Historical Perspective

Sex and Gender Based Health

Mary K. Rojek, PhD

The emerging field of Sex and Gender Based Health (SGBH) seeks to remedy the invisibility of many women’s health issues and improve healthcare for all. In a broad sense, SGBH refers to the differences in health and illness between men and women, but it also acknowledges intersex and LGBTQIA health issues. SGBH can be a foundation for how to think about and research all social determinants of health that contribute to health disparities because every person has a sex and a gender. When applied in the clinical setting, it will improve patient outcomes.

Women’s Health as a Precursor to Sex and Gender Health

The field of women’s health is the precursor to SGBH. Historically, women were excluded from research studies, which limited our understanding of their health issues. There were many reasons for this exclusion. For example, there were concerns about the teratogenic effects of pharmaceuticals if a woman should become pregnant. It was also argued that women’s bodies were the same as men’s bodies and that findings from research on men applied to women. At the same time, it was argued that women were too difficult to study because of their hormonal fluctuations. Clearly, the claims that women’s bodies are both the same and different from men’s bodies could not be true. The inequity in women’s health research began to be remedied when the 1993 NIH Revitalization Act specified that women and minorities should be included in research studies. Even so, many researchers resisted. When women were included in research studies, the data were often not analyzed based on sex.

Discovering Differences in Men’s and Women’s Health

When the results of the Women’s Health Initiative began to be published in the late 1990s and early 2000s, it became clear that there were existing medical practices that harmed some women. For example, hormone replacement therapy was discovered to be harmful to some women’s cardiac health. Subsequent research has shown that women frequently have different symptoms of cardiovascular disease than men. More recent research has shown that the symptoms which are more typical in women actually occur in some men. This knowledge may help us in not only improving clinical care for women at risk, but also for men. This example demonstrates one potential benefit for both women and men from research that uses a sex and gender lens.

Every Cell Has a Sex

A 2001 Institute of Medicine (IOM) report indicated that “every cell has a sex.” In the past, we believed that the sex of most cells was irrelevant after cellular differentiation. According to the IOM report, there can be different mechanisms that make a cells’ sex relevant. For example, having only one copy of certain genes may contribute to men’s greater susceptibility to certain health problems, while having two copies may be protective for women. We are at the early stages of understanding the role of sex chromosomes and hormones in each cell. This situation will improve in the future because the NIH now requires that NIH funded research studies use both male and female cells and laboratory animals.

SGBH and Research

While researchers might decide to focus solely on biology (sex) or social factors (gender), SGBH encourages the study of the intersection of the social environment with biology via epigenetics. SGBH also provides a basis for intersectional research, i.e., stratifying one’s analysis based on multiple social dimensions. Congress is currently considering a bill to require inclusion of both male and female cells and laboratory animals in all human and pharmaceutical research, and that data analysis be disaggregated by sex.

Translation of Research to Clinical Care

We now know that many previous studies which relied on data from one sex have limited generalizability for clinical care. For example, if female lab animals were not included in studies, then the results may not apply to women or may only partially apply to women. As we increasingly have equity throughout the research pipeline, the application of those research findings to curricula will lead to improvements in clinical care for all patients. For example, differences in drug pharmacokinetics and pharmacodynamics have led to more adverse side effects in women, including death. As sex and gender based research improves, clinicians will be more skilled in providing both personalized and precision care for all patients.

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