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Why gender and sex differences need to be considered in health care and medical research

March 15, 2023

Interview by Spike Keith, adapted by Joe Wickins

This International Women’s Day, an Associate Professor at the University of Auckland Bioengineering Institute, Kelly Burrowes (pictured), is calling for more awareness about sex and gender inequities in medical healthcare and research. 

Listen to the full interview

Thursday, 8 March, marked International Women’s Day. This year's theme, "Embrace Equity," stressed the importance of recognising and addressing the unique challenges and experiences of women.

Associate Professor at the University of Auckland Bioengineering Institute, Kelly Burrowes, told 95bFM's The Wire that an ongoing inequity faced by women is discrimination in health care and health research.

Burrowes says there is a lack of awareness about how sex and gender can impact our health. 

While sex refers to biological attributes, including genetics and reproductive organs, gender is shaped by social and cultural influences that may or may not align with an individual’s biological sex.

Burrowes claimed that even in 2023, some clinical trials only recruit male participants or choose not to consider biological differences in their data.

“It’s really important that they’re separated and analysed to see if there are differences between males and females.”

“Our biology is complicated. Women have hormonal fluctuations, so our hormones change over our lifetime and over each month. This actually makes us more complicated to study.”

According to Burrowes, clinical trials can save money and time by only testing their drugs on men, because of cisgender women’s complex menstrual cycles. 

“Common sense might suggest the fact that men and women are different is a pretty good reason for why we should be testing things equally on men and women. But we’re effectively put in the ‘too hard basket’.”

According to 2022 data from the US FDA’s Office of Women’s Health, females have nearly double the risk of developing an adverse drug reaction compared to men. 

“Because women are less tested in the trial phase, once drugs are released to the public for normal use, it’s usually women that have the worse outcomes,” said Burrowes. 

Burrowes said there are many differences in how male and female bodies work, including our reproductive capacities, the shape of our organs, and at a cellular and genetic level, which can result in differences in susceptibility to diseases, symptoms in each disease, and responses to a given treatment.

Burrowes said an example of this is how the current diagnostic criteria for some cardiovascular disorders, such as enlarged hearts, doesn't factor in the heart size of women, which is about 75% of the size of an average male heart.

Hypertrophic cardiomyopathy, a condition that results in a thickening of the ventricular wall, the wall between two sides of the heart, is diagnosed when the wall thickness increases to 15 mm.

But because female hearts are smaller, men are often diagnosed earlier and with less severe symptoms than women.

“It’s absolutely inequitable in terms of diagnosing these diseases,” said Burrowes.

"What really needs to change is that it needs to be sex specific, so the diagnosis needs to be based on whether people are male or female."

Cardiovascular disease is the leading cause of death for both men and women globally. According to the Heart Research Institute NZ, the disease takes an estimated 17.9m lives every year, representing 32% of all global deaths.

Burrowes added that gender inequities are also understudied within healthcare. 

"Gender actually influences your health outcomes, how you’re exposed to your environment, your behaviour, and your mentality.”

“It’s really important that we start to consider both sex and gender in medical research and healthcare."

Last year, the Ministry of Health outlined Aotearoa's first Women's Health Strategy as part of the Pae Ora (Healthy Futures) Act 2022, giving a chance for women to have their say on how the government can support their health and wellbeing.

The strategy is also inclusive of gender diverse, intersex, transgender, non-binary, takatāpui and MVPFAFF+ people.

Public interest journalism funded through NZ On Air