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. For once, sexual equality isn’t the order of the day.
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, men were still regarded as the benchmark.”
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,” explains Seeland. For example, at the start of the pandemic, more women were infected by the virus than men. 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.”
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.
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”
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:
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. At least the risks of this one-sided approach 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.
About the expert
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.