Gender medicine: we’re all different!
Women aren’t just small men. That much is clear. And yet little attention has been given to this in medicine. The consequences – for men and women – can be fatal.
Medicine today is still overwhelmingly geared towards white, male patients aged 45 and weighing 75 kg. “Even during my training, men were still considered the benchmark,” says Ute Seeland, a specialist in internal medicine and chair of the Deutsche Gesellschaft für Geschlechtsspezifische Medizin (German Society for Gender-Specific Medicine).
Even though 30 years of gender research has shown that gender has a huge impact on illnesses and treatment, it’s still not universally acknowledged that women require different treatment to men.
“Even during my training, the man was still considered a benchmark.”
What is gender medicine?
Essentially, gender medicine is an area that deals with the influence of gender on health and illness. It focuses on biological differences between females and males, for example on the influence of genes and hormones. This takes in basic research and prevention, diagnostics, how diseases manifest themselves and how they need to be treated.
However, it also looks at social gender, i.e. how a person sees him or herself, how they are seen by others and how they are influenced by their environment. “Our upbringing, education and social position can influence the development and course of a disease,” says Seeland. One example: at the beginning of the pandemic, more women than men were infected with the virus. This could be because more women work in caring professions or retail, where working from home wasn’t an option. And they use public transport more often. This background knowledge is important when it comes to interpreting the figures and prevention.
Biological and sociocultural factors also play a role when it comes to obesity. In western societies, women are slimmer, which is probably also linked to the ideal of beauty. In societies where having a bigger body is associated with wealth, the opposite is true. Biologically speaking, women are more likely to have a sweet tooth, and progesterone encourages cravings, while male testosterone keeps hunger at bay. All these factors need to be taken into account when it comes to prevention and treatment.
“Our upbringing, education and social position can influence the development and course of a disease.”
Gender medicine – why has it taken so long?
There are several reasons why women and men are often still diagnosed and treated in the same way despite their differences. First of all, medicine has traditionally been male-dominated. The leading positions in medical practices, hospitals, companies and universities were (and often still are) held by men. This means that information in textbooks, guidelines and therapy approaches needs to be revised along gender-specific lines.
The problem is that differentiated data is rare. Labs mainly use male mice and rats for basic research, and women have so far been under-represented in (drug) trials. One of the reasons for this is that the hormonal balance changes considerably during a woman’s lifetime – and even within a month. This, and the fact that many women take hormonal contraceptives, make the results inconsistent.
Other reasons also play a role: in the 1950s and 1960s, miscarriages spiked after pregnant women took an anti-anxiety drug that had been classed as safe. As a result, female test subjects were hardly deployed any longer. And although there is greater awareness of the issue today and steps have been taken to redress the balance, the majority of study participants are still male.
Women and men function differently
Although no two people are the same and there are also big differences between men in terms of their weight or physique, men have biological similarities, just like women. Boys and men are usually taller, heavier and have more muscle mass with less fat. And women’s digestive systems are slower. This is important when considering how quickly a drug works and how high a dose should be prescribed. As recently as 2013, the US Food and Drug Administration had to ask several sleeping pill manufacturers to halve their dosage recommendation for women due to an increase in morning traffic accidents.
Recent studies show that even at the cellular level not all processes are gender-neutral. It was found, for example, that the receptors of female cells transmitted pain signals faster in animal experiments. And if drugs specifically target cell receptors, i.e. the receptor molecules of the cells, it is important to recognise that men and women have different numbers of these receptors. Otherwise, in the worst case scenario, women risk overdosing – and the consequences that follow.
“We’re playing catch-up where women are concerned.”
Why gender medicine is important
In a series on gender medicine published in the Tages-Anzeiger newspaper, it was reported that women in Switzerland live on average four years longer than men. But women suffer more frequently from physical complaints. Women are more often depressed, men go to the doctor less often. Men are more likely to develop cancer, women autoimmune diseases. The list of differences is long. Below is a short insight into the differences between men and women:
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Heart
Heart attacks are one of the most common causes of death. Sharp chest pains that radiate into the left arm are a telling sign that you need to go to hospital immediately. The faster a heart attack is treated, the greater the chances of survival.
However, the symptoms of a female heart attack are relatively unknown. Women are more likely to experience a feeling of tightness in the chest, stomach ache, nausea and vomiting. It was only in the 1990s that U.S. cardiologist Bernadine Healy described “Yentl syndrome” and revealed the big differences in heart attacks between men and women. Until then, research had only focused on male heart attacks. This still has fatal consequences for many women today because they come into A&E on average an hour later, even though every minute counts.
So it’s no surprise that, although far more men suffer heart attacks, women are more likely to die from them. Incidentally, one study shows that women have a better chance of survival if they are treated by women in A&E. They often assess symptoms and risks more accurately than their male colleagues. Simply put, greater awareness of the different symptoms in medical circles and among the general public will help to save lives.
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Infections
Infections don’t always follow the same course. During the pandemic, it was shown that COVID-19 is more likely to be fatal for men, while women are more likely to suffer from long-COVID symptoms several weeks after the infection. “The pandemic highlighted once more that medicine is rarely gender-neutral,” says Seeland.
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Alzheimer’s
Women live longer than men and are therefore also more likely to suffer from Alzheimer’s. And hormones are probably also a major factor – oestrogen, for example, protects the female brain. However, oestrogen levels fall sharply after the menopause, which might explain why so many women suffer from dementia.
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depression
As with Alzheimer’s, women are almost twice as likely to suffer from depression than men. However, depression often does undiagnosed in men, because their symptoms, including aggression or pain, are often considered “atypical”. This is reflected in the suicide rates, with men more likely to commit suicide as a result of depression. “Examples like these show that gender-specific medicine isn’t just women’s medicine,” says Seeland.
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Parkinson’s
Two-thirds of Parkinson’s patients are male. They not only get the disease more frequently, but also earlier and more severely. However, women die more quickly of Parkinson’s than men. This is an indication that women’s treatment needs to be adapted.
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Autoimmune diseases
Women are more affected by diseases such as multiple sclerosis (MS) and lupus, particularly after puberty and the menopause. This could be because women have a stronger immune response than men, but sex hormones such as oestrogen and progesterone, which have an effect on the immune system, also play a role. In fact, MS is often misdiagnosed in women, which means that important treatment time is lost.
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ADHD
In the beginning, this behavioural disorder was typically attributed to boys. It was – and still is – rare for girls to be diagnosed with ADHD or ADD. This is mainly because the symptoms often reveal themselves differently in girls than boys. Girls tend to quietly daydream, behave less impulsively and hyperactively, and therefore attract less attention.
Why gender medicine is needed – the future
Many diseases differ in their symptoms, progression and treatment when it comes to men and women. Gender medicine is therefore needed to ensure that everyone gets the best possible treatment. Because many of the findings of gender medicine are still not reflected in the treatment guidelines of professional associations, the “Gender Medicine and Health” National Research Programme (NRP 83), launched in 2024, aims to help close this gap.
“Gender medicine takes both sexes into account, but we’re playing catch-up where women are concerned,” says Seeland. She wants the change to start in medical training, so she advocates textbooks that focus on this issue, encourages faculties to revise their curriculum, and promotes the next generation of medical students, who are more aware of the differences. Nevertheless, the risks of this one-sided view and the opportunities of differentiated gender medicine are now attracting more and more attention. up to 9,000 articles are published on the topic each year.
Ute Seeland is a specialist in internal medicine and chair of the German Society for Gender-Specific Medicine). She received the science award from the German Medical Women’s Association for her research into the gender differences in arterial pulse wave reflection for the diagnosis of cardiovascular diseases.
