Gender Medicine: Diagnoses and Treatments adapted to Women or Men.
Human illnesses result from a multitude of factors, including genetic, environmental, social, economic, psychological, behavioral, and cultural components. However, the relative importance of these factors varies among individuals, as certain conditions have different frequencies and patterns depending on gender. It is commonly believed that men die primarily from heart disease and women from breast cancer; however, statistics suggest otherwise: the leading cause of death among women is cardiovascular disease, while among men, it is cancer.
Initially, medicine's focus on women's health was directed at certain conditions such as osteoporosis, menstrual disorders, gynecological tumors, breast cancer, cervical cancer, and reproductive health. However, since the late 20th century, diseases have begun to be addressed considering the female gender variable. Since the 1990s, it has been mandatory for all publicly funded clinical trials to include participants of different sexes and races. Analysis of these results has paved the way for the concept of gender-based medicine and has revealed significant differences between men and women in health-related statistics.
It is now known that the majority of people over 50 with high blood pressure are women, that endocrine myopathies (muscle diseases) affect 20% of the female population over 40, and that 38% of women over 50 suffer from parathyroid gland disorders due to vitamin D deficiency. Women, due to their biology, are more sensitive to chemical and environmental pollutants and regulate their cholesterol better with pravastatin than with atorvastatin. For women under 65, the best predictor of cardiovascular risk is LDL cholesterol (the so-called "bad" cholesterol), while after that age, HDL cholesterol (the "good" cholesterol) becomes the best predictor. Furthermore, it is known that drugs such as paracetamol and diazepam act differently in men and women.
Differences between men and women
There are many physiological differences between men and women due to genetic information. Women have two X chromosomes (XX) and men have one X and one Y chromosome (XY) in each of their body cells. From the cellular level, the chromosomes control hormonal balance differently in women and men. Hormones, in turn, influence not only the sex organs but the entire body. In general, the percentage of fat in a woman's body is higher than in a man's, which is not an advantage for men because, as a result, they accumulate fat in the abdomen and liver rather than around the waist; and for this reason, they have twice the risk of developing type 2 diabetes. Women, for their part, have wider hips, bowed legs more frequently, and less cartilage in their knee joints, which can lead to greater wear and tear on that joint. Women also experience more frequent immune hyperreactions, making them more prone to allergies, asthma, and arthritis.
When prescribing medication, doctors must consider the differences between men and women because the same medication that works well in a man may not work in a woman, and others are more effective in women than in men. Taking the wrong medication can cause side effects or even require detoxification. People don't usually think that certain symptoms are caused by side effects or an overdose of medication.
There are several reasons why medications work differently in men and women: the absorption time of a pill differs between men and women; the enzymes that activate the drug's ingredients in the body may have different concentrations in men and women, and therefore sex influences the dose at which the drug's active ingredients reach the bloodstream. Women tend to have more body fat and are smaller than men, so the active ingredient is distributed differently in the tissue, which is why women are more prone to unwanted side effects.
Women, due to their lower body mass, different pain sensitivity, and distinct enzyme metabolism, react differently to many medications, as is the case with alcohol or tobacco. For example, 100 milligrams of aspirin acts as a mild anticoagulant for men but not so much for women, and the effects of the same dose of paracetamol or anesthetic differ between men and women.
Diseases that make a difference
Physicians need a more detailed understanding of the differences in how men and women experience illness, not only in physical but also in mental health. It's crucial to remember that physical health cannot exist without mental health, and that human beings of both genders interact within a different and complex biopsychosocial environment.
The following are some diseases where important differences can be seen, which should be taken into account by gender medicine when making a diagnosis.
Osteoporosis
Menopause has a lot to do with its higher incidence among women, but some doctors warn that other factors influence this disease that can be prevented if its female predominance is taken into consideration, such as endocrine diseases, sedentary lifestyle, nutritional deficiencies, rheumatological diseases or smoking.
Thyroid disorders
Other distinctly female ailments are those related to thyroid dysfunction, which often manifest as fatigue, memory loss, generalized muscle pain, and a tendency toward depression. Some gender medicine specialists suspect that many diagnoses of fibromyalgia, depression, or anxiety may be due to undiagnosed hypothyroidism, mistaken for psychological problems.
Anemia
It is the most common ailment among women under 50. Iron deficiency has been considered normal in women from puberty to menopause. However, this deficiency can mask other endocrine disorders or underlie some diagnoses of anxiety or mental health problems, as it manifests as headaches, fatigue, distress, and difficulties with memory and concentration.
Environmental problems
Diseases related to chemical and environmental problems are more prevalent among the female population because they accumulate 15% more fat in the body, less water, and their metabolic system is different.
Sexually transmitted diseases
Women are at greater risk of sexually transmitted diseases and AIDS because the chances of vaginal erosion are greater than those of the penis.
Primary biliary cirrhosis
It is a liver disease that primarily affects women (90% of diagnosed cases). Some researchers have shown that genetics and women's different hormone levels play a role in both this condition and chronic hepatitis C. In general, women are more prone to liver problems, as their livers have a different enzyme composition than men's and metabolize alcohol and some medications less efficiently.
Depression and anxiety
Statistics show that these ailments are more frequent among women; however, some specialists believe that perhaps it is only because they are diagnosed more often because they express their problems more clearly in medical consultations.
Myocardial infarctions
The symptoms preceding a heart attack are different in women. The pain in the front of the chest is not as intense and is more erratic: sometimes it manifests as stomach, jaw, or neck pain.
Strokes
From menopause onwards, women are as vulnerable as men to cardiovascular diseases, although their arteriosclerosis problems are more localized around the brain and therefore they suffer more strokes.
Fibromyalgia
Men and women perceive pain differently, and hormonal factors may explain this difference. Some experts believe the label fibromyalgia has been used to encompass any pain or discomfort experienced by women that is considered incurable and of unknown cause. They emphasize that many diseases can cause muscle and joint pain and should be considered in differential diagnosis because they are more prevalent in women and are treatable. These include endocrine myopathies, subclinical vitamin D deficiency, secondary hyperparathyroidism due to vitamin D deficiency, polymyalgia rheumatica, and temporal arteritis, among others.
Autoimmune diseases
Rheumatoid arthritis, Sjögren's syndrome, and systemic lupus erythematosus are some of the autoimmune diseases that occur more frequently in women than in men. The cause is unknown, although it may be related to the X chromosome or estrogen levels.
It's not merely a matter of fairness. Taking into account whether the patient is male or female means improving diagnoses and treatments and, consequently, the health and well-being of the population, especially women. Ensuring that patients know which ailments they suffer from most and their associated risks will help prevent them; likewise, understanding that their bodies don't always respond according to traditional medical textbooks can be useful in understanding why doctors sometimes don't seem to address their discomfort or attribute it to psychological factors, and why they need to persist.
The practice of medicine must constantly evolve, adapting to sociodemographic changes and technological advancements, without losing its essence, its purpose, its mission, which is to improve the health of society. Gender-sensitive medicine is a first step toward one day having medicine tailored to each individual.
Ramona Ávila Núñez, PhD
References:
Ariza Andraca, Raúl. (2016). The gender perspective in medicine: the case of women. Acta médica Grupo Ángeles , 14 (4), 193-195. http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1870-72032016000400193&lng=es&tlng=es .
ANMM Bulletin. (2014). Men and women get sick differently. Journal of the Faculty of Medicine of the UNAM (Mexico) , 57 (2), 53-56. http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0026-17422014000200053&lng=es&tlng=es