Gender medicine: different and the same at the same time

Our gender has an impact on symptoms and the success of therapy. Gender medicine wants to use knowledge about these differences

Gender medicine: "In order to treat women and men equally, we have to recognize and explore their differences," says Professor Regitz-Zagrosek

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Man and woman - you don't have to be a doctor to know that there are differences. Even so, medicine has treated both sexes equally for a long time. The result: symptoms were misinterpreted and therapies poorly tolerated. Gender medicine now clearly shows how men and women benefit when we break free from prejudices and explore gender specifics. An interview with the gender researcher Vera Regitz-Zagrosek.

Ms. Regitz-Zagrosek, men develop Covid-19 more severely on average and die more often than women. Why is that?

There are many options. Perhaps men are more likely to have comorbidities that are risk factors for Covid-19. And: The molecular mechanisms that enable the coronavirus to infect the body are partly regulated by sex hormones. Men's androgens can play an unfavorable role. In addition, the immune system of women can cope better with acute infections.

So women have better defenses?

The downside is that their defenses are more often directed against their own body. Women develop autoimmune diseases such as the thyroid gland or rheumatic diseases more often than men. And: They usually react more strongly to vaccinations. Because their immune system reacts better, they usually need less vaccine to build up a protective effect.

Should this be taken into account when developing vaccines against SARS-CoV-2?

Data on effects, side effects and doses in both sexes should not only be obtained in Covid 19 studies. Here we have a deficit: women are still not adequately considered in vaccination and drug studies.

Why is that?

In the past, women were largely excluded from drug development because of possible pregnancies. Your cycle could also influence the result through the ups and downs of hormones. So men and male laboratory animals became the norm. In the meantime we can see that it doesn't work that way.

Why?

Women have more side effects than men - including more severe ones. In addition, men and women differ in terms of the proportion of fat, muscle and water in the body, so that medicines are distributed differently and broken down at different rates.

In the USA, women who took a certain sleeping pill (editor's note: active ingredient zolpidem) had more traffic accidents the next day. The reason: It is broken down more slowly in them, so it works longer. The US Food and Drug Administration then demanded that the patient information leaflet include doses for men and women and that a pill with a low dose be put on the market.

Professor Vera Regitz-Zagrosek is a heart specialist and founding director of the Berlin Institute for Gender Research in Medicine at the Charité in Berlin. She brought the German and the International Society for Gender Medicine into being

© BIH / Thomas Rafalzyk

So there is a rethinking?

Yes. Since 2011 there has been a guideline according to which all population groups should be included in clinical studies according to the frequency of their diseases. I would like the "should" rules to become a "must" so that all examinations include men and women on an equal footing and we can later put together an overall picture from various studies. There are researchers who are already paying attention. Here we occasionally see surprising effects.

Can you give an example?

During an investigation into a heart failure drug that was released in 2019 in New England Journal of Medicine was published, it turned out that women got significantly more benefit from it than men. Another example: One of our research groups found that male test animals developed cardiac arrhythmias more frequently than females after a heart attack.

This is probably due to the female sex hormone estrogen. Building on this knowledge, attempts are now being made to develop a drug that protects both sexes even better against cardiac arrhythmias.

A particularly large number of gender studies come from heart medicine. Why?

Because the differences are so big here. Men get a heart attack about eight to ten years earlier than women. It was long considered a "male disease", although women are also affected, especially after menopause - especially if they have risk factors such as obesity or high blood pressure.

In addition, a heart attack is more common in women than in men without the typical chest pain. Symptoms such as nausea, abdominal pain and shortness of breath can be in the foreground, so that doctors sometimes do not think about a heart attack quickly enough.

Women often wait much longer before calling the emergency doctor. As a result, it takes a long time to get the right treatment and the risk of a fatal outcome increases.

In the case of depression, however, men are disadvantaged. Why is that?

Among other things, this has to do with the fact that men often find it more difficult than women to get help with mental health problems. Symptoms can also differ. Depressed men, for example, suffer more often from irritability instead of the more typical listlessness - which in turn can delay the diagnosis. Unfortunately, men with depression therefore commit suicide far more often than women.

Are there other examples where men are at a disadvantage?

Osteoporosis is also a problem for women. Inadequate bone density is therefore often underestimated by men and their doctors and not diagnosed early enough. In the case of depression and osteoporosis, the drugs are more often tested on women. The bottom line is that they may not work as well on men.

So would a gender-sensitive view of health benefit women and men alike?

That is the goal: in order to treat women and men equally, we have to recognize and explore their differences. If we address the characteristics of both sexes more specifically, we treat everyone better. Drug development and therapy are more effective, and there are fewer side effects.

What can I do myself to receive the best possible treatment?

Being informed and listening to your body is good. But under no circumstances should you adjust the dose of medication yourself. If you think that you have more side effects than the opposite sex or if you doubt the therapy, you should talk to your doctor about it.