Medicine and research have long ignored the differences between men and women. There is an urgent need for clinical trials and treatments to be gender sensitive.
Autism, mental retardation and brain tumors affect men more, while Alzheimer’s, anorexia, osteoporosis or thyroid damage are more common in women. Do diseases have a sex? Yes it seems, especially since biological differences linked to XX and XY chromosomes appear from conception. Then the environment and the gender reinforce them.
The notions of biological differences between the 2 sexes with their repercussions on diseases and their management, are poorly understood by doctors and even often denied. However, not only are certain pathologies more common in one sex than in the other, but their symptoms are not quite the same. The myocardial infarction in its acute phase is a good example of this with a rather “digestive” symptomatology in women which leads to a later diagnosis with all that this can have as a consequence.
These notions are not feminist convictions, but are based on solid studies conducted for several years. The National Academy of Medicine has made it the theme of one of its sessions to alert people to the need to take it into account for both diagnoses and treatments.
Differences from conception
From conception, the female embryo does not behave like the male: among the 23 pairs of human chromosomes, one of them determines the sex, XY for men and XX for women. A letter that weighs heavy: the genetic differences are 15 times greater between a man and a woman than between two men.
Gender also influences gene expression. In each of our cells, about 30% of the genes are expressed differently and this is due to the impact of the sex chromosomes.
In addition, at the sixth week of embryonic life, the gonads will appear and with them, small amounts of hormones. The quantities have certainly nothing to do with those which will be secreted during puberty, but already in utero cells are permeated with these hormones.
Epigenetics and gender activate or slow down
Our genome is stable, definitive and identical in each of our cells. But for these genes to be expressed, they must be activated or repressed. And the environment, in the broad sense of the term, actively influences or slows down the activation of these genes: it is epigenetics that studies these interactions.
Add to this, the influence of gender: it designates the differentiated roles, behaviors and attributes culturally determined by society which considers them appropriate for both male and female. And the effects of epigenetics are very difficult to separate from gender. In the end, the resemblance between a man and a woman is only 98.5%, the same order of magnitude as between a human and a chimpanzee!
Find Professor Claudine Junien on the show La Médecine au Feminine
Research should no longer be unisex
All these elements would force us to reconsider our knowledge. Animal models can help by noting, for example, that females are often more sensitive to pain. During nerve damage, the pain pathways in mice are different in males and females …
The same goes for drugs: a study carried out in Germany in 2006 showed that whatever the active ingredient tested, women have twice the risk of side effects than men. Part of this is due to the way the drug is metabolized in the body. Thus, at the same dose, certain sleeping pills are found more concentrated in the female blood than in the male; statins would increase the risk of diabetes in women after menopause by 71%, and aspirin would be less effective in reducing the risk of heart attack than for men, but would better prevent the risk of having a stroke.
However, currently drugs are mainly tested on men. And in this area, France lags behind other European countries (Germany, Holland, Sweden, Italy) where medicine is approached on the dual approach of sex and gender. And in the United States, the NIH (National Institute of Health) has just announced its new policy for funding research: to be funded, it will now be necessary to include the 2
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