Toxic Masculinity And Male Fragility

male fragility

We’re hearing a lot these days about toxic masculinity and male entitlement and even male fragility. We hear almost nothing, however, about the many ways in which males—from fetal status onward—are, in general, neurobiologically more vulnerable than females. Yes, when I use the term male fragility, I am referring to brains, not egos. Yet, sometimes the two are inextricably connected.

In all age groups, for example, males die earlier than females. What are the many factors that contribute to that? I will detail examples below.

These fetal and birth disparities have nothing to do with culture. They have to do with physiology. Most likely, brain-based. As these boys mature and encounter other disparities, how much is physiological and how much is cultural? Clearly, the two are intertwined. How much does the physiological determine the culture? A lot, I would guess.

Beginning with Biology

Let’s assume we want a healthier, happier future for everyone. How would we begin?  Perhaps where life itself begins:  biology.

I dipped into this subject in the last post: Newsflash: Male, Female Brains Differ, in 100s of Ways.

Simultaneously, I’d like to encourage reassessing cultural tropes that cloud our perceptions and a healthier path forward. For example:

  • “The Feminists dominating our nation’s schools are obsessed with emasculating our boys, simply for not being girls!”
  • “Big Pharma has co-opted the medical establishment into chemically imprisoning young males with highly addictive pills.”(That is, for ADHD+)
  • “The Establishment metes out harsh punishments to mavericks who dare say, ‘Hey, let’s be careful before cramming mind-altering drugs down innocent boys’ throats.'”

I challenged these themes years ago in an article called How Esquire Got ADHD Wrong. It was my response to a dangerously wrong-headed Esquire magazine article, The Drugging of the American Boy.

The Mixed Bag of “Male  Entitlement”

Those narratives are dangerous—and typically self-serving. That is, they often contain some kind of a sales pitch. (Beyond the obvious clickbait potential for the site posting them, I mean.)

For example, The Esquire piece showcased an ersatz guru who sells his lucrative “nurturing boys” program to schools. The gist is, “Only  praise these boys who have alleged ADHD and never criticize or correct them.” Sounds like a recipe for narcissism to me.  (One “name” in ADHD world says the same.) Oh, by the way, that guru says that he “would have been diagnosed with ADHD as a boy”.

Other narratives proliferate, too. Some assert the “scientific fact” that sex is a social construct: The brains of females and males differ hardly at all. (Not true.) Others insist that “Male Entitlement” alone is creating all the problems.

Sure, males do still control much in the world.  American men with advanced degrees still out-earn women with the same degrees.

But “male entitlement” seems a mixed-bag at best:  Males of all ages have higher death rates (from suicide, homicide, accident, and poor health) and greater rates of incarceration, addictions, unemployment, physical fights and domestic violence (as perpetrator), obesity, and of owning a weapon.

By the way, men represent 86 percent of firearm suicide victims, and men are over six times more likely than women to die by firearm suicide.

If we want to reverse diminished life outcomes for males—including those with ADHD and other developmental disabilities—perhaps we should get serious about the science and the statistics.

Consider Motor Coordination Skills

This video ran across my Facebook feed today. Without knowing how these Russian children were selected for these marching lessons, we can’t accurately account for the disparity between the boys and girls when it comes to coordination and rhythmic sense. But we do clearly see differences in motor coordination skills. 

Staggering Statistics: Boys Vs. Girls

The truth is, disparities between girls and boys start much earlier. In the womb, in fact. And these differences are physical.

I listed a few statistics in my previous post:  Newsflash: Male, Female Brains Differ, in 100s of Ways.  For example, consider the  birth statistics that point to greater male mortality. For every 100 girl babies that…

  • … are born alive, 105 boy babies are born alive.
  • …are born dead, 106 boy babies are born dead.
  • … die in the first 28 days of life, 117 boy babies die in the first 28 days of life.
  • …die after the first 28 days of life but before they reach their first birthday, 124 boy babies die.

Male Fragility — from Birth

This chart clearly shows the advantage female babies have when it comes to life itself:

fetal mortality males versus females


For Every 100 Girls With Disabilities—Age 3-5

Consider another category, gender differences among children aged 3-5 with disabilities:

For Every 100 Girls With Disabilities—Age 6-14

For Every 100 Girls With Disabilities—Age <15

  • …with a severe disability, 191 boys have a severe disability.
  • … with a disability and needing assistance, 195 boys have a disability and need assistance.

