Holistic medicine

Gender medicine: definition, history and examples


Gender and health - women and men get sick differently

Sex and gender, in German biological and social gender, are variables that influence health and illness. The concept of gender is based on a complex relationship and integration of gender - as a biological and functional part of the human body - and cultural and psychological behavior, which in turn is shaped by ethnic, social and religious backgrounds.

Diseases differ in men and women

Men and women differ in their health problems. Traditionally, it was taken for granted in medicine that the diagnoses and effective treatments for the male part of society were just as valid for women - if they weren't symptoms that biologically only women can get like pain during menstruation or inflammation of the ovaries .

Gender medicine is a new way of paying attention to the physiological and pathophysiological differences between men and women, and it takes great effort in research and education to revise many chapters in medicine. It is about how illnesses differ between men and women in order to prevent sensible detection of clinical signs, adapt the therapies and make prognoses that take into account the psychological and social background.

Psyche and body play together

Gender medicine is based on the fact that men and women experience health and illness in different ways. The causes, the risk factors, the symptoms, the diagnosis, the treatment, the course of treatment and the prognosis are factors that differ significantly in men and women - and this with a large number of individual pathologies.

Each gender responds to similar ailments in a completely different way. These differences have their origin in the combination of biological, cultural and social factors.

The cells react differently

Gender differences affect not only the sexual and reproductive systems, but also the heart, blood circulation, bone metabolism and the immune system. For example, autoimmune diseases affect women more than men, and coronary artery disease firstly affects women after menopause and secondly, they show different symptoms depending on gender.

The sexes in the cells are also unequal: cells in women react differently to stress, for example induced by drugs, than cells in men. Men and women not only react differently to drugs, but also to natural substances that they ingest with their food.

The history of gender medicine

Gender medicine is a new field with the aim of studying the effects of gender on human physiology and health. As late as the 1980s, all health studies, in so far as they did not relate exclusively to female or male diseases such as uterine diseases or testicular cancer, were aimed at men. The National Institute of Health (NIH) published the first report on women's health in the USA in 1985.

In the mid-1980s, many historians, philosophers and sociologists in the USA opposed the neutrality of the natural sciences or natural sciences that was assumed at the time. At the same time, a new medical research approach emerged that linked health risks to gender. Previously, the “white, male, young” paradigm had applied to standard diagnoses and treatments for various diseases.

Gender also influences social, cultural and economic roles. And the traditional therapies assumed that men and women in the medical field were the same, even though they were exposed to different social, cultural and economic pressures.

It was only in the late 1990s that the disadvantages for women were recognized medically as explained - structurally, socially and institutionally. Then the World Health Organization and the United Nations developed programs based on gender medicine. This perspective even became an integral part of the UN system and became established worldwide: with governments as well as with non-governmental organizations (NGOs).

In 1991, the New England Journal of Medicine first dealt with the "women's issue" in medicine. Bernadine Healy, a cancer doctor and director of the National Institutes of Public Health, published a report on Yentl syndrome. Two separate studies were conducted comparing men and women with coronary artery disease. It was shown that doctors discriminated against women with their attitudes and behavior. Compared to men, women had to undergo significantly more wrong diagnoses and ineffective operations.

Gender medicine at the university

Although the gender issue was now under discussion, it took almost 10 years before it had practical consequences for medical training. The first course on gender medicine didn't even take place at Columbia University until 2002, under the title “” A new approach to health care with insights on the biological differences between women and men ”.

In order to achieve the goals of gender equality and to create a balance between men and women in all areas of life, the Council of Europe looked for new strategies and methods to define and develop working standards based on gender aspects. Gender justice was developed using general principles and standards to ensure the full participation of men and women in society. Gender mainstreaming, a new perspective on gender justice, has developed at all levels since 1998.

Why does medicine affect men and women differently?

1. Physical size and anatomy

Women are often smaller than men, but are given the same dose of medication. This means that they have a higher concentration of the agents in their body, which could explain different reactions to specific substances. Anatomical differences between the sexes can also lead to a higher sensitivity in women to certain medications.

2. Differences in body processes

The kidneys play an important role in neutralizing poisons and transporting excess medication out of the body. Kidney performance declines in older women, studies have shown it to be more severe than in men.
That is why some women are exposed to higher concentrations of active substances during medication. In addition, special enzymes in the stomach and liver from the P450 system behave differently in men and women. However, these help to remove excess medicine from the body.

3. Differences in the level of stomach acid

The digestive system of men and women works differently, and therefore medicine that men and women take orally works differently for the sexes. The level of stomach acid in women is lower than in men and therefore the stomach empties more slowly. This leads to the fact that the stomach of women absorbs the active substances longer, that is, their total dose increases.

4. Physical differences

Traditionally, the effects of medication were considered to be the same for women and men, with men usually providing the test subjects. New studies indicate that women do not respond to certain substances the same way as men. This is most likely due to physical differences that are directly related to the absorption and processing of these substances.

So women have a higher percentage of body fat than men, a menstrual cycle and hormonal fluctuations. Menopause and hormone treatments later in life also affect drug reactions.

