Gender medicine and women's health: better care and prevention for women
Gender medicine is a new science, born in the 1990s. It seems strange to think of it, but until then science had never posed the problem of a possible differential response to drugs of men and women, as well as a difference between the genders in susceptibility to diseases
The differences are linked to numerous factors that certainly depend on the hormonal set-up, after development, but also to sources of genetic variability, between males and females, which lead one to reflect on the issue of the need to personalise treatment from birth.
Gender medicine, personalisation of care and treatment for men and women
Gender medicine is not only related to gender, but something much more complex.
In fact, it is not only biological characteristics, determined by the different male and female chromosomes and hormonal and biological factors, but also social and economic aspects, lifestyle habits and role in society that have an important influence on medicine and the development of pathologies between men and women.
There are, in fact, pathologies that tend to affect one gender more than another.
Depression, for example, has always been considered a more common pathology in women, probably influenced by hormonal factors, but also by life experiences and greater social and family difficulties.
Conversely, certain types of cancer, such as lung cancer, have always been considered more frequent in men, probably due to the habits that, especially in the past, distinguished the male sex, exposing them to a greater risk, such as smoking.
Other diseases not related to gender but to specific age such as, for example, heart disease and, in particular, ischemic heart disease have been considered predominantly male.
However, this is a myth: women are protected, but only before the menopause, as there is a link with their hormonal tone.
However, this is still not recognised and doctors themselves still consider heart attacks to be a disease to which men are more susceptible, paying less attention to prevention in the female sex, but above all prescribing more drugs that prevent these events to men than to women.
Differences in susceptibility to disease may therefore depend on a multitude of factors (age, gender, environment, diet, life experiences) and one could say that diseases per se are abstract entities as each sufferer is different from the others.
Do side effects prefer women?
Side effects are said to prefer women and this is partly true, often because the dosage of the drug is not adapted to female physiology and its efficacy has not been specifically evaluated in this population.
In the female population, the variables involved are also greater.
Women are also more at risk because of some of their lifestyle habits, because they take more care and more drugs, more supplements, and are therefore more exposed to drug interactions and interference toxicities.
Tailor-made treatments and clinical trials
Another problem that has a very broad dimension is that of the efficacy of drugs, since until very recent years all trials, except those specific to molecules used to produce female-only drugs such as, for example, contraceptives, were only tested on the male population.
Animal experimentation has also always followed this trend, partly because of cultural legacies, partly because the male population is certainly more homogeneous.
Studying a drug on a woman, in fact, means having to consider many factors that may distinguish her from others such as, for example, the phase of her cycle, her fertile or menopausal age, the drugs she has taken, and other factors that may prove confusing and increase the costs of the trial itself.
All this has confronted medicine with certain questions, such as the correct dosage of drugs: average dosages, in fact, are established on the basis of the effects assessed on a man weighing 70 kg.
Women, on the other hand, on average weigh much less and have a very different physical structure, with a different composition in terms of mass, elements which, if not considered from a clinical point of view, lead to a gross oversimplification.
If a drug is prescribed at a dosage appropriate to the weight of the average man, in women it will remain in circulation longer at high concentrations, with the risk of overdose and increased side effects.
Drugs are metabolised in the body differently between genders: alcohol, for example (which is a drug, even if it is not used for therapeutic purposes), has a different elimination time, even in relation to weight, between men and women.
Another issue is related to the effectiveness of medicines: different disease mechanisms can make a therapy differently effective between men and women.
Aspirin, for example, which at low dosage is used for the prevention of ischaemic heart disease, has a recognised effectiveness in what is called secondary prevention, but seems to act differently with regard to the prevention of primary events in different genders.
Gender medicine, some practical tips
Whenever possible, to better follow the doctor’s instructions on dosage, medicines in drops are preferred to those in tablets, capsules or suppositories, because they are more modulable.
With regard to dosage, one should follow the instructions of the doctor, who should be informed about the use not only of other medicines, but also of supplements.
These are certainly products that women in particular, but also men, resort to: those who use them should be aware that they may interfere with the action of traditional drugs, giving rise to side effects.
For instance, a supplement might contain a substance that has to be metabolised by the liver.
If this organ is involved in metabolising a supplement, a classic medicine remains in the body longer, exposing it to potential side effects.
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