For years, it has been known that different genders have different health care needs. This is due to both biological and psychosocial reasons rooted in society. For example, heart attacks in women and eating disorders in men are often diagnosed and treated comparatively late, because these diseases can manifest themselves differently in the respective "unexpected" gender.
Differences are also evident on the part of medical professionals: a female physician is more likely to correctly diagnose heart attacks in women, while male colleagues often downplay the same risk in female patients.
The University of Zurich (UZH) is now taking an important step into the future of patient care by becoming the first university in Switzerland to fill a chair in gender medicine by August 2024. Currently, candidates for the professorship are presenting their research. Planned research beyond the two traditional genders of male/female has not yet been reported.
The world's first institute for gender medicine was founded in New York in 2001, followed by the Karolinska Institute in Stockholm in 2002 and by the Charité Berlin in 2003.
Gender medicine not only examines the biological “sex” but also the social "gender".
What is gender medicine anyway?
Women and men have clear biological differences as described by the biological "sex". In addition to different sexual characteristics, women are usually smaller, lighter and have lower muscle mass. There are also differences in organs such as the liver and intestines: the female liver often has more difficulties to metabolize drugs and intestinal activity is lower. As a result, overdoses can occur more quickly in women and for many medications lower doses suffice.
However, the different sexes are also exposed to different psychosocial stress. Gender medicine is also about this social "gender". Social conventions and role expectations can have a significant impact on a person's health and lifestyle. In general, men often have an unhealthier lifestyle, drink more alcohol, smoke more often and pay less attention to a healthy diet. Men are also statistically less likely to adopt health-promoting measures such as preventive checkups.
Gender medicine is about exploring these biological and social differences between the sexes to improve medical care.
Differences in the immune system
In immunology, gender differences have long been known. For example, men are more susceptible to viral infections, while women suffer more frequently from autoimmune conditions such as thyroiditis (Hashimoto's) or multiple sclerosis and react more strongly to vaccines.
It is believed that until menopause the female immune system is more active in order to have the strength to protect new life. However, if this strong immune system is directed against the host itself, particularly pronounced autoimmune reactions, in which the body attacks itself, may occur. The male immune system is weaker in its defense against infections, but in the case of dysregulation, reactions against the self are less intense.
Due to their very active immune system, women often react more strongly to vaccinations. This can be negative in terms of adverse vaccine reactions, but also means that lower vaccine doses can be sufficient and vaccine protection lasts longer.
Gender differences can also be observed in the COVID-19 pandemic: to date, more men died from acute COVID-19 infection, while especially young women with high stress levels have an increased risk of contracting Long COVID. This shows how important it is to consider gender in clinical research, but also in care and early intervention.
Men have one X and one Y chromosome, women two X chromosomes. This has an effect on the immune system.
Genetic and hormonal differences
Many hormonal and immunological differences can be explained by looking at the genetic differences between men and women. Men have only one X chromosome, women two. Women inherit one X chromosome each from mother and father.
Many genes that regulate the immune system are located on the X chromosome. By having X chromosomes of both parents available, women have a wider range of defense mechanisms.
Women also produce more estrogen and less testosterone than men. Estrogen stimulates the immune response and influences metabolism. This results in a certain protective effect against type 2 diabetes. If estrogen levels fall after menopause, the risk of metabolic diseases increases accordingly.
In the past, clinical trials were mainly conducted in men.
Gender differences in clinical research
Given that so many biological and psychosocial differences are known, it is surprising that so far most of the medical research has been conducted in men and male laboratory animals. This has historical, financial, and biological reasons.
Female laboratory animals are more expensive and historically women were considered the "weaker sex" and thus not expected to participate in clinical trials. Additionally, from a researcher's perspective, an all-male cohort avoids studies being disrupted by hormonal fluctuations in the female cycle, menopause, or hormonal contraception. Furthermore, it is ethically difficult to include women with desire for children in studies before embryotoxicity (potential severe consequences for the developing child) has been conclusively determined. Therefore, in the past, drugs and therapies were mainly studied in young men.
It was only in 1994 that a U.S. regulation required drugs to be tested on women at all in clinical trials. Since January 2022, companies in the EU must conduct clinical research with a representative age and gender distribution. This means that drugs for diseases that occur particularly frequently in one sex should also be tested preferentially in that sex. In women, additional attention should be paid to whether a disease occurs more frequently before or after menopause, and the study should be adapted accordingly.
The problem of underrepresentation of women in clinical research has thus been recognized and steps are being taken in the right direction. We are therefore particularly pleased that UZH is also making efforts to improve this situation and are following the candidate selection process with great interest.
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