Differences between men and women are therefore expressly not limited to the reproductive organs, but both genders react differently to certain medications, are differently susceptible to certain diseases, which also have different effects.

The following examples show some forms of how diseases and medications affect men and women differently.

Differences between men and women in heart disease

In the past, most assessments of heart disease in women came from studies in men. The symptoms are different in women, and they are at greater risk of dying in a year after a heart attack. Women are also less responsive to procedures to solve heart-related medical problems and are less responsive to blood thinners.

The symptoms in women are more subtle and therefore difficult to identify. These include malaise in the stomach, neck, jaw or back and shortness of breath - all of them unspecific symptoms that can indicate various illnesses. Therefore, women often do not suspect that their perceptions could be a heart attack. They put the warning signals aside because they assume another cause of the symptoms.

In addition, gynecology often misdiagnoses the symptoms, and in the end those affected will recognize their heart condition when it is too late. Men, on the other hand, benefit from more thorough diagnoses and more aggressive treatment.

It is not a secondary scene: In the United States, 500,000 women die of heart disease every year, 50,000 more than men. Compared to men, they have a higher risk of having a second in the year after the heart attack.

The risk factors also differ. Men are generally increasingly at risk from the age of 55. Women are at increased risk during menopause if their hormonal balance changes.

Depression

Depression affects women two to three times more often than men. This is partly because the female brain produces less of the neurotransmitter serotonin, which regulates emotions.

The differences between the sexes in the causes and course of depression require different therapies. Twice as many girls fall ill as teenagers, but adolescent men are at greater risk of depression becoming more severe, while girls' disease tends to be episodic.

While twice as many female teenagers suffer from depression, the risk of developing substance or drug addiction as a result is far greater - as is the risk of suicide.

Studies show that a depressive illness affects the brains of boys and girls differently, that both sexes experience the illness differently and therefore require different therapy.

Depression and role model

Social roles also have an impact on the course of mental illnesses, which in turn also have organic causes. Depression is one example: men in traditional roles often do not dare to talk about their illness because it does not correspond to the image of a “strong man”; Women in traditional women's roles develop feelings of guilt because they can no longer fulfill their “mother duties” and other promised work in the reproductive field.

Psychosocial and biology

Depression, anxiety, negative stress, sexual violence, domestic violence and escalating rates of substance abuse affect women to a greater extent than men - in different countries and different social milieus.

This shows the complex task of gender medicine: biological differences between men and women are linked to social roles that societies attribute to men and women.

Pressure from multiple roles, gender discrimination and related factors such as poverty, hunger, malnutrition, overwork, domestic violence and sexual abuse also have a negative impact on women's health. The more of these social factors occur, the more frequent and severe are the mental health impairments in women, from mental disorders to psychosomatic illnesses.

Cultural discrimination of biological characteristics

An example of this specific burden on women is religiously and culturally determined discrimination against women during their menstruation. Many women suffer from symptoms such as abdominal pain, iron deficiency due to heavy bleeding or malaise due to fluctuating hormone levels before and during their menstruation.

In countries like India or Nepal, menstrual periods are considered impure, and women must isolate themselves during this time. In rural areas this often means that they have to move to unheated stables or other unsanitary buildings. This aggravates the complaints.

What is physical, what is psychological?

A typical interweaving of psyche and body is also shown by the “hysteria” in women, which was widely discussed in Freud's age. These psychological symptoms were characterized by irrational behavior in which those affected no longer had self-control over their actions. Even though hormone levels in the body may have changed here, the thesis at the time that women “naturally” tend to have emotional outbursts was wrong.

The patients at the time were mostly women from the middle class - locked in a corset of constraints as to how a “real woman” should behave. Those affected had to submit to the man in a patriarchal society. Supposedly irrational behavior could not be controlled and thus offered an unconscious possibility of temporarily breaking out of this prison.

The challenge for gender medicine is to include the interplay of biological and social factors in diagnosis and therapy and to avoid short-lived, purely biological or purely psychosocial conclusions.

Reactions to substances

Women and men differ in their reactions to medication. These differences can have a critical impact on treatment, so they need to be adjusted to ensure effective therapies.

Women get Alzheimer's more often than men

Two thirds of all people who develop Alzheimer's are women. In addition, women are usually the ones who care for Alzheimer's patients privately. So you bear both the risk of falling ill and the burden of looking after the sick.

Without substantiating this through studies, until recently there was “wisdom” that women are more likely to develop Alzheimer's because they live longer. In contrast, new studies indicate that menopause hormone changes and other gender differences offer potential explanations.

Lung cancer

More women die from lung cancer each year than from breast, ovarian or uterine cancer, which are purely female diseases. The main cause of lung cancer is indisputable smoking. But three times more women die from lung cancer who never smoked than men.

So far, little research has been done into the role of gender-specific factors such as hormones in the onset of lung cancer. This makes it difficult to identify differences in the emergence, risk and survival of women and men and to verify these studies.

