Clinician Articles and Resources

A collection of tools, screening recommendations, clinical guidelines, and a small sample of journal articles showing the clinical relevance of using a sex and gender specific lens. There are tens of thousands of articles documenting sex differences.

PUBMED SEARCH TOOL
SCREENING AND ASSESSMENT TOOLS — Patient questionnaires to evaluate risk
MEDICAL DEVICES — Sex disparities in medical devices
CLINICAL CARE — Articles using a sex and gender lens and having clinical relevance.

Cardiology
Dermatology
Endocrinology
Gastroenterology
Gynecology
Immunology
Men’s health
Musculoskeletal
Neurology
Nutrition
Pain
Psychology/psychiatry
Pulmonology
Special populations

CLINICAL GUIDELINES
RECOMMENDED BOOKS
PATIENT EDUCATION — Sex and gender specific resources for patients

PubMed Search Tool

The Sex and Gender Specific Health website’s resources page contains a PubMed search tool to find articles showing sex and gender differences for health conditions. Basic and advanced PubMed tools are available, as well as instructions for use. Click on Literature Search & Database Resources.

Screening and Assessment Tools

Patient questionnaires to evaluate risk

Ovarian Cancer Screening Tool

Ovarian cancer symptom survey may improve early detection in primary care settings

A simple three-question paper-and-pencil survey, given to women in the doctor’s office in less than two minutes, can effectively identify those who are experiencing symptoms that may indicate ovarian cancer, according to a study by researchers at Fred Hutchinson Cancer Research Center. The study represents the first evaluation of an ovarian cancer symptom-screening tool in a primary care setting among normal-risk women as part of their routine medical-history assessment. The results are published online in the Open Journal of Obstetrics and Gynecology.

Early detection promises a cure rate of approximately 70 to 90 percent. However, more than 70 percent of women with ovarian cancer are diagnosed with advanced-stage disease, when the survival rate is only 20 to 30 percent.

The researchers evaluated the effectiveness and feasibility of several different symptom screening surveys, settling on three questions that focus on the following symptoms as potential indicators of ovarian cancer:

Abdominal and/or pelvic pain
Feeling full quickly and/or unable to eat normally
Abdominal bloating and/or increased abdomen size

The survey then asks about the frequency and duration of these symptoms. The study questionnaire that was tested in the clinic was based on a symptom-screening index developed in 2006 by Andersen and co-author Barbara Goff, M.D., professor and director of Gynecologic Oncology at the University of Washington School of Medicine

Breast Cancer Risk Assessment Tool

The guideline uses the National Cancer Institute’s Breast Cancer Risk Assessment Tool to define which women have a higher risk of developing breast cancer. The Breast Cancer Risk Assessment Tool uses a woman’s age, race, and medical history to determine her risk for breast cancer. In addition, women with lobular carcinoma in situ (LCIS), a condition in which abnormal cells are found in the lobules or glands of the breast, are considered to be at increased risk.

Medical Devices

Sex disparities in medical devices

Sex Differences in Medical Devices

March 21, 2012
Evaluating sex differences in medical device clinical trials: time for action. Dhruva, S. S., & Redberg, R. F. The safety and effectiveness of medical treatments can differ in men and women for many reasons related to different epidemiologic characteristics, physiology, and body size. In general, women have higher bleeding rates and procedural morbidity and mortality than men, which means that their risk/benefit ratios for many implanted medical devices can differ from men. This document discusses the underrepresentation of women in medical device clinical trials and provides recommendations for increasing enrollment of women and performing sex-specific analyses.

Clinical Care

Articles using a sex and gender lens and having clinical relevance. Categories include: biopsychosocial model, cardiology, dermatology, endocrinology, gastroenterology, gynecology, immunology, men’s health, musculoskeletal, neurology, nutrition, pain, pediatrics, psychology/psychiatry, pulmonology, special populations

Biophysical Model

The biopsychosocial model is an approach that enables clinicians to integrate both sex and gender into practice because sex is a biological variable and gender is a psychosocial and sociocultural variable.

The Philosophy and Practicality of the Biopsychosocial Model

November 1, 2004
The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry. Borrell-Carrió, F., Suchman, A. L., & Epstein, R. M. The biopsychosocial model is both a philosophy of clinical care and a practical clinical guide. Philosophically, it is a way of understanding how suffering, disease, and illness are affected by multiple levels of organization, from the societal to the molecular. At the practical level, it is a way of understanding the patient’s subjective experience as an essential contributor to accurate diagnosis, health outcomes, and humane care. The authors defend the biopsychosocial model as a necessary contribution to the scientific clinical method, while suggesting 3 clarifications. They propose a biopsychosocial-oriented clinical practice with 7 pillars.

Work Hours and Health in Women

2009
Work status, work hours, and health in women with and without children. Floderus, B., Hagman, M., Aronsson, G., Marklund, S., & Wikman, A. Having children may contribute to fatigue and poor self-rated health particularly in women working 40 h or more per week. Student mothers and job seeking mothers were also at increased risk of poor self-rated health.

Travel-associated Illnesses

March 15, 2010
Sex and gender differences in travel-associated disease The authors evaluated sex and gender differences in health outcomes and in demographic characteristics and found statistically significant differences in morbidity by sex. A summary of their findings: Women are proportionately more likely than men to present with acute diarrhea, chronic diarrhea, irritable bowel syndrome, upper respiratory infection; […]

Cardiology

Pivotal WISE Study Delineates Sex Differences in Ischemic Cardiac Disease

February 2006
Insights from the NHLBI-Sponsored Women’s Ischemia Syndrome Evaluation (WISE) Study: Part I: gender differences in traditional and novel risk factors, symptom evaluation, and gender-optimized diagnostic strategies. Shaw, L. J., Merz, C. N. B., Pepine, C. J., Reis, S. E., Bittner, V., Kelsey, S. F., … & Rogers, W. J. The 2006 WISE Study (Women’s Ischemia Syndrome Evaluation), sponsored by the NHLBI, is arguably one of the most significant, pivotal studies which opened our eyes to sex differences in ischemic cardiac disease, which is commonly MI with Non Obstructive Coronary Arteries (MINOCA) in women. It pleads for education of clinicians on sex differences in not only symptoms (more likely to be fatigue, nausea, and jaw pain), but also in risk markers (high-sensitivity CRP), cardiac testing results (stress echocardiography), SPECT cardiac imaging (single-photon emission computed tomographic imaging), and treatment programs.