For dozens more examples, you can download the full report here: For Every 100 Girls, compiled by Pell Institute Senior Scholar Tom Mortenson and published in 2008 by The Pell Institute for the Study of Opportunity in Higher Education.

Physiology and Culture: Intertwined

These fetal and birth disparities have nothing to do with culture. They have to do with physiology. With the nervous system at the core. As these boys mature and encounter other disparities, how much is physiological and how much is cultural? Clearly, the two are intertwined.

“Molly-Coddled” Men More Successful?

One clear (if perhaps controversial) voice is that of United-Kingdom-based adolescent psychiatrist Sebastian Kraemer.  Consider this 2004 BBC newspiece entitled Molly-Coddled Men  “More Successful”, in which Kramer is quoted:

“If parents know that boys are a bit behind in their development and generally weaker in every way except muscle then they will do a better job than they are doing now,” he said.

“If you want a real man, treat your baby boy as weak not as strong, then he will become strong.”

Dr. Kraemer said, by looking at research, the critical period appeared to be in the first month of life when the brain is still developing.

This is when parents should pay extra care, he said.

“It means looking after your baby like a fragile creature, not a little lump of muscle.”

Why Recognize Male Fragility?

Four years earlier, in 2000, Kraemer wrote a highly cited article in the prestigious British Medical Journal entitled The Fragile Male.

The article is short, worth the read, and perhaps points one way to begin mitigating the lifespan of challenges for many men—and therefore elevating the rest of society as well.

Some excerpts:

The human male is, on most measures, more vulnerable than the female.

Part of the explanation is the biological fragility of the male fetus, which is little understood and not widely known. A typical attitude to boys is that they are, or must be made, more resilient than girls. This adds “social insult to biological injury.”


The data presented here have implications for the upbringing of boys.

The more developmental problems there are, the more sensitive care is required. Yet difficult babies often receive less good care, precisely because they are more difficult to look after.

Biological and social constraints work together against the interests of the male. If parents were more aware of male sensitivity, they might change the way they treat their sons.

Doctors, too, need to be aware that male patients may withhold their health concerns for fear of appearing needy or may ignore them altogether.


Male Entitlement, Male Fragility


Follow Up To The Fragile Male

Kraemer followed up a few years later (2009-2019) with Notes on the Fragile Male, a short, very readable piece.  Excerpts:

Mortality rates: Males are more likely to die or be damaged by stress than females at every age from conception to old age, from very low birthweight babies (22% vs 15% die) to schoolchildren to old men.

Y chromosome: One factor is that while males have only one, females have two X chromosomes – with one in reserve – so that a mutation on one can be counteracted by its absence on the other.

Social class difference: From toddler to school leaving age, boys in the bottom social class are more than twice as likely to die from any cause as those at the top. There is a social gradient for girls but it is not so marked.

Male risk-taking:  Biologically, a species does not need many males if one individual can produce offspring from many females. In many (but not all) mammalian species, only a minority of males produce offspring. The rest are redundant, so it’s worth taking big risks if you want to get a mate. It makes evolutionary sense that males tend to be less cautious than females.

“Gina, What Is Your Point Here?”

One reader commented on my previous post (Newsflash: Male, Female Brains Differ, in 100s of Ways):

I’ve read this article with great interest. Having concluded my reading, I am lost as to its conclusions or what you intended to do with it. I’d appreciate a clarification.

Excellent question! With two short blog posts, I’ve waded into a sea of cultural landmines. What was I thinking?

My response, in part, went like this: 

Haha! I figured someone would say that. 🙂

I tried, obviously not entirely successfully, to explain in the first paragraph:

Science and sociology: The two fields often find themselves at loggerheads. That is the case with ADHD.  Life scientists point to the evidence and social psychologists explain ADHD as a “social construct”). 

And, it’s increasingly the case when it comes to accepting that there are differences between the male and female brain. 

Personally, I’m siding with science. 

Perhaps you are not aware of the growing insistence from ideologues. They claim, as I write in the post, that the only difference between males and females comes from the culture, not biology. That any “bad behavior” from men is always volitional, a choice. 

That is simply not the case. One factor: The male brain from birth to death is more vulnerable to dysfunction, illness, and injury…

       If we don’t try to clearly understand these vulnerabilities, we draw the wrong conclusions and implement the wrong solutions.

What did I “intend to do with” this information?  I simply hoped to spark reflection and invite scrutiny of popular but dangerously anti-science and simplistic tropes.

