Gender medicine – gender-sensitive medicine

What is gender medicine?

Gender medicine is a field of research that emerged in the USA in the late 1980s under the term ‘women’s health research’ and came to Europe at the turn of the millennium. It investigates how biological differences between women and men affect health and what influence the gender factor – that is, the different ways in which upbringing and society shape individuals depending on their sex – has on the development of diseases.

Today, the term ‘gender-sensitive medicine’ is also widely used, as research focuses not only on gender factors but also on the biological differences between men and women. Both sexes are intended to benefit from these findings.

What are the areas of focus in gender medicine?

Gender medicine investigates gender-specific differences between men and women in relation to health and disease. This includes:

• Investigation of clinical presentations and disease progression: researching how certain diseases manifest and develop differently in men and women.
• Analysis of risk factors: identifying and comparing gender-specific risk factors for various diseases.
• Development of gender-specific diagnostic procedures and methods: Optimising diagnostic options to take gender differences into account.
• Development and optimisation of treatments: Adapting and developing treatment methods that take gender-specific differences into account.
• Prevention strategies: Developing preventive measures specifically tailored to the needs of men and women.

The aim of gender medicine is to improve the health of women and men and to reduce inequalities in healthcare.

Examples of gender-specific differences in medicine

Cardiovascular diseases

Cardiovascular diseases are the leading cause of death in both sexes, but they present with different symptoms and follow different courses. A typical symptom of a heart attack is a stabbing chest pain that may radiate into the arms. In women, however, the pain during a heart attack can be much milder and present as non-specific symptoms such as a feeling of tightness in the chest or pain in the upper abdomen.

Cancer

Men are more likely to develop cancer and have a higher mortality rate than women. There are also differences in the types of cancer that affect men and women. Gender medicine investigates these differences and develops gender-specific diagnostic and therapeutic procedures to optimise treatment outcomes.

Mental health

Women are more frequently affected by mental health conditions than men, and the symptoms as well as the effectiveness of treatments can vary.

Why is gender medicine important?

The findings of gender medicine research help to take account of gender differences in relation to illness and health. This leads to better diagnosis, more effective treatments and, overall, better healthcare for both women and men. It can also empower patients to better understand and manage their own health.

What is the gender health gap?

For a long time, medical research and teaching were primarily focused on male patients, and there was no gender-specific research, diagnosis or treatment. This led to inequalities in healthcare provision for women and men, which persist to this day. The differences in health status and healthcare between men and women are referred to as the gender health gap.

What are the implications of the gender health gap?

The effects of the gender health gap are far-reaching and affect both individuals and society as a whole. Here are some of the most significant consequences:

• Under-treatment or misdiagnosis in women: As medical research and teaching have long been geared towards male patients, specific data for women is often lacking. This leads to under-treatment or misdiagnosis.
• Inaccurate diagnoses in men: The gender health gap can also lead to inaccurate diagnoses and incorrect treatment in men, particularly when they suffer from conditions that are generally considered to be more typical of women. One example is osteoporosis, which is often regarded as a women’s disease, even though men can also be affected.
• Impact on life expectancy: Although women live longer on average, they spend around 25 per cent fewer years in good health compared to men. This is partly because women’s specific health needs are often not adequately taken into account.

Women’s and men’s bodies – what are the differences?

Women usually have two X chromosomes, whilst men usually have one X and one Y chromosome. In terms of hormones, women generally have higher levels of oestrogen, whilst men have higher levels of testosterone. However, there are numerous other biological differences:

• Height and weight: On average, women are shorter and lighter than men.
• Heart and lungs: Women’s hearts beat faster because their lung and heart volumes are smaller.
• Liver enzymes: Women break down alcohol more slowly because their liver enzymes are less effective.
• Basal metabolic rate: Women have a lower basal metabolic rate and therefore require less energy in the form of calories.
• Oxygen uptake: Women take in less oxygen when breathing.
• Kidney function, metabolism and the immune system: These systems function differently in women and men.

Symptoms in women and men – what are the differences?

For numerous conditions, the symptoms differ between men and women. Two examples of this are heart attacks and depression.

