Medicine Looking Deeper Into Vital Differences Between Women and Men
Men and women aren’t
That’s hardly an
earth-shattering observation, but the fact is that, aside from the most obvious
physical differences between the sexes, medicine has generally treated women as
if they were merely smaller men.
“When we look
closely, we tend to find differences” between men and women, says Sarah L. Berga,
MD, Wake Forest Baptist Health’s chair of obstetrics and gynecology and vice
president for women’s health services. “But for most of the past, we never
That started to
change in the late 1980s, when physicians and researchers recognized that women’s
health encompassed more than those conditions unique to females; that women’s
experiences with gender-common conditions and the treatments for them often differed
significantly from those of men.
“If women didn’t
respond to a drug the same way as men, the thought was that it was because
their body size was different,” Berga says. “Then the idea arose that maybe it
was also because their bodies were different.”
began to explore how women’s and men’s bodies differed, some of the answers
“One of the biggest
things we’ve learned is that cellular biology is sex-specific,” says Berga,
whose interest in sex differences dates to her undergraduate days at the
University of Virginia in the 1970s. “Every single cell has a chromosomal sex,
and the ‘cellular machinery’ is independent of hormones.
“But we’ve also
learned that most sex differences are the result of the interaction between
this chromosomal distinction and hormones.”
As a result, it is now
commonly accepted that there is a biological basis for sex differences in a
number of common conditions, among them heart disease, stroke, arthritis,
dementia, colon cancer and depression. And there’s active research into why
other conditions—including obesity, bronchitis, asthma, multiple sclerosis and
thyroid disease—occur more frequently in women than men.
“We’re beginning to
truly understand how men and women differ in very fundamental ways and how
these differences affect disease risk, symptoms, diagnostic sensitivity and
specificity, and responses to therapy,” says Berga, who joined the Wake Forest
Baptist faculty in November 2011. “We now need to adjust our approaches and
develop sex-specific interventions and therapies so both men and women
The best way to do
that, she says, is through research that directly compares men and women.
“If you do a study in
men and then do another study in women you will not have learned anything about
sex differences,” she says. “You may have learned about X in men and Y in women
but you probably won’t have gotten the full story. Direct comparison is the
only way to get that. It’s important that we discipline ourselves to do it this
In addition to
gender, age and ethnicity are also being studied as factors in medical
differences more frequently than in the past.
“Age is a definitely big
modifier,” Berga says, “and we’re beginning to understand different genetic elements
in different populations that can affect responses to drugs or make a disease
more common in one group than another.”
Wake Forest Baptist researchers
are among those active in this field, with recently published studies indicating
High blood pressure
is potentially more dangerous for women than men.
● Women who survive a stroke have
a worse quality of life than their male counterparts.
● Calcium supplements regularly
prescribed to prevent osteoporosis in women undergoing treatment for breast
cancer may not be effective and could even be harmful.
reduce hot flashes in women are ineffective in men who experience hot flashes
as a side effect of hormone therapy for prostate cancer.
African-Americans are at higher risk of heart attack from atrial fibrillation
than men and whites.
So have findings such
as these had a widespread impact on diagnosis and treatment?
“Not as much as you
might think,” Berga says, adding that the vast majority of diagnoses, therapies
and drug dosages for common conditions are still based on symptoms, responses
and outcomes in adult white males.
“That doesn’t mean
they’re all bad or wrong,” she says. “You might suspect that something should
be done differently according to gender, but you can’t say there is unless you
And that’s not
necessarily a simple, direct path.
“There are two things
going on at once,” Berga says. “One is the urge to simplify, to make things
efficient, to arrive at something that’s one-size-fits all. The other is that
if something doesn’t work in a one-size-fits all model, then you have to find the
reason and determine what should be changed, and you run into questions about
how much it will cost to do this, how long it will take and so on.”
Berga is generally in
favor of going down that road.
“Now that we have the
tools to find out certain things, we should use them,” she says. “The more we
know about individual people, the better we can help them.”