Aspirin for the Primary Prevention of Cardiovascular Events in Women and Men

January 18, 2006
Aspirin for the primary prevention of cardiovascular events in women and men: a sex-specific meta-analysis of randomized controlled trials. Berger, J. S., Roncaglioni, M. C., Avanzini, F., Pangrazzi, I., Tognoni, G., & Brown, D. L. For women and men, aspirin therapy reduced the risk of a composite of cardiovascular events due to its effect on reducing the risk of ischemic stroke in women and MI in men. Aspirin significantly increased the risk of bleeding to a similar degree among women and men.

Aspirin for the Primary Prevention of Cardiovascular Events in Women and Men Update

March 17, 2009
Aspirin for the primary prevention of cardiovascular events: an update of the evidence for the US Preventive Services Task Force. Wolff, T., Miller, T., & Ko, S. Aspirin reduces the risk for myocardial infarction in men and strokes in women. Aspirin use increases the risk for serious bleeding events. CLINICAL GUIDELINES

MI Chest Pain Differs by Sex

February 22/29, 2012
Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality. Canto, J. G., Rogers, W. J., Goldberg, R. J., Peterson, E. D., Wenger, N. K., Vaccarino, V., … & NRMI Investigators. Key Findings: Proportion of MI patients who presented without chest pain was significantly higher for women than men (42.0% vs 30.7%) Younger women presenting without chest pain had greater hospital mortality than younger men without chest pain, and these sex differences decreased or even reversed with advancing age. In this registry of patients hospitalized with MI, women were more likely than men to present without chest pain and had higher mortality than men within the same age group, but sex differences in clinical presentation without chest pain and in mortality were attenuated with increasing age.

Congenital Heart Disease Affects More Boys

2010
Sex Differences in Mortality in Children Undergoing Congenital Heart Disease Surgery In the pediatric population, more boys have surgery and high risk procedures for congestive Heart Disease and high-risk procedures. While girls who had high-risk procedures were at higher risk for death, this can be accounted for by the lower number.

Sex Differences in PreAdmisssion of STEMI

October 2012
Article in Press Abstract Analysis of Sex Differences in Preadmission Management of ST-Segment Elevation (STEMI) Myocardial Infarction. Greenberg, M. R., Miller, A. C., MacKenzie, R. S., Richardson, D. M., Ahnert, A. M., Sclafani, M. J., … & Burmeister, D. B. No significant gender differences were apparent in the STEMI patients analyzed, whether the MI Alert was initiated in the ED or prehospital initiated. Initiating prehospital-based alerts significantly decreased the time to the cath lab.

Sex Differences in Sports Related Sudden Cardiac Arrest

November 4, 2013
Characteristics and Outcome of Sudden Cardiac Arrest during Sports in Women Eloi Marijon, Wulfran Bougouin, David S. Celermajer, Marie-Cécile Périer, Florence Dumas, Nordine Benameur, Nicole Karam6, Lionel Lamhaut7, Muriel Tafflet7, Hazrije Mustafic4, Natalia Machado de Deus8, Jean-Yves Le Heuzey9, Michel Desnos9, Paul Avillach10, Christian Spaulding6, Alain Cariou4, Christof Prugger3, Jean-Philippe Empana3 and Xavier Jouven1 Abstract […]

Job Status and Hypertension

2011
Gender and sex differences in job status and hypertension Jane E Clougherty, Ellen A Eisen, Martin D Slade, Ichiro Kawachi, Mark R Cullen. There are significant risks of hypertension associated with hourly status for women, possibly exacerbated by sociodemographic factors predicting hourly status (eg, single parenthood, low education).

Exercise Stress Testing in Women

2010
Exercise in Cardiovascular Disease: Going Back to Basics. Circulation. Priya Kohli and Martha Gulati

Web-based Formula Can Predict Risk of MI and Stroke among Women

February 14, 2007
Development and validation of improved algorithms for the assessment of global cardiovascular risk in women: the Reynolds Risk Score. Ridker, P. M., Buring, J. E., Rifai, N., & Cook, N. R. The authors developed, validated, and demonstrated highly improved accuracy of 2 clinical algorithms for global cardiovascular risk prediction that reclassified 40% to 50% of women at intermediate risk into higher- or lower-risk categories. A user-friendly calculator for the Reynolds Risk Score can be freely accessed at http://www.reynoldsriskscore.org.

Evaluation of the AHA Cardiovascular Disease Prevention Guidelines for Women

February 16, 2010
Evaluation of the American Heart Association cardiovascular disease prevention guideline for women. Hsia, J., Rodabough, R. J., Manson, J. E., Liu, S., Freiberg, M. S., Graettinger, W., … & Howard, B. V. Risk stratification as proposed in the 2007 AHA guideline is simple, accessible to patients and providers, and identifies cardiovascular risk with accuracy similar to that of the current Framingham algorithm.

Sex Differences in Coronary Artery Disease

August 2007
New insights into ischemic heart disease in women. Bellasi, A., Raggi, P., Merz, C. B., & Shaw, L. J. Coronary artery disease is different in women than in men in its pathogenesis, symptoms, and prognosis. Compared with men, women have: as great a prevalence of coronary disease, at least in their older years; a higher death rate from coronary disease; worse outcomes after acute coronary events; different pathophysiologic mechanisms of coronary disease; different presentations and risk factors. Screening tests also differ in efficacy in men and women.

