same-age boys. This is the reason why baby girls recognize sounds like their mother’s voice sooner than baby boys do. As far as we know right now, this doesn’t translate into a difference in the way adult men and women hear. But it is interesting to note that there is a discrepancy in how well we hear right off the bat, as well as a difference in the systems in the brain that we use to decode what spoken language really means.
There’s an old joke that men lose 50% of their hearing once they say “I do”. In my experience, there’s no ring required. Communication difficulties take place between fathers and daughters, brothers and sisters, and on one-night stands. Certainly, men’s ability to process language and understand what is said to them begins to diminish as early as age 35, while women preserve this function until their menopausal.
At that point, the playing evens out a bit, with an interesting twist. A study published in the Journal of Speech, Language, and Hearing Research showed that women lose their ability to assess cues from the tone of someone’s voice for a period of time after menopause. This is part of the cognitive dissonance that comes from an estrogen dip, the same dip that can also make it difficult for menopausal woman to remember details and make decisions. Like those lapses, it has an impact on our ability to navigate the world. Tone, of course, adds essential information to our communications. It tells us when a comment is meant to be ironic, a joke, or just plain cruel. If you strip the loving, teasing vocal note out of even the most gentle jibe, it can sound harsh and heart hurtful. This tone-deafness may explain the complaint I hear so often about pre-menopausal women – “she takes everything I say the wrong way!”.
There’s some evidence that men, no matter what their age, actually process the information they hear differently than women do because a fundamental differences in our brains. In general, humans use the left part of the two symmetrical halves of our brains to produce language and understand speech, and the right for dealing with tasks that involve our physical position and other spatial relationships.
Some of the differences between men’s and women’s brains that may cause differences in the way we process and produce information include the following:
- Women have more nerve cells in the left half of the brain, the seat of our ability to process language.
In the brain, quantity of cells often does correlate with quality. And the brain of a gymnast for example, the part of the brain that controls balance and motor skills is larger than it is in other people, and the more she practices, the larger it gets.
- Women have a greater degree of connectivity between the two parts of the brain
The thick network of fibers that connects the two halves of the brain, called the corpus callosum, is larger in women than it is in men. This may lead to greater traffic between the two halves of the brain in women. For example, men and women appear to process single words in a similar fashion, but when they’re interpreting full sentences, men tend to use a single specific area in the brain, while women mobilize the same areas but in both sides. A study at Indiana University in 2000 showed that women used an area of the brain just above the ears and both halves of their brains in listening to an excerpt from a John Grisham book, while men used the same region, but only on the left side.
I find the revelation that men and women use actually use different systems to hear staggering – and one with many as-yet unexplored implications. If it is found that women and men actually process and decode what they hear differently, will it change the way we educate the two sexes? Advertise to them? Talk to one another? We can only imagine.
- Women have more dopamine in the part of the brain that controls language.
Nerve cells don’t talk to each other by touching; they release chemical messengers called neurotransmitters, which are picked up and “read” by other nerve cells. Women have higher concentrations of the neurotransmitter called dopamine in the part of the brain responsible for language and memory skills. In other words, their cells have more messengers at their disposal, and more messengers means more information delivered more efficiently.
Researchers believe that women score higher on tests of verbal learning than men, particularly if they are younger, in part because of this higher dopamine availability in their brains.
So women appear to use more of their brains – they have more cells, and they use a greater percentage, encompassing more areas – in listening to and in making speech. Does that necessarily mean that women are better at it? There are any number of studies to suggest that they are, but I prefer to think of it this way: The increase accessibility of some of the systems may make listening to, understanding, and producing speech easier for a woman.

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.”