Gender medicine: women are sick differently

Symptoms, risk factors, drug tolerance: In many areas of medicine there is a big difference between men and women. This also has consequences for the therapy

Full waiting room: Nevertheless, the doctor should not lump women and men together

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Men have it twice as hard when they have a cold. In addition to nasty viruses, they are followed by malicious slogans. "My husband can multitask. He can cough and whine," blaspheme women. Or: "A real man can only be put on sick leave if it is life-threatening. For example, if he has a cold."

Dr. Kyle Sue, a medical doctor at Memorial University of Newfoundland, Canada, was fed up with being portrayed as a whimper. He looked for relevant studies, combed through hospital statistics and came to the conclusion: The men’s runny nose really does exist. With flu, men have to go to the clinic more often than women of the same age. If the respiratory tract is infected, they are also more prone to complications, reports Sue im British Medical Journal.

Women have a more active immune system

Even if Sue's study ultimately cannot clarify whether men with a cold may suffer particularly expressively: That they are more often and more severely ill with respiratory infections is not surprising for Professor Vera Regitz-Zagrosek. "Women have the more active immune system," says the head of the Institute for Gender Research in Medicine at the Charité University Hospital in Berlin. The downside: With them, the defense is also more often directed against their own body. "Three quarters of the patients who suffer from autoimmune diseases such as rheumatism or multiple sclerosis are female," reports Regitz-Zagrosek.

The fact that biology has no equality is not only evident from the immune system. "There are serious differences between men and women in many important diseases," says Regitz-Zagrosek. The heart specialist is a pioneer in gender medicine, a relatively young discipline that is for the first time taking a look at what everyone actually knows: men and women are different.

Drug Studies: Women were often excluded

In medicine, however, this was ignored for a long time. Apart from diseases of the genital organs as well as pregnancy and childbirth, it was based on only one human model: the man. Male medicine begins with the mouse. New drugs are first tested on animal subjects: young male mice. "Active ingredients that only show a good effect on female animals do not even come into development," says Regitz-Zagrosek.

For a long time, women were excluded from drug tests that are mandatory for the approval of a new active ingredient. As a test subject, it was not just the ups and downs of her hormones that made her unpopular, which can dilute the results. Younger women can also get pregnant. After the thalidomide scandal, in which a sleeping pill led to deformities in thousands of children, the fear of the risk was too great.

Women suffer from drug side effects more often

But even if you exclude women, you put them in danger. A well-known example: digoxin. Until the turn of the millennium, the supposedly tried and tested drug was prescribed across the board to patients with cardiac insufficiency. Long-term observation in the late 1990s seemed to confirm this practice. Then doctors re-analyzed their data - separated by gender. Result: Apparently the preparation only helped men. Women who took it died on average from heart problems even earlier than without the drug. "A disaster," says Regitz-Zagrosek.

Digoxin is arguably the most dramatic example of how different drugs can work. It is far from the only one. "Women generally suffer from side effects more often," says Professor Margarethe Hochleitner. In the outpatient clinic of the women's health center at the University of Innsbruck, she is confronted with the consequences every day. For example, antihypertensive agents are more likely to lead to swollen legs in patients.

Hochleitner describes a typical story of suffering: The patient is given dehydrating agents. It gives her cramps and takes magnesium. This leads to stomach problems, whereas the next drug is prescribed - with new side effects. "There are more modern remedies that women tolerate much better," says the doctor. Few doctors have this in mind.

The "small" differences: weight, hormones, chromosomes

There are many reasons why drugs work differently in women. As a rule, they are smaller and weigh less. "Medicines are therefore often overdosed," explains gender specialist Hochleitner. "Women and men differ in every cell in the body," emphasizes Professor Sabine Oertelt-Prigione, who heads the chair for gender medicine at Radboud University in Nijmegen in the Netherlands. There are sex chromosomes in every cell. "Many genes that are important for immune function are on the X chromosome," says Oertelt-Prigione.

And hormones also have an important influence.While estrogen pushes the defense, testosterone has an inhibitory effect. This can be seen, for example, with vaccinations. In a study by researchers at the Walter Reed Army Medical Center in Washington, half the dose was enough for women to get the same effect as men with a flu shot. Protection also usually lasts longer in women.

Rethinking patient care and research

Wouldn't it make sense to determine the vaccination doses and the period between the boosters on a gender-specific basis? "All of this is being discussed," says Oertelt-Prigione. It is far from everyday life. It often takes a long time for new findings to find their way to the patient - and not just in gender medicine. "But there is a rethinking," assures Oertelt-Prigione. When a new drug is approved, women now have to be included in the tests.

In research, too, the focus is opening up to differences - with surprising results. The Canadian pain researcher Jeffrey Mogil showed that when working with mice, it is not just the sex of the animals that determines the result - but also that of the researchers. The rodents were less sensitive to pain when examined by men. Mogil was able to identify pheromones as the cause. The male scent put the mice under stress and diminished the sensation of pain.

Smoking, belly fat, and stress are more dangerous for women

In the meantime, new study results appear almost every few days, which show how big the small difference is. Most of them still come from cardiac medicine, which was the first specialty to focus on gender-specific aspects. There are already successes here. Heart attacks in women often went undetected in the past. "At a large clinic, the chances of women and men are now equally good," says Regitz-Zagrosek.

But also with other common diseases like diabetes it is increasingly evident that women are sick differently than men. The risk factor belly fat has a stronger impact on them. Influences such as smoking, fine dust and stress generally harm them more. In the case of cancer, however, male patients have the worse cards. Not only do they get sick more often. "If they have the same tumor, the man bears the higher risk of dying from it," says Hochleitner.

The big question is why? A lot of research is needed to answer them - and not just for the benefit of women. Some diseases such as depression or osteoporosis go undetected, especially in men. The stronger sex should also be interested in the background of a fact: women still live an average of five years longer than men.

Gender medicine: how women and men differ

Liver: Women tolerate less alcohol than men. For the most part, the cause is the liver. Not only is it smaller in women; some enzymes also have different levels of activity depending on gender. This also has an impact on the breakdown of drugs. Since women are also often smaller and lighter, they tend to overdose on drugs.

Hormones: The sex hormones play a key role in making women and men look different. But their effect goes much further. The messenger substances influence, among other things, the immune system, the metabolism and the function of organs.

Heart: Stinging chest pain that radiates into the arm, a feeling of tightness, as if an elephant were standing on one: Almost everyone thinks of a heart attack when they hear such symptoms. But this can also be atypical. This is much more common in women. They then often feel sick, exhausted or have upper abdominal pain. The result: frequent misdiagnoses. Gender medicine first drew attention to this.

Intestines: The female intestine usually works a little slower than that of men. This doesn't just affect drug absorption. Harmful substances in food have more time to attack the intestinal wall. Men, on the other hand, develop rectal and colon cancer more often and earlier.

Thyroid gland: Women are significantly more likely to develop the thyroid gland, such as Graves' disease or Hashimoto's thyroiditis.

Fat cells: On average, women have more fat tissue and less muscle mass than men. The proportion of water in your body is lower, however.

Kidneys: Older women in particular often have kidney weakness. Drugs stay in the body longer, which can lead to overdoses.

Bones: Brittle bones are not just a women's problem. About a third of men over the age of 70 suffer from osteoporosis. But this often goes undetected.

Immune system: Especially in middle age women have the stronger immune system. The disadvantage: you suffer more often from autoimmune diseases.