Effects of Menstrual Cycle on Serum Lipids

September 1, 2010
A longitudinal study of serum lipoproteins in relation to endogenous reproductive hormones during the menstrual cycle: findings from the BioCycle study. Mumford, S. L., Schisterman, E. F., Siega-Riz, A. M., Browne, R. W., Gaskins, A. J., Trevisan, M., … & Wactawski-Wende, J. Endogenous estrogen, like exogenous estrogen, appears to have beneficial effects on the lipid profile. Because lipoprotein cholesterol levels vary across the menstrual cycle, cyclic variations in lipoprotein levels may need to be considered in the design and interpretation of studies in reproductive-age women and in the clinical management of women’s cholesterol.

Unintended Benefits of Statins and Sex Differences in Risks

May 20, 2010
Unintended effects of statins in men and women in England and Wales: population based cohort study using the QResearch database. Hippisley-Cox, J., & Coupland, C. Statin use was associated with decreased risks of oesophageal cancer but increased risks of moderate or serious liver dysfunction, acute renal failure, moderate or serious myopathy, and cataract. There were sex differences in risks associated with many of these conditions.

Sex Differences in Pharmacokinetics and Pharmacodynamics of Anti-Hypertensive Drugs

November 17, 2011
Sex-related differences in pharmacokinetics and pharmacodynamics of anti-hypertensive drugs. Ueno, K., & Sato, H. Sex-specific differences in pharmacokinetics and pharmacodynamics have been reported to have important clinical consequences. In this review, some representative sex-specific differences in absorption and transporters (that is, P-glycoprotein (P-gp)), metabolic processes (that is, those that involve cytochrome P450 (CYP)), clearance (Cl) processes (for example, renal excretion or other pharmacokinetic parameters) and involvement of sex hormones (that is, estrogen and testosterone) in the regulation of some metabolic enzymes are introduced for each of the following categories of anti-hypertensive drugs: calcium-channel blockers, angiotensin-receptor blockers and angiotensin-converting enzyme inhibitors, diuretic agents, and β-adrenergic-receptor blockers (β-blockers). In many cases, female sex is a risk factor for adverse effects or attenuated clinical responses because of lower Cl, smaller distribution volumes, higher activity of some metabolic enzymes (especially hepatic CYP3A4), or presence of sex hormones.

Women with Diabetes at Higher Risk for CHD than Men

May 25, 2014
Diabetes as risk factor for incident coronary heart disease in women compared with men: a systematic review and meta-analysis of 64 cohorts including 858,507 individuals and 28,203 coronary events. Peters, S. A., Huxley, R. R., & Woodward, M. Women with diabetes have more than a 40% greater risk of incident CHD compared with men with diabetes. Sex disparities in pharmacotherapy are unlikely to explain much of the excess risk in women, but future studies are warranted.

Sex Matters in Heart Transplants

February 2014
Cardiac size and sex-matching in heart transplantation: size matters in matters of sex and the heart. Reed, R. M., Netzer, G., Hunsicker, L., Mitchell, B. D., Rajagopal, K., Scharf, S., & Eberlein, M. This study evaluated whether worsened outcomes in sex mismatch are related to mismatch of organ size in heart transplantation. Differences in donor–recipient pHM modulated the survival associated with donor–recipient sex mismatch and identified donor heart undersizing as an otherwise occult and potentially preventable cause of mortality following orthotopic heart transplantation.

Sex specific risks of heart disease and cognition

March 28, 2013
Sex-specific risk of cardiovascular disease and cognitive decline: pregnancy and menopause. Miller, V. M., Garovic, V. D., Kantarci, K., Barnes, J. N., Jayachandran, M., Mielke, M. M., … & Rocca, W. A. This review draws on epidemiological, translational, clinical, and basic science studies to assess the impact of hypertensive pregnancy disorders on cardiovascular disease and cognitive function later in life, and examines the effects of post-menopausal hormone treatments on cardiovascular risk and cognition in midlife women.

Gender Differences in Myocardial Infarction

October 2012
Age and gender differences in quality of care and outcomes for patients with ST-segment elevation myocardial infarction. Bangalore, S., Fonarow, G. C., Peterson, E. D., Hellkamp, A. S., Hernandez, A. F., Laskey, W., … & Get with the Guidelines Steering Committee and Investigators. Young patients aged 45 years or less presenting with ST-segment elevation myocardial infarction overall had similar quality of care and in-hospital outcomes as older counterparts. However, quality of care was significantly lower and mortality was higher in young women (vs young men) and the very young (≤35 vs 36-45 years).

Sex Differences for Heart Failure Treatment

October 3, 2007
Sex and racial differences in the use of implantable cardioverter-defibrillators among patients hospitalized with heart failure. Hernandez, A. F., Fonarow, G. C., Liang, L., Al-Khatib, S. M., Curtis, L. H., LaBresh, K. A., … & Peterson, E. D. Less than 40% of potentially eligible patients hospitalized for heart failure received ICD therapy, and rates of use were lower among eligible women and black patients than among white men.

Management of Hypertension in Women

December 8, 2011
Management of hypertension in women. Engberding, N., & Wenger, N. K. In absolute numbers, since 1984, more women than men died of CV disease each year. Most CV events occur in women with known traditional CV risk factors. Aside from smoking cessation, hypertension (HTN) control is the single most important intervention to reduce the risk of future CV events in women. This review highlights peculiarities of HTN as they pertain to women, and points out where diagnosis and management of HTN may require a gender-specific focus.

