Usually women live longer than men and female centenarians largely outnumber male centenarians. The findings of previous studies identifying a population with a femininity ratio close to 1.0 among centenarians in the mountainous region of Sardinia was the starting point of an in-depth investigation in order to compare mortality trajectories between men and women in that population. The exceptional survival of men compared to women emerges from the comparison with similar Italian data. Age exaggeration for men has been strictly excluded as a result of the age validation procedure. The discussion suggests that besides biological/genetic factors, the behavioral factors including life style, demographic behavior, family support, and community characteristics may play an important role. No single explanation is likely to account for such an exceptional situation and a fully integrated multidisciplinary approach is urgently needed. 1. Introduction In developed countries, it has been widely documented that females live longer than males [1–3]. This female advantage in survival, the so-called Longevity Gender Gap (LGG), results from lower female death rates throughout the lifespan [4–6]. In traditional societies, the LGG was less pronounced and even inversed [7] and a secular trend of increasing LGG is generally observed. Nevertheless the trend has changed in the recent decades resulting in a slightly decreasing LGG [8]. In general, it has been observed that during the life course, the occurrence of certain diseases such as cardiovascular diseases, lung cancer and accidents are more frequent among males [9] and this trend is confirmed when extending the comparison to the top 12 causes of deaths [10]. The cumulative effect of these differences throughout the life course, results in a greater proportion of females surviving at more advanced ages. In populations experiencing a low mortality, the femininity ratio (F/M) among centenarians is usually above 4, that is, there are more than 4 female centenarians per male centenarian (data source: Human Mortality Database). However, recent research has shown that in certain populations the F/M ratio among the oldest olds may be remarkably lower, and when this occurs it is often the result of a reduced excess of male mortality rather than a higher mortality of women [11–13]. Among these populations, the one living in the Mediterranean island of Sardinia certainly represents an interesting case study. This region has been suspected to be characterized by a particularly high male longevity [14]. Considering the importance
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