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Sex differences in medicine
A man can be diagnosed with the same disease as a woman, and yet the course the disease takes in each could prove very different. And a treatment which works for one gender may prove ineffective for the other. Put simply, men and women are wired differently, and thus it is critical to study the impact that sex differences may have on diseases and their treatments.
To learn more about this hot topic in medicine, BeWell spoke with Marcia Stefanick, PhD, professor of medicine (Stanford Prevention Research Center) and co-director of the Stanford WSDM Center (Women & Sex Differences in Medicine).
What is the relevance of gender medicine?
Gender medicine recognizes that due to sex differences in pathophysiology, being a woman or being a man significantly influences the course of many diseases. By better understanding that clinical manifestations of prevalent diseases differ in women and men, gender medicine aims at better disease management and treatment of both sexes.
Certain diseases are categorized as “a woman’s disease” or “a man’s disease,” and yet — except for diseases of sex-specific reproductive organs — men get women’s diseases and women get men’s diseases. An example is osteoporosis, which we usually consider a woman’s disease. However, men account for one in three hip fractures — a fact that most people don’t know.
Generally, if you look at conditions that have been designated as “what men get,” you will notice that when a woman gets one of those disorders, she is often much sicker than the average male with the same disorder. And vice versa when a male contracts “a woman’s disease,” such as breast cancer.
Does this result in health disparities?
Yes. Because we may have primarily studied a particular disease in only one of the sexes, usually males (and most basic research is done in male rodents), the resulting treatments are most often based on that one sex’s physiology. Such treatments in the other sex might not be appropriate. One example is sleep medication. Ambien is the prescription medicine recently featured on the TV show, 60 Minutes. Reporters found out that women were getting twice the dose they should because they had been given the men’s doses; consequently, the women were falling asleep at the wheel and having accidents. Physicians had not taken into account that women are smaller and their livers’ metabolize drugs differently than do men’s. Some women have responded by reducing their own medication dosages, and yet that practice of self-adjusting is not the safest way to proceed, either.
Why can’t physicians do a better job prescribing meds for women?
While we know that women are often smaller and metabolize drugs differently than men, we have relatively little quality research on those specific differences. Alarmingly, 8 out of 10 drugs pulled off the market in 2009 were removed because of much more adverse reactions in women. Upon review, very often it is found that the medication had not been adequately tested in females.
How would you recommend we take gender into consideration when making medical choices?
This answer seems obvious, but it’s far from easy: better education. A good example is the “red dress campaign,” which is educating women to be aware of their risk and symptoms for heart attack and to report their symptoms in a way that will get more immediate attention by medical professionals. The campaign also educates physicians to recognize the different symptoms women may report (fatigue, nausea, pain in the right arm) before reporting the chest pain that men typically report. Heart disease used to be considered a man’s disease and even now most people are not aware that it is the leading cause of death in women, as well as in men.
Does this take us closer to individualized medicine?
Gender medicine is actually an important step which can precede and prove more cost-effective than individualized medicine. We are going after every genetic test in the universe and kind of missing the fact that just by looking at a person you can get important diagnostic information. Just by learning whether a patient is a man or a woman, plus their age and ethnicity, provides a physician with information that often proves the strongest predictor of most diseases.
… any final thoughts?
The WSDM is very interested in understanding the biology that does (or doesn’t) make men and women different, as well as the gendered issues which bias medical practice to a man’s or a woman’s advantage (or disadvantage).
Researchers also need to take into account reproductive phases. Women are complicated because of major changes in “sex hormones” during menstrual cycles, pregnancy and menopause, whereas men just have a gradual lowering of their primary sex hormone (testosterone) as they age. Researchers need to study the impact of those changes on disease states and treatment options. Therefore, it would be simplistic to say we’re only studying men vs. women. We are studying the differences between women and men throughout the continuum of life’s many complex stages.
For more information on gender research, learn more from Stanford’s Gendered Innovations initiative, which employs methods of sex and gender analysis to create new knowledge across the fields of health and medicine, engineering, the environment and science.
Interview conducted by Julie Croteau and edited by Lane McKenna.