Dermatology

Prognosis of Melanoma

January 2014
Prognostic Factors in Young Women with Cutaneous Melanoma Burton AL, Egger ME, Quillo AR, Stromberg AJ, Hagendoorn L, Scoggins CR, Martin RC, McMasters KM, Callender GG. ABSTRACTBackground: Gender is an established prognostic factor in cutaneous melanoma; women as a group have a better overall prognosis than men. However, the investigators hypothesized that melanoma in young […]

Age and Gender As Independent Predictors in Melanoma

February 27, 2008
Age and gender are significant independent predictors of survival in primary cutaneous melanomaLasithiotakis, K., Leiter, U., Meier, F., Eigentler, T., Metzler, G., Moehrle, M., … & Garbe, C. Older age and male gender are associated with prognostically unfavorable primary CM. Expansion of current preventive strategies to target these subgroups is warranted. Moreover, age and gender are independent predictors of the outcome of CM patients. Females have a better prognosis than males but this difference disappears after the age of 65. Younger patients have a more favorable prognosis than older patients, a difference more pronounced in women.

Endocrinology

Screening for Osteoporosis

July 20, 2010
Screening for osteoporosis: an update for the US Preventive Services Task Force. Nelson, H. D., Haney, E. M., Dana, T., Bougatsos, C., & Chou, R. Purpose: To determine the effectiveness and harms of osteoporosis screening in reducing fractures for men and postmenopausal women without known previous fractures; the performance of risk-assessment instruments and bone measurement tests in identifying persons with osteoporosis; optimal screening intervals; and the efficacy and harms of medications to reduce primary fractures. Although methods to identify risk for osteoporotic fractures are available and medications to reduce fractures are effective, no trials directly evaluate screening effectiveness, harms, and intervals. For postmenopausal women, bisphosphonates, parathyroid hormone, raloxifene, and estrogen reduce primary vertebral fractures. Trials are lacking for men. Bisphosphonates are not consistently associated with serious adverse events; raloxifene and estrogen increase thromboembolic events; and estrogen causes additional adverse events.

Osteoporosis Affects Men

August 22, 2013
Causes, consequences, and treatment of osteoporosis in men Banu J. Coordinated Program in Dietetics, College of Health Sciences and Human Services and Department of Biology, College of Science and Mathematics, University of Texas-Pan American, Edinburg, TX, USA . Men undergo gradual bone loss with aging, resulting in fragile bones. It is estimated that one in five men will suffer an osteoporotic fracture during their lifetime. The prognosis for men after a hip fracture is very grim. A major cause is reduction of free testosterone. Many other factors result in secondary osteoporosis, including treatment for other diseases such as cancer and diabetes. Patients should be screened not only for bone density but also assessed for their nutritional status, physical activity, and drug intake. Therapy should be chosen based on the type of osteoporosis.

Bisphosphonates for Prevention of Osteoporotic Fractures

January 2011
When do bisphosphonates make the most sense? A cochrane musculoskeletal group review: should you prescribe bisphosphonates for postmenopausal patients for primary as well as secondary prevention of osteoporotic fractures? Here’s what the evidence tells us. Winzenberg, T., & Jones, G. All these bisphosphonates (in this review) have demonstrated efficacy for the secondary prevention of vertebral fracture. All except ibandronate have demonstrated efficacy for non-vertebral fracture, as well, and the evidence suggests that ibandronate will also be effective if adequate doses are given. For women at significant risk for fracture, it seems clear that the benefits of treatment outweigh the risks. The case is not so clear cut for women at lower risk.

Women with Diabetes at Higher Risk for CHD than Men

Metabolic Syndrome Sex Differences

November 2013
Sex Differences in the Metabolic Syndrome: Implications for Cardiovascular Health in Women. Pradhan, A. D. This minireview highlights sex differences in the epidemiology, etiology, biology, and clinical expression of the metabolic syndrome. In particular, key sex differences include distinctions in (a) prevalence of dysglycemia, (b) body fat distribution, (c) adipocyte size and function, (d) hormonal regulation of body weight and adiposity, and (e) the influence of estrogen decline on risk factor clustering.

Sex Disparities in Diabetes Care

October 2013
Sex disparities in the quality of diabetes care: biological and cultural factors may play a different role for different outcomes: a cross-sectional observational study from the AMD Annals initiative. Rossi, M. C., Cristofaro, M. R., Gentile, S., Lucisano, G., Manicardi, V., Mulas, M. F., … & Giorda, C. Women show a poorer quality of diabetes care than men. The attainment of the LDL-C target seems to be mainly related to pathophysiological factors, whereas patient and physician attitudes can play an important role in other process measures and outcomes.

Gender-Specific Care for Diabetes

June 2006
Gender-specific care of the patient with diabetes: review and recommendations. Legato, M. J., Gelzer, A., Goland, R., Ebner, S. A., Rajan, S., Villagra, V., & Kosowski, M. Men and women differ in their experience of diabetes mellitus (DM). There are also many biological differences in DM between the sexes.

Sex differences in Cancer Risk

April 8, 2013
Amiodarone and the risk of cancer: a nationwide population-based study. Su, V. Y. F., Hu, Y. W., Chou, K. T., Ou, S. M., Lee, Y. C., Lin, E. Y. H., … & Liu, C. J. Amiodarone may be associated with an increased risk of incident cancer in males, with a dose-dependent effect.

Gastroenterology

Men’s Health: Sex Differences in IBS

March 1, 1997
Gender differences in irritable bowel symptoms. Thompson, W. G. Among IBS patients, pain-related Manning symptoms are similar in men and women, but mucus, incomplete evacuation, distension and scybala are less common in men. Less reporting of these symptoms by men may account for reduced clinical reliability of the Manning or Rome criteria in men and their apparent low prevalence of IBS.

Sex Differences in the Gut

May 7, 2013
Sex differences matter in the gut: effect on mucosal immune activation and inflammation. Sankaran-Walters, S., Macal, M., Grishina, I., Nagy, L., Goulart, L., Coolidge, K., … & Flamm, J. There is a demonstrated upregulation in gene expression related to immune function in the gut microenvironment of women compared to men, in the absence of disease or pathology. Sex differences in the mucosal immune system may predispose women to inflammation-associated diseases that are exacerbated following menopause. This study highlights the need for more detailed analysis of the effects of sex differences in immune responses at mucosal effector sites.

