The gender health gap: how historically neglecting sex differences has impacted women’s health.
Sex differences have historically been neglected in clinical research, design and practice. To mark International Women’s Day, we explored how this ‘one size fits all’ approach to medical research and treatment impacts women’s health.
Men and women are different in several ways in terms of their biological makeup, and it has been long known that the expression of genes on X and Y chromosomes have a profound effect on health and well-being. Difference in sex not only contributes to the physiological and anatomical variations but also influences the behavioural traits and disease risks. For instance, most autoimmune diseases occur more frequently in women while hypertension is observed more frequently in young men than in young women. Unsurprisingly, this is no exception for drug metabolism: most drugs are absorbed, metabolised, and eliminated differently between males and females.
Despite this knowledge, our current clinical management and medical treatment of most diseases is rarely gender-specific. Very few medical guidelines systematically address the difference in sex and gender, indeed this aspect is often overlooked in the design of clinical research in the first place. When interpreting the research findings without gender-specific analyses, the applicability to clinical practice becomes suboptimal. This makes it hard to achieve equitable treatment, because adjustments have not been made to the specific needs of each gender.
Failure to consider the differences in the physiology of males and females in the drug development process can lead to serious consequences. One prominent example is drugs commonly used to treat cardiovascular conditions, including digitalis, angiotensin-converting enzyme inhibitors, beta-blockers, and aspirin. Studies revealed that significantly more side effects occurred in women, particularly life-threatening arrhythmia (aka irregular heart rhythm).