For centuries, medicine ignored the biological differences between women and men. But a rethink is beginning. Covid-19, doctors say, makes gender-specific medicine "acceptable. This is a huge opportunity – for everyone.
The 78-year-old woman came to the emergency room of Berlin’s Charite hospital after a serious fall. Doctors treated nasal bone fracture and bruises, but could not find a cause for the fall. After five days, her daughter sought advice from Ute Seeland, a gender medicine and internal medicine specialist: her mother was suffering from anxiety, an unexplained fatigue. Seeland reduced the dose of blood pressure-lowering medication and switched the patient to a different heart drug – the woman was able to return home quickly and hasn’t fallen since.
Women and men get the same dose
"It is striking that women in particular are often unable to say why they fell after a fall. But it is often due to an excessive reduction in blood pressure or heart rate", explains Seeland, who is chairwoman of the German Society for Gender-Specific Medicine. That’s because doctors often prescribed women the same medications as men, at the same dosages.
"As a rule, drugs used in cardiovascular medicine are still developed, tested and marketed without taking gender differences into account",
says Seeland. Gender-specific medicine, which focuses on these differences, is gaining in importance.
Gender medicine is gaining momentum
Vera Regitz-Zagrosek is one of the pioneers. "Gender medicine says that men and women are not the same in medicine and that these differences need to be taken into account to treat people well", explains the cardiologist. In 2003, she founded the Institute for Gender Research in Medicine at the Charite Hospital in Berlin, the only one in Germany to date.
At first, female doctors and scientists noticed that symptoms differed when it came to heart attacks: Men often complain of typical chest pain, women more of diffuse nausea or back pain. As a result, heart attacks often go undetected in women, who are more likely to die from them. Female patients are treated less carefully, and prevention of heart attacks is also worse, Regitz-Zagrosek criticizes.
Men made medicine – and discriminated against women
For centuries, men made medicine. Best-selling British-American author Bill Bryson writes in his "Brief History of the Human Body" that, that most of the time mankind knows "frighteningly little about women and their make-up" knew. All examinations of the woman below the neck were usually performed by the doctor by "blindly feeling under the sheets" before "while looking rigidly at the ceiling". Physician Ute Seeland puts it this way:
"It has been discrimination against women all along."
Today, two-thirds of medical students in Germany are female. But Regitz-Zagrosek criticizes that there is only one woman among the deans of the 40 medical faculties at universities.
Women also underrepresented in studies
Women are also underrepresented in clinical research studies: Since the thalidomide scandal, researchers have been afraid of side effects if a woman becomes pregnant. "But what do I get from research that does not take gender differences into account??", asks Seeland.
"I can’t apply the results to the entire population because they don’t fit 50 percent at all."
The physician calls for the question of gender differences to be included as early as in basic research. In the digitalization of medicine, the data sets that flow into the apps must already be "based on all genders are based. "It means a renewal of research."
Women have less muscle, but a higher percentage of body fat. Their kidneys break down drugs more slowly. The monthly cycle causes hormone fluctuations. Some women use contraception, others don’t, or they become pregnant.
The female body ages differently from the male body.
Physician Seeland is particularly interested in perimenopause, the phase around the end of childbearing potential. The female body is practically "doing a role backwards back to puberty, with changes that reach all the way into the receptors. This phase is the starting point for many diseases – but it is largely unexplored, she says.
Corona makes gender medicine respectable
Male and female immune systems also work differently. "With pregnancy, the body must tolerate half of a foreign genome", explains Eva Peters, a psychoneuroimmunologist from Giessen. The immune system is adapted to this by relying on experience, i.e. on "learned immunity". In men, on the other hand, innate immunity is stronger. The flip side of these differences is evident in many diseases, she says: Women suffer more frequently from autoimmune diseases, and influenza is more severe in men – the much-ridiculed "men’s cold.
"Many diseases involve the immune system."
As the coronavirus spread and hospitals filled up, it suddenly became noticeable: More men are becoming seriously ill, and they are dying more frequently. The causes are not yet fully understood, but immunologist Peters is certain that the immune system plays a role. With Covid-19, there is "definitely a gender-specific aspect", stresses the Bielefeld gender physician Sabine Oertelt-Prigione.
The corona pandemic has "turned perceptions around", Regitz-Zagrosek believes: "Gender medicine has become socially acceptable." That’s good, because gender-sensitive medicine benefits both – or rather all – genders. For medicine it means a huge opportunity. Modern research, says Eva Peters, means "looking at everything – and to get away from outdated ideas.