AND (largely) merit of women. If today we talk about personalized medicine, if there is more attention to the care needs of each individual patient, if we can hope for a medicine of the future that is more equitable, we owe it largely to the female gaze. Not only because by now the majority of white coats are “pink” (there are 400,000 doctors, just under 70 percent of the National Health Service personnel), but above all because the gender approach to diseases has opened up a better world for all patients.
Gender medicine, an advantage for everyone
Valeria Raparelli and Daniele Coen tell it in That voice that no one hears (Joined), explaining how gender medicine is the way to everyone’s healthprovided that we dispel the misunderstanding into which many fall when they think of it as “women’s medicine”, in a vision of women’s health needs that stops at pathologies of the reproductive system and of the breast.
Understand that women are different in the risk of getting sick in general, in the modalities of development and manifestation of the various diseases, in the response to treatments it has instead been the gateway for a revolution that has and will always have greater (positive) repercussions on anyone.
That voice that nobody listens by Valeria Raparelli and Daniele Coen, Arrived 320 pages, €18
“In the last few years we have moved from a disease-centered medicine to one that looks at the person who needs treatmentrecognizing the differences based on biological sex and psycho-socio-cultural gender» observes Valeria Raparelli, researcher affiliated to the University Center for Studies on Gender Medicine of the University of Ferrara and co-head of the transatlantic network Going Fwd (Gender Outcomes INternational Group: to Further Wellbeing Development, international group on the outcomes of gender medicine for the development of wellbeing).
«Doing so made it possible to understand and recognize barriers, prejudices and habits that have characterized research and clinical practice in the past, penalizing the female sex. Above all, it was a spark thanks to which today, instead of giving everyone the same therapeutic response regardless of need and individual characteristics, we try to offer everyone the best response for their specific needs, for a medicine that is more respectful of biological, social psychological and cultural.
There is no great distance between gender medicine and precision medicine: the second considers above all the genetic and biological characteristics, gender medicine too, but underlines the importance of the identity, relational and social elements that differentiate us».
Single-sex searches
Recognizing the peculiarities of women’s health was the first opportunity to realize how much not having listened to the female voice risked preventing a “right” medicine. «Women remain consumers of drugs mainly studied on men» specifies Daniele Coen, doctor, popularizer and co-author of the book. «Response to drugs and side effects are different in both sexes, but this becomes difficult to demonstrate if a representative number of women are not included in the studies. Those included in phase 1 studies that evaluate the safety and tolerability of medicines, for example, are few and so the dosages are established on male characteristics. But are we sure that the phase of the menstrual cycle or the taking of hormonal therapies does not change the effect? Understanding these limitations is changing research. In 2016, for example, the international guidelines Sager (Sex and Gender Equity in Research) were created precisely to ensure sufficient attention to aspects related to sex and gender».
The result of these efforts will be the ability to give increasingly “tailor-made” medicines. In the meantime, however, one shouldn’t be afraid to take medicines: «The new ones will have to demonstrate that they have also been evaluated well on women, for those that we have been using for decades we have data “collected in the field” with clinical practice. And, if doubts remain, it is good to ask the doctor and thus dispel the fears» specifies Raparelli.
A gender medicine, for all genders
The new awareness of female differences extends attention to diversity to other categories, from young to old, from people of different ethnicities to transgenders: the goal is to arrive at a medicine that is personalized because it is truly inclusive, far from the stereotypes which, for example, in the past labeled women as “anxious” or underestimated their pain, branding any disorder they were not affected by as “psychosomatic” the causes are immediately obvious.
Raparelli explains: «Women suffer from anxiety more often than men, their perception of pain varies at different stages of the menstrual cycle. However, attributing the cause of everything to anxiety is a prejudice that risks reducing the attention of doctors towards the patient. Also believe that women tolerate pain less, underestimating it, in addition to resulting in inadequate or late therapies can pave the way for wrong or delayed diagnoses, as often happens for conditions such as endometriosis or vulvodynia (to which the book devotes a chapter, ed ). Who knows how many women of all ages struggle with pain, who knows how many in 2023 did not receive a correct diagnosis ».
Why are there more obese men
It shouldn’t happen again, as well as the fragility of women in the face of certain diseases should be clear by now. The book points out that for a longer life expectancy and probably also for biological factors, women have a higher risk of Alzheimer’s. And how much it is a non-unisex approach to cardiovascular disease is importantwhich are also a serious problem for her. Stroke is the second leading cause of death for women and certain aspects of a woman’s life, such as pregnancy or use of the birth control pill, influence the likelihood. We need targeted preventionas well as treatments “up to” those provided to men.
The differences between the sexes emerge on many occasions: a recent study by the Federico II University of Naples underlined that hormonal differences “guide” choices at the tablewith women who have little resistance to the desire for carbohydrates and tend to concentrate the consumption of most of the calories in the first part of the day, while men let themselves be tempted more by fatty or salty foods and between meals, even at night. Which most often causes obesity. This is important information to know, because a gender approach to health also means serving the interests of men. Even in their case there are “forgotten” diseases or diseases that are not dealt with as they should.
«The biological, physiological, cultural, anthropological differences change the sensitivity of men and women to diseases and therapies. Starting from here, you can create a medicine that overcomes the binary concept of gender and offers the right treatment to everyone» concluded Raparelli and Coen.
He and osteoporosis
Gender medicine is also good for him, explains Daniele Coen. Which, concretely, exemplifies: «Thinking about health in a transversal way means sensitize men to the request for help and assistance in case of mental illness, overcoming the cultural stereotype of masculinity which makes them more exposed to these problems. It involves specifically addressing male depression, and proposing interventions to reduce the risk of suicide, which is higher among men. Gender medicine for him means making sure that diagnostic tests and treatments for osteoporosis are tested on men, to counteract bone fractures that have worse outcomes in males. Again: to encourage the fight against risk factors such as smoking and alcohol which are more common among men; try to better understand why cardiovascular diseases and tumors have a higher prevalence in men in order to find solutions. In short, the gender approach adds food for thought for an increasingly tailored medicine for everyone”.
Transgenders looking for answers
“A black hole”. This is how Valeria Raparelli defines what is known about health of non-binary or transgender people, even less represented than women in clinical trials. Very little is known about everything from cerebro and cardiovascular risks to drug interactions in transgenders undergoing hormone therapy of gender affirmation, which is also a path faced by an increasing number of people.
Each chapter of That voice that no one hears dedicates a space to what is known today about the health of those who do not recognize themselves in the male/female categories, but much still needs to be done. «It is not tolerable to adjust to invisibility, recognizing the health needs of these people is essential. Raparelli reiterates. «Including everyone, without discrimination, is a cornerstone of gender medicine. Everyone has the right to receive answers for their specific health problems. If we lack the sex and gender specific approach, we all lose the right to health. Equity, diversity and inclusion are concepts increasingly applied in medicine».
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