Sexually transmitted diseases

The anatomy of women exposes them to sexually transmitted diseases to a greater extent than men. Unlike the relatively thick skin of the penis, a woman's vagina is covered by a thin membrane that makes it easier for viruses and bacteria to penetrate. The vagina is also warm and moist, providing the environment in which bacteria thrive.

In addition, in some of the most common venereal diseases, the symptoms are much more direct in men than in women, for example with yeast infections or chlamydia.

Autoimmune diseases

Autoimmune diseases are a collective term for diseases in which the immune system responds to its own defenses in the event of tissue damage or dysfunction. They can be systemic or affect only individual organs. Three out of four people with such diseases are women. For example, you suffer from multiple sclerosis or rheumatoid arthritis.

The reasons why such diseases particularly affect women are unknown, but it is known that they are related to previous infections. Such diseases are in the top ten causes of death for women over 65 in the United States.

Firstly, since these diseases often begin when young women are “at their best” and also show themselves in unspecific symptoms, they often go undetected initially: multiple sclerosis, for example, can drag on for decades. Because women are badly affected, research into gender medicine is urgently needed.

Pain

Women suffer from pain more than men. More than 70% of people who suffer from chronic pain are women. The musculoskeletal system of women reacts differently than that of men. While there are no general differences in the frequency of muscle pain in men and women, women react differently to rehabilitation programs.

Is it the hormones?

Hormones explain some of these gender differences. For example, the monthly ups and downs of female hormones such as estrogen can trigger a migraine, a condition that occurs three times as often in women than in men and women, especially during the period when the level of estrogen is low.

Studies suggest that fluctuations in estrogen are even related to the body's ability to control pain. During the period, women only produce a small amount of endorphins, which are the body's natural pain relievers.

The brain

The brain plays an important role in the medical differences between the sexes, but not in that women are stupid than men or vice versa. Rather, men and women use different areas of the brain to respond to pain.

Women activate their limbic system, the emotional center of the brain, men, on the other hand, the part in which the analytical skills develop. Researchers speculate that old gender roles are reflected here, which in turn arose in biological evolution.

So women had to protect their children in painful situations, an extremely emotional task. Injured men, on the other hand, were more concerned with eliminating the cause of the pain - for example, a predator. But emotions would have been harmful.

In the case of illness, this leads to women developing anxiety disorders or depression more often than men while suffering from pain. Anxiety and depression increase the feelings of pain.

Fat and estrogen

Much is unexplored, but only the focus on gender brings the questions to the table. Thus, the risk of women developing diabetes increases with their obesity, and the complications affect them more than lean women. Traditionally, this could simply be explained by the fact that fat people generally develop diabetes more quickly. Prof. Dr. However, med Suzanna Hofmann points out that estrogen could also play a role.

Heart disease

In the case of heart failure, various medications work differently in men and women: digitalis, antiarrhythmics, anticoagulants, beta blockers.

This is crucial for digitalis, because it is fatal if overdosed: proportionally more women die of heart failure with digitalis than men. The causes are still unknown, but “suspects” are higher blood levels in women, as is the lower kidney function of older women. In addition, the female estrogen and male testosterone affect the ion channels on the heart.

So being female is explicitly a risk factor when taking antiarrhythmics, antidepressants and antiallergics.

Alcohol

Men and women with the same weight and the same size experience the effects of alcohol in the body differently. Women are more vulnerable to the consequences of alcohol and abuse.

The alcohol is more concentrated in your blood; they get drunk faster and experience alcohol poisoning at lower doses, which is also fatal with less alcohol than with men.

One reason for this is that women have less body fluid than men of the same weight and therefore reach higher levels of alcohol in the blood with a lower amount of alcohol than men. The proportional ratio of alcohol to body fluid shifts.

In the long term, women's bodies are at greater risk of suffering damage from continued alcohol consumption. Women who drink a lot are at high risk for the following diseases: high blood pressure, liver diseases and damage to the pancreas. Proportionally more women die from cirrhosis than men.

Risks in men

Gender medicine does not only help women, but also men who respond to certain treatments less well than women. Prof. med Margarethe Hochleitner from the Medical University of Innsbruck explains: “If a woman and a man get the same cancer - same age, same state of health - then the man has a much higher risk of dying from it. And if both die, the man dies faster. So a man is disadvantaged in any case. Chemotherapy works better for women. And there is the big exciting question: why is that? ” (Somayeh Ranjbar, translated and supplemented by Dr. Utz Anhalt)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dr. phil. Utz Anhalt, Barbara Schindewolf-Lensch

Swell:

  • Foundazione ISTUD: Gender Medicine - A new approach for healthcare, September 2013, istud.it
  • American Autoimmune Related Diseases Association: Women & Autoimmunity (accessed: September 11, 2019), aarda.org
  • National Institute on Alcohol Abuse and Alcoholism: Are Women More Vulnerable to Alcohol's Effects? December 1999, pubs.niaaa.nih.gov
  • Ärzte Zeitung: Gender-specific medicine - The little difference is bigger than expected (accessed: September 11, 2019), aerztezeitung.de


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