Jed Diamond investigates the ways in which the female and male bodies tend to be medically different, and require different treatments and approaches for the same conditions.
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We all know that sex is important. If it weren’t for sex we wouldn’t be here. Whoever we are, young or old, rich or poor, from the U.S., Iran, or Afghanistan, we all came to life in the same way. A sperm from our father found an egg from our mother and our life proceeded from there. But once we were born and grew up, we’ve seen sexual health matters as being restricted to “bikini medicine.” Women go for breast check-ups, while guys get their prostates checked. Women have Pap tests (or Pap smears) looking for cancers and pre-cancers in the cervix. Men bend over tables getting a digital rectal exam (DRE) to check for enlarged prostates and cancer or pre-cancer.
Beyond that, most doctors and researchers assumed that for the other cells, organs, and systems of the body men and women were pretty much the same. But it turns out they were, very, very wrong. Understanding sex and the ways men and women are similar and different has created a new field called Gender Medicine or Sex and Gender-Specific Medicine its changing the way we look at health, disease, treatment, and prevent. Of course, as I said in my last essay, “Empathy and the Gendered Brain” sex differences speak about averages, not absolutes.
According to the International Society for Gender Medicine, “Gender-specific medicine is a new way of looking at the physiologic and pathophysiological differences between men and women and great efforts need to be invested in research and education in order to re-write many chapters in modern medicine.” One of the field’s founders, Marianne J. Legato, M.D. says, “Everywhere we look, the two sexes are startlingly and unexpectedly different not only in their internal function but in the way they experience illness.” Here’s how:
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1. Men and women metabolize drugs differently and may need different dosages.
A report broadcast on CBS 60 Minutes on February 9, 2014 is a major game-changer in the field of gender-medicine. According to Lesley Stahl of 60 Minutes, “Earlier this year, the Food and Drug Administration made an unusual and surprising announcement. It cut the recommended dose of the most popular sleep drug in the country, Ambien, in half for women. It turns out men and women metabolize Ambien, known generically as Zolpidem, very differently, leaving women with more of the drug in their bodies the next morning, and therefore at a greater risk of impaired driving.”
More and more, scientists are realizing that the differences between men and women are dangerously understudied and that pervasively and fundamentally, sex matters. In the case of Ambien women have been getting too high a dose for more than 20 years and this is likely true for many other drugs as well. Men, likely have been getting too low a dose of various drugs. Larry Cahill, a neuroscientist at the University of California Irvine, says, “If you’re clumping men and women together in your study and there truly is a sex difference, you’re not just harming the women; you’re harming the men. You’re muddling up the understanding of what’s going on, you’re muddling up the path to clear treatment, not just for the women, but for the men as well.”
2. Men and women have different brain structure and function.
Louann Brizendine, M.D. is a professor of clinical psychiatry at the University of California, San Francisco and Co-director of the UCSF Program in Sexual Medicine. In her books The Female Brain and The Male Brain she describes significant differences. For instance, The Anterior Cingulate Cortex weighs options and makes decisions. It’s the worry-wort center, and it’s larger in women and smaller in men.
The Medial Preoptic Area is the area for sexual pursuit. It’s 2.5 times larger in the male. The Temporal Parietal Junction is the solution seeker. It’s more active in the male brain, comes on-line more quickly, and races toward a “fix-it-fast” solution.
The Hippocampus is the center for emotional memory. It’s the elephant that never forgets a fight, a romantic encounter, or a tender moment—and won’t let you forget it either. It’s larger and more active in women and one of the main reasons that, as Dr. Marianne J. Legato suggests in the title of one of her books, Why Men Never Remember and Women Never Forget.
3. Male and female hearts are different.
Heart disease presents differently in men and women. Men may feel a crashing pain in their chest. Women more often experience fleeting pain in the upper abdomen, shortness of breath, sweating, and nausea. In general, coronary artery disease strikes men almost two decades earlier than it does women; most men with coronary artery disease are dead by the time they are 65. The electrical system of the heart is different in men and women. Women have faster heart rates and a different electrocardiogram than men.
4. Male and female lungs are different.
Even when corrected for body size, men’s lungs are bigger than women’s. It is more dangerous for women to smoke than for men. For the same number of cigarettes smoked, women are 20 to 70 percent more likely than men to develop lung cancer. A man takes 12 breaths per minute while a woman takes only nine breaths per minute on average.
5. The male and female skeletal systems is different.
Eighty percent of roughly 210,000 hip fractures each year occur in women. Women are more likely to get osteoporosis than men. As a result osteoporosis in men is often misdiagnosed and mistreated. Osteoporosis isn’t a disease of older women alone, many people believe. Back pain in an older man will prompt an informed doctor to order a bone density test, just as he would for a woman.
6. Mortality is different for males and females.
Because of their greater biologic vulnerability and the fact that society assigns men the most dangerous jobs, men are five to six years younger than women when they die. Further, the suicide rate for males is 3 to 18 times higher than it is for women and increases with age. “Over 375,000 lives would be saved in a single year in the U.S. alone if men’s risk of dying was as low as women’s,” says Daniel J. Kruger, PhD. According to Randolph Nesse, M.D., “If you could make male mortality rates the same as female rates, you would do more good than curing cancer.”
7. Males and females are different in every cell of their bodies.
According to David C. Page, M.D., professor of biology at the Massachusetts Institute of Technology (MIT), “There are 10 trillion cells in human body and every one of them is sex specific.” It has been said that our genomes are 99.9% identical from one person to the next. “It turns out that this assertion is correct,” says Dr. Page, “as long as the two individuals being compared are both men. It’s also correct if the two individuals being compared are both women. However, if you compare the genome of a man with the genome of a woman, you’ll find that they are only 98.5% identical.”
It turns out the difference is significant. “Already at my institute,” says Dr. Page, “we have discovered that XX cells and XY cells go about their business, of making proteins for instance, in slightly different ways.” He concludes, “We need a tool kit that recognizes the fundamental difference on a cellular, organ, system, and person level between XY and XX. I believe that if we do this, we will arrive at a fundamentally new paradigm for understanding and treating human disease.”
Jed, it’s so strange that you just wrote this article because I *just* watched a TEDX talk with David Page about this before finding your article. This is such important information. Four men in my family have been affected by heart disease. I’ve done a lot of research about how heart disease affects men differently than women. And it’s really key for us to pay attention to these differences. Not only do women experience different symptoms when it comes to heart disease, the way our arties become clogged is also different. Women tend to get an even coating of plaque… Read more »
“A man takes 12 breaths per minute while a woman takes only nine breaths per minute on average.”
That’s backwards, Men have bigger lungs and LOWER respirations per minute