Does Timing of First Colonoscopy Vary Between the Sexes?

September 28, 2001
Sex-specific prevalence of adenomas, advanced adenomas, and colorectal cancer in individuals undergoing screening colonoscopy. Ferlitsch, M., Reinhart, K., Pramhas, S., Wiener, C., Gal, O., Bannert, C., … & Weiss, W. Among a cohort of Austrian individuals undergoing screening colonoscopy, the prevalence and NNS of AAs were comparable between men aged 45 to 49 years and women aged 55 to 59 years.

Gynecology

HRT After Joint Surgery

2013
Hormone replacement therapy and mid-term implant survival following knee or hip arthroplasty for osteoarthritis: a population-based cohort study Prieto-Alhambra, D., Javaid, M. K., Judge, A., Maskell, J., Cooper, C., & Arden, N. K. Osteolysis and subsequent prosthesis loosening is the most common cause for revision following total knee arthroplasty (TKA) or total hip arthroplasty (THA). Hormone replacement therapy (HRT) could reduce osteolysis through its antiresorptive effects. We studied whether HRT use is associated with reduced revision rates in a community-based cohort of women undergoing TKA or THA for osteoarthritis. HRT use is associated with an almost 40% reduction in revision rates after a TKA/THA.

Sex specific risks of heart disease and cognition

Immunology

Sex Differences in Influenza Vaccine

January 3, 2014
Systems analysis of sex differences reveals an immunosuppressive role for testosterone in the response to influenza vaccination Key Findings: Marked sex differences in immune response to infections and vaccination exist. The reason may be a cluster of genes involved in lipid metabolism that are modulated by testosterone and that correlate with the higher antibody-neutralizing response […]

Sex Influences Immune Response and Treatment

September 26, 2012
Sex influences immune responses to viruses, and efficacy of prophylaxis and treatments for viral diseases. Klein, SL. The intensity and prevalence of viral infections are typically higher in males, whereas disease outcome can be worse for females. Several variables should be considered when evaluating male/female differences in responses to viral infection and treatment: these include hormones, genes, and gender-specific factors related to access to, and compliance with, treatment. Knowledge that the sexes differ in their responses to viruses and to treatments for viral diseases should influence the recommended course of action differently for males and females.

Men’s Health

Communicating about Prostate Cancer Screening and Treatment

November 26, 2015
Patient–provider communication about prostate cancer screening and treatment: new evidence from the Health Information National Trends Survey. Bhuyan, S. S., Chandak, A., Gupta, N., Isharwal, S., LaGrange, C., Mahmood, A., & Gentry, D. This study helps identify implications for changes in physician practice to adhere with the PSA screening guidelines.

Osteoporosis Affects Men

Poor Semen Quality May Signal Other Health Issues In Men

January 2015
Relationship between semen production and medical comorbidity Eisenberg, M. L., Li, S., Behr, B., Pera, R. R., & Cullen, M. R. The authors identify a relationship between many different medical comorbidites and male semen production. Although genetics help guide a man’s sperm production, his current condition and health play an important role.

Men’s Health: Sex Differences in IBS

Men’s Health Neglected in Global Health?

May 18, 2013
Gender and global health: evidence, policy, and inconvenient truths. Hawkes, S., & Buse, K. (2013). Gender is missing from, misunderstood in, and only sometimes mainstreamed into global health policies and programmes. In this Viewpoint, we survey the evidence for the role of gender in health status, analyse responses to gender by key global health actors, and propose strategies for mainstreaming gender-related evidence into policies and programmes.

Musculoskeletal

The criticality of gender specific medicine in spine health

May 24, 2017
AUTHORS: Templeton, K,MD, Werbinski, JL, MD It has been 36 years since the publication of the “Physicians’ Health Study,” which showed that low dose aspirin decreased the risk of a first heart attack in the 50,000 male physicians studied.1 This study became more infamous for its backlash from women than its epidemiological findings, since it […]

HRT After Joint Surgery

Sports Injuries in Women

January 1, 2008
Sports injuries in women: sex-and gender-based differences in etiology and prevention. Templeton, K. J., Hame, S. L., Hannafin, J. A., Griffin, L. Y., Tosi, L. L., & Shields, N. N. (2008). It is important to review some of the areas of sex- and gender-based differences in sports injuries for which there is significant research, such as osteoporosis, the female athlete triad, and anterior cruciate ligament injuries. It is also necessary to examine those areas in which more information is needed, such as injuries to the shoulder, foot, and ankle.

Sex Differences in Knee Osteoarthritis

December 23, 2012
Mechanical contributors to sex differences in idiopathic knee osteoarthritis Nicolella, D. P., O’Connor, M. I., Enoka, R. M., Boyan, B. D., Hart, D. A., Resnick, E., … & Coutts, R. D. The occurrence of knee osteoarthritis (OA) increases with age and is more common in women compared with men, especially after the age of 50 years. We identify gaps in knowledge related to mechanical influences on the sex differences in knee OA.

Sex and Gender Influence Osteoarthritis Pain

December 17, 2012
Neural and psychosocial contributions to sex differences in knee osteoarthritic pain. Sluka, K. A., Berkley, K. J., O’Connor, M. I., Nicolella, D. P., Enoka, R. M., Boyan, B. D., … & Coutts, R. D. Women with knee osteoarthritis (OA) have greater pain and greater reductions in function and quality of life than men. This review explores the neural and psychosocial factors that contribute to knee OA pain with an emphasis on differences between the sexes and gaps in knowledge.

