Article by Natalia de la Figuera – Co-founder and COO of GENESIS Biomed

• Biological sex should be considered as a variable in all health-related biomedical research.

• The recognition that biological sex conditions diseases underlines the need for a differentiated approach in medicine in line with the current trend of so-called personalised medicine.

That biological sex, both in humans and in any other animal, conditions both physical characteristics and behaviour is something we have known since ancient times. For example, the female lioness is smaller than the lion and does not have a mane, which makes her more adapted to hunting, while the larger, less agile and stronger male defends the territory and the group. Nature shows us countless examples and yet it is curious how historically, medicine has applied a generalised approach to the treatment of diseases, without adequate consideration of sex differences, except in those conditions or diseases related to the reproductive system. However, recent research has shown that men and women have different patterns of disease. Diseases or conditions other than those related to the reproductive system affect both sexes, often with different frequency or presentation, or may require different treatments. These differences come from exposures, susceptibilities and responses to disease-initiating agents, differences in energy storage and metabolism, and dissimilar diagnostic and therapeutic interventions. Understanding the basis for these sex-based differences is important for developing new approaches to prevention, diagnosis and treatment.

Biological sex should therefore be considered as a variable in all biomedical and health-related research.

Among some of the diseases where there are notable differences, highlighting the importance of a personalised approach to medical care, we can indicate:

Autoimmune diseases:

Autoimmune diseases, where the immune system attacks the body itself, are notably more common in women than in men. Oestrogens, which are present at higher levels in women, may influence the immune system and predispose women to these diseases. Notable examples include systemic lupus erythematosus where the prevalence in women is 90%, multiple sclerosis which is 2-3 times more common in women than in men and rheumatoid arthritis which affects approximately three times more women than men.

Mental Illness:

Gender differences are also evident in the area of mental illness: In pathologies such as depression, women are twice as likely to suffer from depression compared to men, and the same is true for Generalised Anxiety Disorder.  Again, hormonal differences and social expectations contribute to the disparity.

Cardiovascular diseases:

Women and men have anatomical and functional differences in their cardiovascular systems. For example, women have smaller hearts, stronger ventricular contractility, smaller blood vessels and smaller overall blood volume in the circulation. The manifestations of cardiovascular disease also differ by gender. During a heart attack, men usually present with oppressive chest pain, widespread pain in the arms, nausea and cold sweat, while women mainly present with pain under the sternum, abdominal pain, shortness of breath, nausea and extreme fatigue. Stroke incidence is higher in women than in men among those under 30 years of age, while rates are higher in men than in women during middle age, although the risk of stroke increases during specific life stages, such as pregnancy, postpartum and menopause.

These are just a few examples, but differences are present in all other diseases such as metabolic, respiratory, neurological, etc.

Conclusion

The recognition that biological sex conditions diseases underlines the need for a differentiated approach in medicine following the current trend of so-called personalised medicine, where an innovative approach to disease prevention and treatment takes into account differences in genes, environment and lifestyle of individuals. Differences in disease prevalence, presentation and complications between men and women highlight the importance of personalising treatments and preventive strategies. Continued research in this area is crucial to develop more effective and equitable interventions, thus improving the health and well-being of the entire population. Medical education must also be adapted to integrate these perspectives, ensuring that health professionals are well prepared to provide appropriate care to all patients, regardless of their biological sex.