Sex differences in medicine

Sex differences in medicine include sex-specific diseases or conditions which occur only in people of one sex due to underlying biological factors (for example, prostate cancer in males or uterine cancer in females); sex-related diseases, which are diseases that are more common to one sex (for example, breast cancer and systemic lupus erythematosus which occur predominantly in females);[1] and diseases which occur at similar rates in males and females but manifest differently according to sex (for example, peripheral artery disease).[2]

Sex differences should not be confused with gender differences. The US National Academy of Medicine recognizes sex differences as biological at the chromosomal and anatomical levels, whereas gender differences are based on self-representation and other factors including biology, environment and experience.[3][4] That said, both biological and behavioural differences influence human health, and may do so differentially. Such factors can be inter-related and difficult to separate. Evidence-based approaches to sex and gender medicine try to examine the effects of both sex and gender as factors when dealing with medical conditions that may affect populations differently.[5][6][3]

As of 2021, over 10,000 articles had been published addressing sex and gender differences in clinical medicine and related literature.[citation needed] Sex and gender affect cardiovascular,[7]pulmonary[8] and autoimmune systems,[9][10]gastroenterology,[11][12]hepatology,[5]nephrology,[13]endocrinology,[14][15]haematology,[16]neurology,[17][18][19][20]pharmacokinetics, and pharmacodynamics.[21][22][6][3]

Sexually transmitted diseases, which have a significant probability of transmission through sexual contact, can be contracted by either sex. Their occurrence may reflect economic and social as well as biological factors, leading to sex differences in the transmission, prevalence, and disease burden of STDs.[23]

Historically, medical research has primarily been conducted using the male body as the basis for clinical studies. The findings of these studies have often been applied across the sexes, and healthcare providers have traditionally assumed a uniform approach in treating both male and female patients. More recently, medical research has started to understand the importance of taking sex into account as evidence increases that the symptoms and responses to medical treatment may be very different between sexes.[24]

BackgroundEdit

Females and males exhibit many differences in terms of risk of developing disease, receiving an accurate diagnosis, and responding to treatments. A patient's sex has been increasingly recognized as one of the most important modulators of clinical decision making.[25] Sex differences have been found across a broad range of disease areas, including many diseases which are sex-specific. The sex chromosome complement and sex hormone environment are known to be the primary constitutive difference between females and males.[26] The imbalance of gene expression between the X and Y chromosomes is present within virtually all cells in the human body. Sex hormones are crucial in body development and function and also thought to contribute to sex differences in some diseases.[27] It is suspected that many differences between the sexes are also influenced by social, environmental, and psychological factors which are difficult to tease apart from biological ones.[4]

CausesEdit

Sex-related illnesses have various causes:[5]

  • Genetic sex differences start at conception depending on whether an ovum fuses with a sperm cell carrying an X or a Y chromosome. This leads to sex-based differences at the molecular level for all male and female cells.[5]
  • In males, the X chromosome carries only maternal imprints, while in females X chromosomes are present with both maternal and paternal imprints. In female cells, random processes of X-inactivation "turn off" the extra X chromosome. As a result, females, but not males, are mosaics. Female cells may express higher levels of some genes.[28][29][30]
  • Sex differences at the chromosome and molecular level exist in all human cells, and persist life-long, independent of sex hormones in the body.[5]
  • Sex-linked genetic conditions that differ in males and females may reflect the effects of genetic damage on an X chromosome. In some cases, the presence of an "extra" X chromosome in female cells may lessen the impact of such damage. In severe cases, males may die during development and females may survive but display a sex-linked illness.[28]
  • The reproductive system develops differently for each sex. Sex-specific parts of the male and female reproductive systems affect the rest of the body and also can be affected differently by diseases.[31]
  • Socially constructed norms relate to gender roles, relationships, positional power, and a wide variety of behaviours. Norms affect people differentially depending on their sex and gender.[5]
  • Different levels of prevention, reporting, diagnosis, and treatment have been observed based on sex and gender.[5]

Examples of sex-related illnesses and disorders in humansEdit

FemalesEdit

Examples of sex-related illnesses and disorders in human females:[6]

MalesEdit

Examples of sex-related illnesses and disorders in male humans:[6]

See alsoEdit

ReferencesEdit

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