Sex Differences Evident in Knee Osteoarthritis

February 4, 2013
Addressing the gaps: sex differences in osteoarthritis of the knee. Boyan, B. D., Tosi, L. L., Coutts, R. D., Enoka, R. M., Hart, D. A., Nicolella, D. P., … & Kohrt, W. M. Epidemiologic studies have established that there are sex differences in the incidence and severity of knee OA. Therapeutic approaches to the treatment of osteoarthritis (OA), particularly regenerative medicine strategies, have not yet taken known sex differences into consideration. Effective interventions will require a better understanding of the mechanisms involved in the disease and its differential expression in men and women.

Neurology

Parkinson’s Undertreated in Women

January 14, 2014
Disparities in deep brain stimulation surgery among insured elders with Parkinson disease Allison W. Willis, MD, MSCI, Mario Schootman, PhD, Nathan Kung, MD, Xiao-Yu Wang, Joel S. Perlmutter, MD and Brad A. Racette, MD University of Pennsylvania Perelman School of Medicine, Philadelphia and Washington University School of Medicine, St. Louis ABSTRACT Objective: To identify sociodemographic, […]

Cognitive Impairment Higher in Men

July 31, 2012
Incidence of Mild Cognitive Impairment Differs by subtype and is higher in men. The Mayo Clinic Study of Aging R.O. Roberts, Y.E. Geda, D.S. Knopman, R.H. Cha, V.S. Pankratz, B.F. Boeve, E.G. Tangalos, R.J. Ivnik, W.A. Rocca, and R.C. Petersen. Abstract Objective: Although incidence […]

HPA Axis, the Female Reproductive System

December 17, 2012
Interactions between the hypothalamic-pituitary-adrenal axis and the female reproductive system: clinical implications. Chrousos, G. P., Torpy, D. J., & Gold, P. W. Although melancholic depression is easier to recognize, another prevalent form of major depression—atypical depression—is also more common in women than in men. Patients feel lethargic, fatigued, and unmotivated and demonstrate hyperphagia and hypersomnia. Several lines of evidence suggest that these symptoms are associated with hyposecretion of CRH (3). This hyposecretion may contribute to a significant increase in the incidence of allergic and autoimmune phenomena in this form of depression and in its two homolog transient states, the postpartum blues or depression and the postcure state of patients with the Cushing syndrome.

Sex Differences in Depression

April 17, 2013
Depression is a common mental disorder that co-occurs in other neurological and somatic diseases. Further, sex differences exist in the prevalence rates of many of these diseases, as well as within non-disease associated depression[…]

Sex and Gender Differences in Alzheimer’s

October 4, 2012
Sex and gender differences in Alzheimer’s disease: recommendations for future research Carter, C. L., Resnick, E. M., Mallampalli, M., & Kalbarczyk, A. Alzheimer’s Disease (AD) disproportionately affects women in both prevalence and severity; however, the biological mechanisms underlying these sex differences are not fully understood. Sex differences in the brain, such as in brain anatomy, age-related declines in brain volume, and brain glucose metabolism have been documented and may be important in understanding AD etiology. The full impact of sex as a basic biological variable on this neurodegenerative disease remains elusive. To address the evidence for sex differences in AD, the Society for Women’s Health Research (SWHR) convened an interdisciplinary roundtable of experts from academia, clinical medicine, industry, and the government to discuss the state-of-the-science in sex and gender differences in AD.

Psychosocial factors of relevance to sex and gender studies in Headache

June 1, 20112
Psychosocial factors of relevance to sex and gender studies in headache. Smitherman, T. A., & Ward, T. N. In addition to biological underpinnings, psychosocial factors such as gender and social role expectations, coping strategies, and affective variables likely contribute to observed sex- and gender-related differences in headache. The present narrative reviews and summarizes extant literature pertaining to these psychosocial factors. Gender and social role expectations and coping styles differ between men and women who experience headache and pain, in turn affecting differences in responding to pain.

Stroke Symptom Differences in Males and Females

February 19, 2009
LAcute stroke symptoms: comparing women and men. Lisabeth, L. D., Brown, D. L., Hughes, R., Majersik, J. J., & Morgenstern, L. B. A high prevalence of nontraditional symptoms among both genders was found, with women more likely to report nontraditional symptoms and, in particular, altered mental status, compared with men.

Sex Differences in Stroke

April 2012
Age-and ethnic-specific sex differences in stroke risk. Sealy-Jefferson, S., Wing, J. J., Sánchez, B. N., Brown, D. L., Meurer, W. J., Smith, M. A., … & Lisabeth, L. D. This study was performed to compare the age-specific sex differences in stroke risk in MAs and NHWs. Among both NHWs and MAs aged 45 to 79 years, men were at higher risk of stroke than women were. The magnitude of increased stroke risk in men compared with women diminished with age, and after age 79 years, no sex difference in stroke risk was observed. Reasons for the loss of protection from stroke in aging women of all races/ethnicities are not fully understood.

Nutrition

coming soon

Pain

Girl Who Cried Pain

2001
The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain 2001 Journal of Law, Medicine & Ethics, Vol. 29, pp. 13-27, 2001 Authors: Diane E. Hoffmann-University of Maryland Francis King Carey School of Law and Anita J. Tarzian-University of Maryland Francis King Carey School of Law Abstract: In general, women report more severe levels […]

Men, Women and Pain

September 6, 2006
Sex and gender differences in pain: a selective review of biological and psychosocial factors Edmund Keogh, PhDDepartment of Psychology, University of Bath, Claverton Down, Bath E-mail: e.m.keogh@bath.ac.uk ABSTRACTEvidence suggests that there are important differences between men and women with respect to the perception and experience of pain. The objective of this review is to provide […]

Sex Differences in Pain Perception and Treatment

March 1, 2009
Sex-based differences in pain perception and treatment. Paller, C. J., Campbell, C. M., Edwards, R. R., & Dobs, A. S. Sex-based differences in pain perception and treatment. A substantial body of research indicates that women experience greater clinical pain, suffer greater pain-related distress, and show heightened sensitivity to experimentally induced pain compared with men. The factors underpinning sex differences in the experience of pain are multifactorial and complex, and include psychosocial factors and gonadal hormone levels. Women perceive more pain during the luteal phase, and estrogen antagonists provide long-term pain relief in certain situations.

