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What is Gender Medicine?

Sex- and gender-dependent differences exist on every level in human health and disease By Neelum T. Aggarwal, MD

Prior to 2000, there was very little discussion about gender medicine. However, with the establishment of the Partnership for Gender Specific Medicine at Columbia University (1997), the Karolinska Institutet (2002), and the Charité Universitätsmedizin Berlin (2003), studies began to systematically examine comparisons between women and men. In 2001 and 2010, the Institute of Medicine in the U.S. declared that being a woman or a man significantly influenced the course of disease and should be considered in diagnosis and therapy.

Biological Differences and Socio-cultural Processes
For starters, gender medicine aims to improve treatment for women as well as for men. It is different than women’s health because it also focuses on men’s health. Gender medicine deals with the effects of sex including biological differences between females and males. Examples of sex differences can include different concentrations of sex hormones, different expression of genes on X and Y chromosomes, or a higher percentage and deposition of body fat in women.

Gender, however, is the result of socio-cultural processes. Associated with behavior, stress, and lifestyle-related diseases, gender has been shown to determine access to health care, help-seeking behavior, and even individual use of the health care system. Recent studies have shown that gender largely determines one’s compliance with preventative measures, and whether one follows up on referrals or accepts invasive strategies like a pacemaker implant, heart transplant, or other surgeries.

Relationship to Improved Care
In medicine, it isn't easy to separate the influence of sex and gender on disease. However, we do know that considering the impact can lead to improvements in care. For example, clinical manifestations of prevalent diseases differ in women and men; it is thought that this is due partially to sex differences in disease mechanisms. Again, this is seen especially in cardiovascular disease risk factors, disease and symptoms of atrial fibrillation, myocardial infarction, and heart failure. Pre-diabetic women have shown an early decrease in glucose tolerance whereas men exhibit early elevated fasting glucose. Diabetes has a different weight as a cardiovascular risk factor in women and in men. Furthermore, it is known that the pathophysiology of coronary syndromes differs in both genders, and some stress- induced syndromes occur only in women. Exercise ECG has less sensitivity in women than in men, while ischemic sudden death occurs predominantly in men. Understanding these differences can lead to the investigation of mechanisms that may ultimately translate into new therapeutic approaches.

Another area gaining increased attention is pharmacologic and non-pharmacologic interventions. Differences in the pharmacokinetics, metabolism, and drug distribution in men and women have been identified. Many drugs require different doses in women and men for optimal effect, with one theory suggesting that at a biological level, ion-type channels in the kidney and heart may differ in men and women, therefore explaining differences in drug action and effectiveness when used to modify kidney function or heart rhythm.

Effects of non-pharmacological interventions also show differences in women and men. Coronary bypass surgery has been shown to have an earlier mortality in women and revascularization therapy may be less effective in women with unstable angina than in men. Taken together, knowledge of different therapeutic procedures with different strategies in men and women could lead to the development and incorporation of these aspects into guidelines, which can ultimately enhance the efficiency of pharmaceutical and interventional therapies.

Link to Personalized Medicine
Personalized medicine, which aims to consider all individual risk factors, including ethnicity, lifestyle, personal history, risk profiles, and genetic disposition, should also include the role of gender. Many studies have found gender to be an independent risk factor after accounting for demographics, co-morbidities, and psychosocial factors. Looking forward, individualized clinical care algorithms and care plans based on individual risk profiles should be developed on top of gender-based assessments.

For more information, please check the Organization for the Study of Sex Differences (www.ossdweb.org) and the International Society for Gender Medicine (www.isogem.com).

Dr. Aggarwal is a cognitive neurologist at the Rush Alzheimer’s Disease Center and a board member of the Sex and Gender Women’s Health Collaborative (www.SGWHC.org).

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