Why Men Die First
Chapter 6- The Male Libido – Men and Sex
Listen to the dry voice of science on the subject of monogamy:
Monogamous pair bonds are relatively rare among mammalian species…only about 3 percent of mammalian species display such bonds, and even fewer appear to exhibit obligate monogamy 
Monogamy is one of the most puzzling of mammalian mating systems, for it is not clear why males should confine themselves to breeding with a single female. 
For most scientist who think about the reason for monogamy, the most persuasive explanations for it are practical ones: Males stay with one female when the cost of more than one is too expensive.
That translates int contemporary life: One of my patients, in love with a woman to whom he wasn’t married, told me that divorce was too expensive to contemplate- despite the attraction of the idea of changing spouses! Environmental resources may be so scarce that competing for them is the overwhelmingly important priority; many men are consumed by a 14-hour workday that they then continue on their ever-active BlackBerrys.
Scarcity of women is another factor in compelling male commitment: Females may hold control of such a large territory that males cannot defend more than one from interlopers, and reproductive success depends on an investment not only in the female, but in helping he raise the offspring successfully. This was true in the Wild West, where men hotly competed for the occasional woman hardy enough to venture in to the untamed world of that time.
So monogamy ultimately turns out to be an eminently practical decision. The increase in the number of house husbands in the current climate of women’s ever-greater success in the marketplace attests to the practicality of monogamy in a world where women have tremendous earning power and command a greater investment in child- rearing (and nest maintenance) form their spouse. At a recent conference of powerful women at Harvard I met a managing director who was as remarkable for her obvious intelligence as for her personal beauty. She had married one man who had stayed at home while she pursued her successful career, only to lose him to cancer. Within a year she had met and married a second man, who also was content to remain at home while she traveled into the marketplace and around the world, earning the family income. She loved both men dearly and had chosen wisely for her purposes. As had each of her husbands.
Adolescent males present a unique problem with commitment: The problem of promiscuity in adolescent males (and its attendant epidemic of sexually transmitted disease) is compounded by the issues discussed earlier in this book, such as risk taking.
Adolescent often intellectually acknowledge their vulnerability to risk- talking about it quite rationally but believing (illogically) that they will never experience any adverse consequences of such behavior.
One of my patients, a stunning African American male who is a superlative athlete, has a whole bevy of women competing for his attention. I asked him if he had a favorite; predictably he answered that he slept with many young women. “Do you use a condom?” I asked. “Not always”, he answered. “Why not?” I countered. “Because it fells better without one” was the immediate answer. He reassured himself that testing annually for HIV infection was enough to monitor his sexual activity. Denial, I often remind myself, is an essential part of young male behavior. Unfortunately for them, evolution has fashioned young males at the peak of their physical powers to believe they are immortal. They enthusiastically take the enormous risks needed to perpetuate awareness that they are vulnerable, and often engage in mortally dangerous behavior.
Testosterone’s fueling of sexual desire isn’t restricted one sex. Many studies of testosterone treatment of women with low libido document its impact.
|In a study led by investigators from the prestigious Massachusetts General hospital in Boston, a testosterone patch in 75 women produced spectacular results: The percent of women having sexual fantasies at least once a week doubled and the number of women who had intercourse at least once a week went form 23 percent to 41 percent. Desire, the intensity of arousal, and enjoyment and intensity of orgasm all increased significantly. Women reported less depression and an improved sense of wellbeing on the hormone.|
 J.T. Curtis, Y.Liu et al., “Dopamine and monogamy,” Brain Research 1126 (1) 2006: 76-90
 T.H. Clutton-Brock, “Mammalian mating systems,” Proceeding of the Royal Society B Biological Sciences 236(1285) (1989): 339-372.
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.”