Sex, gender, and pain: women and men really are different

February 2000
Sex, gender, and pain: women and men really are different. Fillingim, R. B. Sex-related differences in the experience of both clinical and experimentally induced pain have been widely reported. Females are at greater risk for developing several chronic pain disorders, and women exhibit greater sensitivity to noxious stimuli in the laboratory compared with men. Psychosocial factors such as sex role beliefs, pain coping strategies, mood, and pain-related expectancies may underlie these effects. In addition, there is evidence that familial factors can alter pain responses, and these intergenerational influences may differ as a function of sex. Sex hormones are also known to affect pain responses, which may mediate the sex differences.

Sex, Gender and Pain: A Review

May 2009
Sex, gender, and pain: a review of recent clinical and experimental findings Fillingim, R. B., King, C. D., Ribeiro-Dasilva, M. C., Rahim-Williams, B., & Riley III, J. L. This article reviews the recent literature regarding sex, gender, and pain. The growing body of evidence that has accumulated in the past 10 to 15 years continues to indicate substantial sex differences in clinical and experimental pain responses, and some evidence suggests that pain treatment responses may differ for women versus men.

Sex Differences in Catastrophizing and Endogenous Pain

February 2009
Associations between catastrophizing and endogenous pain-inhibitory processes: sex differences. Goodin, B. R., McGuire, L., Allshouse, M., Stapleton, L., Haythornthwaite, J. A., Burns, N., … & Edwards, R. R. The current study examined whether diffuse noxious inhibitory controls [DNIC] mediated the relationship between catastrophizing and pain among 35 healthy young adults and examined the moderating effects of sex to determine whether the magnitude or direction of associations differed among men and women.

Pediatrics

ADHD in Girls and Boys

November 9, 2013
ADHD in girls and boys–gender differences in co-existing symptoms and executive function measures. Skogli, E. W., Teicher, M. H., Andersen, P. N., Hovik, K. T., & Øie, M. ADHD is diagnosed and treated more often in males than in females, but girls may be consistently underidentified and underdiagnosed because of differences in the expression of the disorder among boys and girls. One aim of the present study was to assess in a clinical sample of medication naïve boys and girls with ADHD, whether there were significant gender x diagnosis interactions in co-existing symptom severity and executive function (EF) impairment. The second aim was to delineate specific symptom ratings and measures of EF that were most important in distinguishing ADHD from healthy controls (HC) of the same gender. Girls had higher rates of self reported anxiety.

Child Mental Health Sex Differences

May 2002
Child sex differences in primary care clinicians’ mental health care of children and adolescents. Gardner, W., Pajer, K. A., Kelleher, K. J., Scholle, S. H., & Wasserman, R. C. There are substantial sex differences in the mental health care of children in the primary care system.

Congenital Heart Disease Affects More Boys

Pharmacology

Sex Differences in Pharmacokinetics and Pharmacodynamics of Anti-Hypertensive Drugs

Psychology/Psychiatry

HPA Axis, the Female Reproductive System

Sex Differences in Depression

Sleep Health: Sex and Gender Differences

July 10, 2014
Exploring Sex and Gender Differences in Sleep Health:A Society for Women’s Health Research Report Monica P. Mallampalli, PhD, MS, and Christine L. Carter, PhD, MPH ABSTRACT Previous attempts have been made to address sleep disorders in women; however, significant knowledge gaps in research and a lack of awareness among the research community continue to exist. There is […]

Gendered Response to Depression

October 2013
The Experience of Symptoms of Depression in Men vs Women Analysis of the National Comorbidity Survey Replication Lisa A. Martin, PhD; Harold W. Neighbors, PhD; Derek M. Griffith, Abstract Excerpt: Until now, women have been diagnosed with depression twice as often as men. However, men reported higher rates of anger attacks/aggression, substance abuse, and risk taking compared with women. Analyses using the scale that included alternative, male-type symptoms of depression found that a higher proportion of men (26.3%) than women (21.9%) (P = .007) met criteria for depression. Analyses using the scale that included alternative and traditional depression symptoms found that men and women met criteria for depression in equal proportions: 30.6% of men and 33.3% of women (P = .57).

Sex Impacts Depression CoMorbidities

April 17, 2013
Not all depression is created equal: sex interacts with disease to precipitate depression. Nemeth, C. L., Harrell, C. S., Beck, K. D., & Neigh, G. N. In this review, the case is made for needing a better recognition of the source of the symptoms of depression with respect to the sex of the individual; in that, some disease states, which includes the neuroendocrine and immune reactions to the underlying pathophysiology of the disease, may initiate depressive symptoms more often in one sex over the other. The diseases specifically addressed to make this argument are: epilepsy, Alzheimer’s disease, cancer, and cardiovascular disease.

Sex Specific Effects with Schizophrenia

October 17, 2013
Sex Differences in the Genetic Risk for Schizophrenia: History of the Evidence for Sex-Specific and Sex-Dependent Effects Goldstein, J. M., Cherkerzian, S., Tsuang, M. T., & Petryshen, T. L. Few investigators have systematically and rigorously studied sex differences in the familial (and specifically, genetic) transmission of schizophrenia. Population and clinical studies have identified significant sex differences in incidence, expression, neuroanatomic and functional brain abnormalities, and course of schizophrenia. This review highlights the history of work in this arena. The evidence supports the presence of genetic risks of which some are sex-specific (i.e., presence in one sex and not the other) or sex-dependent (i.e., quantitative differences in risk between the sexes).

