BY ANISHA YAGNIK – It has long been known that men and women are biologically different. Women carry the baby and men thank their stars that they don’t have to turn into a hormonal balloon for nine months. However, it is important to note that although everyone is aware of the reproductive differences, male and female bodies differ in so many other less-acknowledged yet very important ways. Most people know about the established field of women’s health, which focuses on the reproductive system. Trying to distinguish itself from women’s health and make itself heard is another distinct field called sex-specific medicine. This is a medical practice that considers how male and female physiologies respond differently to diseases and treatment. Scientists and physicians that advocate for and practice sex-specific medicine will take into account their patients’ biological sex when making clinical decisions.
Research on cardiovascular disease is among the most studied sex-specific literature in recent years that has been applied clinically and shared with the public. Literature shows that men and women are at risk for cardiovascular disease at different ages, from different causes and via different physiological mechanisms. Heart attack symptoms are typically described as a chest pain or pressure, shortness of breath and sharp pain in the arm and shoulder, but these are actually the typical symptoms experienced by men. Women, on the other hand, may be less likely to realize that they are having a heart attack, due to the small vessel heart disease—blockage of the smaller vessels rather than the main artery—that is more common among women. The symptoms, which include fatigue, nausea and lightheadedness, are less alarming and can occur weeks before the actual heart attack. This knowledge has become well-known in the medical community but is not yet common knowledge among the populace. In a 2012 National Survey taken by the American Heart Association, it was found that only 18% of women answered that nausea was a sign of a heart attack, compared to 56% of women who answered “chest pain” and 60% who answered “pain that spreads to shoulders, neck, or arm”. Understanding the sex-specific differences in cardiovascular health also gives insight for women to prevent a heart attack. The causes for heart attacks in men are typically related to heavy exercise, whereas the causes for women are more often social and psychological. Dr. Vera Regitz-Zagrosek of The International Society for Gender Medicine suggested in 2012 that factors such as job stress —as a result of social inequality in the workplace—can increase risk of cardiovascular disease for women.
Although sex-specific literature is available and fairly well-known in the medical communities, it is often ignored in laboratories as well in the doctor’s office. Until a few decades ago, most clinical trials —using both humans and animals—were conducted using male subjects and the results were applied to women, under the assumption that the female physiology would perform the same way as the male physiology. This practice can lead to adverse effects when faced with the reality that the patient’s biological sex can change their response to drugs and other treatments. Some sleep-aid drugs are a key example of the differences in male and female physiology. Alyson McGregor, an emergency medicine doctor and women’s health advocate who gave a TED Talk in 2014 entitled, “Why medicine often has dangerous side effects for women,” said that many women who took sleep-aid drugs ended up in car accidents because the suggested dosage is metabolized slower in their bodies than in men. These incidents could have been prevented if the drug had been tested on women as well as men when it was being produced. She also pointed out that in the ER, the same treatments are routinely given to patients regardless of their sex. Not only were the drugs tested on mostly men, but they were also administered as if all patients were men.
Scientists in the research field are much at fault for not practicing sex-specific medicine, but the doctors play an equally vital role, as they decide the ultimate diagnosis and treatment. Today, many doctors don’t practice sex-specific medicine. However, we are constantly training the next generation of doctors. The problem can be fixed at the root. Medical school curricula need to differentiate between women’s health and sex-specific medicine, and emphasize the equal importance of the latter. A survey and study conducted by Jenkins and colleagues in the journal Biology of Sex Differences in 2016, most medical students nationwide felt that they were not properly educated on sex-specific medicine, and that, based on their education, they would not feel prepared to treat their patients using that technique. The literature is available and convincing. Practicing sex-specific medicine is essential for ensuring accurate diagnosis and it cannot be ignored.