Did it work?

*According to a 2008 U.S. CDC report: Health, United States, 2008, with Special Feature on the Health of Young Adults.

—I welcome your comments.

Gina Pera


5 thoughts on “Toxic Masculinity And Male Fragility”

  1. The book “The Countdown” by Dr. Shanna Swan discusses this in regards to global fertility rates. Males in general are more vulnerable in the womb to environmental stressors. I suspect my ADHD may have been a result of the lack of regulation in material and chemical use in my country of birth, as my birth mother was a factory worker and it was in the process of industrializing while I was born.

  2. I think your topic is fascinating. I also take issue with the numbers you provided. I don’t trust them for many valid reasons:

    1. what are the ratios for gender comparisons? These will be more reliable than straight number comparisons (i.e. 100 to 103). Just under half of the numbers you provided are close enough that they could be explained by something other than what your are stating.

    2. I don’t trust that the studies accurately address the number of females who are impacted by the same things. Women’s pain and reported experience have been, until the last 2-3 decades, largely dismissed and written off as them being over sensitive. I myself was told I didn’t have adhd repeatedly, only to be diagnosed at age 42, and am currently struggling to get a diagnosis for my aspergers. Why? Same reason: these manifest differently in women than men, and almost all studies are focused on young white males. I am a female poc. My daughter experienced significant issues throughout her young life because of undiagnosed issues and doctors telling us to try harder, we weren’t working hard enough, pay more attention, etc. It took going through hell to get her diagnosis of adhd, ptsd, and epilepsy. Doctors literally told me that her seizure wasn’t anything to worry about after witnessing it and I’d told them they happened with some consistency.

    I posit, with extremely valid reasons, that there is a huge, huge problem with the current statistics on what females experience growing up, and I don’t trust the stats you’ve provided…not because you selected poorly, but because of the inherent bias that went unnoticed and unacknowledged in studies themselves, and in doctors until just recently. I think these studies need to have another factor applied to account for the high margin of error bias causes. Until they do they’re not reliable beyond a certain point.

    I’d like to see another version of this article with all of these factors taken into account.

    1. Hi Callista,

      Thanks for your comments. You make important points.

      Definitely, we know that women’s experience has been neglected in much medical research. For many years, the excuse was the women of childbearing age should not undergo experiments. But thank goodness, that attitude started changing in recent decades.

      And definitely the same for POC.

      We also know that some physical issues present differently in girls versus boys. Even in adults, I’ve read, the signs of heart attack tend to be different — perhaps more subtle — in women than in men.

      Just to be clear: I did not fancy this a definitive manifesto, and I am not a paid statistician. 🙂 I’m simply offering food for thought.

      Yes, the differences are small in some cases between boys and girls, insofar as these statistics, and some no doubt represent judgment calls that might be off the mark.

      But some disparities are so large as to be unquestionably significant.

      In the case of fetal death rate, that is a fairly clear cut metric.

      If you find a better source for these statistics, I’d love to know about it.

      Thanks for writing.

  3. I found the article intriguing. My quibbles: 1) the premise that statistical disparities need to be addressed 2) negative outcome elimination is our goal and 3) the lack of multivariate analysis and lack of depth in organizing and examining the data. To be fair, it’s a blog post so 3) is impractical and you sited sources that I didn’t read. I never start with the notion that disparities need to be addressed and sometimes you need negative outcome to get spectacular outcomes.

    1. Hi Andrew,

      Thanks so much for reading, and commenting.

      You make good points.

      These statistical disparities alluded to, between male and female outcomes, are massive and pervasive. And they are growing more disparate by the year. The many charts in that PDF I link to, “For Every 100 Girls,” make that very clear.

      I think we can address some of these without futzing with, as you say, whatever negative outcome might be needed to get spectacular outcome. The goal is more spectacular outcome.

      For example, we might factor into our educational systems the biological fact that boys mature more slowly than girls.

      We might emphasize, as Dr. Kraemer suggests, the gentler treatment of boy babies. We might better educate parents on the delay in developing impulse-control with boys, so instead of responding with punitive measures they can respond with more helpful strategies.

      We might improve healthcare models that take into account many men’s reluctance to get regular healthcare exams and to follow up on early indicators of disease. Perhaps this means more reminder systems, more education, etc.

      The world is changing, and men who cannot function as well in the “Knowledge Economy” are feeling marginalized, dismissed, and disrespected. Perhaps the more we can help them, the better off we will all be.


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