ADHD in Girls and Boys

Child Mental Health Sex Differences

Pulmonology

Sex Impacts Respiratory Diseases

September 1, 2013
Sex and inflammation in respiratory diseases: a clinical viewpoint Georges J Casimir, Nicolas Lefèvre, Francis Corazza2 and Jean Duchateau Sex differences play a role in the prognosis of acute or chronic inflammatory, respiratory diseases. Learn more about the consequences of severe inflammation vary in relation to sex, depending on illness duration.

Gender and Chronic Obstructive Pulmonary Disease

August 2, 2007
Gender and chronic obstructive pulmonary disease: why it matters. Han, M. K., Postma, D., Mannino, D. M., Giardino, N. D., Buist, S., Curtis, J. L., & Martinez, F. J. Gender and chronic obstructive pulmonary disease: why it matters The authors present current knowledge regarding how gender influences the epidemiology, diagnosis, and presentation of COPD in addition to physiologic and psychologic impairments and attempt to offer insight into why these differences might exist and how this may influence therapeutic management. Women may actually be at greater risk of smoking-induced lung function impairment, more severe dyspnea, and poorer health status for the same level of tobacco exposure. Nonsmokers with COPD are also more likely to be female. Men and women may be phenotypically different in their response to tobacco smoke, with men being more prone to an emphysematous phenotype and women an airway predominant phenotype.

Managing COPD in Aging Population

December 13, 2013
Considerations for managing chronic obstructive pulmonary disease in the elderly. Taffet, G. E., Donohue, J. F., & Altman, P. R. In advanced COPD, insufficient drug efficacy was found in 19% of the population– predominantly female (80%), of shorter stature with lower lung capacity–was unable to generate the required peak inspiratory flow through the simulated resistance of a DPI. Treatment of COPD with inhaled therapy should be customized to each older patient.

Sex and Race Differences in COPD Risk

July 2, 2018
Race and gender disparities are evident in COPD underdiagnoses across all severities of measured airflow obstruction. Mamary, A. J., Stewart, J. I., Kinney, G. L., Hokanson, J. E., Shenoy, K., Dransfield, M. T., … & COPDGene® Investigators. We aimed to determine the influence of race, gender and Global initiative for chronic Obstructive Lung Disease (GOLD) stage on prevalence of prior COPD diagnosis at COPDGene® enrollment.

Secondhand Smoke has Notable Sex Specific Effects

March 22, 2012
Unraveling the relationship between aeroallergen sensitization, gender, second-hand smoke exposure, and impaired lung function. Brunst, K. J., Ryan, P. H., Lockey, J. E., Bernstein, D. I., McKay, R. T., Khurana Hershey, G. K., … & Evans, S. Pediatric Allergy Immunology 2012: 00. Background: Reductions in lung function were observed among children exposed to SHS, and the number of aeroallergen-positive SPTs at age 2 modifies this relationship. Girls experiencing early childhood allergic sensitization and high SHS exposure are at greater risk of decreased lung function later in childhood compared to non-sensitized girls and boys and demonstrate greater deficits compared to boys with similar degrees of sensitization.

Special Populations

Patient Centered Care for Muslim Women

December 29, 2010
The purpose of this study was twofold: (1) to address the gap in existing literature regarding provider perspectives about provision of high-quality, culturally appropriate, patient-centered care to Muslim women in the United States and (2) to explore congruence between provider and patient perceptions regarding barriers to and recommendations for providing such care.

Gender Risk Factors for Silent Cerebral Infarcts in Sickle Cell Anemia

April 19, 2012
Associated risk factors for silent cerebral infarcts in sickle cell anemia: low baseline hemoglobin, sex, and relative high systolic blood pressure. DeBaun, M. R., Sarnaik, S. A., Rodeghier, M. J., Minniti, C. P., Howard, T. H., Iyer, R. V., … & Bernaudin, F. The most common form of neurologic injury in sickle cell anemia (SCA) is silent cerebral infarction (SCI). In the Silent Cerebral Infarct Multi-Center Clinical Trial, we sought to identify risk factors associated with SCI.

Clinical Guidelines

Cardiovascular Disease in Women: Update on the 2011 American Heart Association Guidelines

Evidence-based guidelines for the prevention of cardiovascular disease in women developed in 2004, updated in 2007, and updated again in 2011. For the original 2004 guidelines, over 1,270 articles were screened by the panel, and 400 articles were included for evidence tables. The summary evidence used by the expert panel in 2011 can be obtained online as a Data Supplement at circ.ahajournals.org.

10Q Report: Advancing Women’s Heart Health through Improved Research, Diagnosis and Treatment

June 2011
The 2011 10 Q Report presents a consensus by leading experts on the top ten questions in cardiovascular care for women. The report provides a road map for future research concerning women’s cardiovascular health. Answers to the questions should improve early detection, accurate diagnosis and treatment for women living with or at risk of heart disease.

Understanding the Impact of Sex and Gender on Alzheimer’s Disease: A Call to Action

June 12, 2018
Precision medicine methodologies and approaches have advanced our understanding of the clinical presentation, development, progression, and management of Alzheimer’s disease (AD) dementia. However, sex and gender have not yet been adequately integrated into many of these approaches.

Management of Osteoporosis in Post-Menopausal Women

2010
Position statement by the North American Menopause Society

Opiode Use, Misuse and Overdose in Women

July 19, 2017
This report was developed as part of an initiative of the U.S. Department of Health and Human Services
(HHS) Office on Women’s Health (OWH) to examine prevention, treatment, and recovery issues for
women who misuse opioids, have opioid use disorders (OUDs), and/or overdose on opioids.

Recommended Books

Patient Education

Sex and gender specific resources for patients

Heart Truth Patient Education

Resources for your patients about cardiovascular disease in women.

IBS in Men: A Different Disease?

An overview of differences in men compared to women. W. Grant Thompson, MD, FRCPC, University of Ottawa, Ontario, Canada.

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