Heart attack

• Men: Typical symptoms include a stabbing chest pain, pain radiating down the left arm, and cold sweats.
• Women: More common symptoms include nausea with vomiting, shortness of breath, pain in the throat, neck and back, and tiredness.

Depression:

• Women: Usually suffer from low mood, loss of interest, difficulty concentrating and self-doubt.
• Men: Often tend to display aggressive and hostile behaviour.

These differences highlight how important it is to recognise and take gender-specific symptoms into account in order to ensure an accurate diagnosis and effective treatment.

What role do medicines play in gender-specific medicine?

Clinical trials have so far focused predominantly on men. However, medicines affect women differently to men. This is due to several factors:

• Absorption and metabolism: The female body absorbs, metabolises and excretes medicines differently to the male body.
• Hormones: The female body undergoes cycle-related hormonal fluctuations. Hormones regulate many processes in the body and also influence the effect of medicines.
• Side effects: Women and men may react differently to medicines in terms of side effects.

Do women need different medicines to men?

The effects and tolerability of medicines can differ between the sexes. Specific differences have been identified for some medicines. For example, certain painkillers (e.g. morphine) have a stronger effect in women, and women also face a higher risk of side effects. Some antidepressants (e.g. sertraline) have a stronger effect in women, and some anticoagulants (e.g. heparin) carry a higher risk of bleeding in women.

How do gender differences affect various diseases?

Women and men exhibit different risk factors, symptoms and disease progression for various conditions – here are a few examples:

Heart attack

Men: Mainly affected at a younger age. Typical symptoms include severe chest pain, a strong feeling of pressure or tightness, a burning sensation in the chest, panic, cold sweats, paleness and shortness of breath.

Women: In contrast, a heart attack in women often presents as stomach discomfort, vomiting and nausea, pain in the upper abdomen, back pain, shortness of breath, exhaustion and weakness.

Diabetes

Men: More men than women are affected by diabetes, due to unfavourable abdominal and liver fat distribution and lower insulin sensitivity.

Women: Women, on the other hand, appear to have protective factors against diabetes up until the menopause, with oestrogen playing an important role. However, this changes after the menopause, and women’s risk of developing diabetes then increases. Another risk factor for diabetes, which is often more pronounced in women, is stress, which is linked to high pressure and lack of sleep. This tends to lead to weight gain in women, which increases the risk of diabetes.

Mental health

Depression often manifests itself differently in men than in women.

ADHD

ADHD has long been regarded as a predominantly male disorder. Girls and women often display different symptoms. They are less hyperactive/impulsive and tend to compensate for their symptoms, leading to underdiagnosis.

What is medical gaslighting?

Medical gaslighting occurs when doctors do not take a person’s health problems seriously and – often without prior diagnosis – attribute them to certain characteristics such as, amongst others, gender, ethnic background or weight. The consequences of medical gaslighting include, for example, incorrect or flawed diagnoses and, as a result, inadequate treatment.

What challenges exist in gender medicine?

Gender medicine faces several challenges:

1. Lack of gender-specific data: There are still too few studies that systematically investigate differences between the sexes. This lack of data makes it difficult to gain precise and comprehensive insights.
2. Complexity of research: Even when gender-specific data is available, taking gender into account in research is methodologically complex. It requires precise approaches to avoid bias and achieve valid results.
3. Lack of knowledge within the healthcare sector: Many doctors and healthcare professionals in general do not yet have sufficient knowledge of gender medicine.
4. Lack of guidelines and training programmes: There is often a lack of gender-specific guidelines and comprehensive training and continuing professional development programmes for healthcare professionals. Without these guidelines, it is difficult to ensure standardised and gender-sensitive medical care.
5. Healthcare system: The healthcare system is often not geared towards the different needs of people with different gender identities.

Recommended reading

Regitz-Zagrosek V et al: Gender Medicine: Why Women Need a Different Approach to Medicine: With Practical Tips on Prevention and Diagnosis. Scorpio Verlag, Munich, 2020.

Hofmann A et al: Women’s Medicine – Men’s Medicine. The small difference is greater than thought: Revolutionary insights into why women and men’s health works differently. Goldegg Verlag, Berlin, 2021.