Gender Medicine

Recently I have read a book called “Gender Medicine” by Marek Glezermann and I wanted to share the concept of “Gender Medicine”, as well as a few examples to better understand it.

Gender Medicine, or how it is properly called “Medicine related to sex and gender”, is a branch of medicine that analyses the different reactions on a disease or on a drug related to sex and gender.

To grasp this definition, the notion of “sex” and “gender” has to be clear.

Sex is a genetically determined characteristic. Every human being has 2 sexual chromosomes.

If both those chromosomes are so-called “X chromosomes”, then the person is of female sex.

If, however, one chromosome is an X chromosome and the other one a Y chromosome, the person is of male sex. This is already fixed before one’s birth and an individual has no influence whatsoever on its sex.

Gender, on the other hand, is dependent on a variety of factors, such as culture, tradition or sexual orientation. If we take the example of a transsexual woman, we can say that she is of male sex because she was born with a Y chromosome. But her gender would be a woman.

This difference between sex and gender is important to understand, as there are diseases that are influenced either by sex or gender.

Colour blindness is related to the male sex. It will appear if there is a problem on the X chromosome. As female beings have two X chromosomes, this means that they are protected. If there is a problem on one X chromosome and the other is functional, the body will simply use the chromosome that is normal. Thus for the disease to show up, both X chromosomes would have to be dysfunctional. Male beings, however, having only one X chromosome, do not have this security mechanism and will be more often affected by this disease.

Carpal tunnel syndrome is a condition, where a hand nerve is compressed, thus reducing the mobility of the hand. This disease affects mostly women, since jobs that require repetitive use of hand and wrist are traditionally done by women. For example women are more commonly waitresses or secretaries than men.

An opposite example is malaria, which affects more men than women. This is related to the fact that in the countries where this disease exists, women have to be covered from head to toe due to cultural and religious beliefs.Malaria is transmitted by a mosquito, and as men show more skin than women, they are more likely to be stung.

Note: For the sake of simplicity, I will from now on refer to the words “man” and “woman” for both sex and gender.

While looking at these rather simple examples, one can see that there is a significant difference between diseases affecting men and women. How come it has taken this long notice and analyse these phenomena?

We live in a society where everything was built upon a male model. Up until last century, women were seen as second class citizens and the general concensus was, that women were merely a different type of man. One assumed that, apart from reproductive processes, a woman’s body was exactly the same as a man’s body.

However, just as children are not treated in the same way than adults in medicine, so women should not be medically treated in the same way than men.

Concerning drugs, women do not always react in the same way on a certain medicine than men.This is a consequence of the fact, that women are largely excluded from medical trials. Before a new drug can be released, it has to undergo several tests to assure that it will not mediate any negative effects. Yet those tests used to not include women because of the risk of fœtotoxicity. There was always a risk that a woman could be pregnant and that the drug would harm the unborn child.

Nowadays, women may be participating in these tests, but they are still outnumbered by men. There is always a lingering possibility that they will become pregnant during the trial. Those trials are long, months or sometimes years, and the organisers do not want to have to exclude a woman because she became pregnant during that time. Additionally, results are usually not analysed with respect to sex and gender. Adverse effects are mostly evaluated with regard to frequency. As there are more male participants than female, this means that the adverse effects experienced by men will logically also be more frequent.

There are many different examples on how sex and gender can influence our bodies’ reaction on the environment, a disease or a drug. First, I will mention circumstances that have an impact on children’s development during pregnancy and later on I will give examples on atypical responses in women and men.

Congenital adrenal hyperplasia is a genetic disease, in which girls produce a lot more testosterone than what would be considered normal, and this even before their birth.

A Swedish study has found that these girls prefer playing with toys that are traditionally viewed as male, such as cars and trucks.

The following two examples regard diet. If a woman eats very little during her pregnancy, this will transmit a message to the baby, namely that food is scarce in its environment. This leads to the fact that this baby will need less food after its birth to grow normally than a baby which has not known this antenatal restriction.

The downside of this mechanism is, that those children will eat everything that is offered to them because their subconscious mind tells them that there is little food.

If one gives those children unlimited access to food, they will develop obesity.

A similar observation was made in the Netherlands. In 1944, during the so-called “Hongerwinter”, the Nazis established a blockade. This means that no goods could enter the Netherlands, thus also no food. Researchers compared the evolution of the children born during this winter (who did not have access to a lot of food during pregnancy) to that of children born later on.The “Hongerwinter” children were much more affected by obesity, diabetes and high blood pressure during adulthood than the children born both before and after this winter.

In medicine, women represent the population that is at a biggest disadvantage. This is so because most clinical observations are fitted to men.

The best known example is that of a heart attack.

The typical symptom of a heart attack is a brutal chest pain that radiates into the left arm and into the left little finger. However, this is a typical male symptom.In women, a heart attack can present itself in a completely different way: women experience mostly neck or back pain. Very often, they do not feel any pain, but a general sense of uneasiness.This leads to the fact, that if women describe these symptoms in an emergency service, doctors will not immediately think of a heart attack and might simply send these women home.

During a woman’s hormonal cycle, the body produces different hormones in different quantities.These hormones have an influence on different physiological processes, such as saliva production. Because saliva helps to digest food and also drugs, the difference in its composition will lead to a difference in absorption. A clinical case has been described, where a woman who was treated for epilepsy complained that her treatment worked less efficiently during the second half of her cycle. It turned out that progesterone, a hormone produced in big quantity during that part of the female cycle, inactivated the drug.

Another example where women react differently to a drug than men is the sleeping pill Ambien.

Women catabolize this drug much more slowly than men, they actually only need half the dosage required for men in order to witness the same effects.Women who took an Ambien pill adapted to the male metabolism still had a lot of active substance in their bodies the next morning. This means that they were drowsy, tired, their reflexes less developed. This was related to a lot of car accidents if those women drove to work for example. Nowadays, two different dosages for Ambien exist: one adapted to men and one adapted to women.

Pain is a characteristic often used to underline differences between men and women.

In our culture, we expect that men will not complain as much about pain and women, regardless of whom can tolerate it better.In emergency services, the consequence is that men who complain about pain will be taken care of earlier. One supposes that for a man to admit that he is in pain, it has to be extremely important. Because one expects women to complain more about pain than men, their pain is often taken less seriously.

Even if women are more at risk to be discriminated, there are some situations where men are at a disadvantage. This is particularly the case in diseases that affect more women than men.

For example, men who have breast cancer have to take medication that was developed for women. These drugs work in a less efficient way because of men’s high testosterone level when compared to women. This means that, additionally to the anti-cancer treatment, men are required to also undergo a hormonal treatment which lowers their testosterone secretion.

Furthermore, the criteria used to diagnose depression are based upon the symptoms which women express. Some examples are a troubled sleep rhythm or loss of energy.In men, more typical symptoms are aggressiveness or overworking. This means that men are not correctly diagnosed and will not undergo treatment even if they would need it.

These examples, whilst showing a big inequality in care and treatment, also demonstrate that Gender Medicine starts to attract more and more attention. If this were not so, we would not know about all those examples.

It will probably be a long time before there will be true equality concerning different sexes and genders in medicine. However, if we start talking more about Gender Medicine and what it entails, everyone can play its part in promoting change in this area.