SWHR Live Online
National Women’s Health Week: Sex Differences in Health Awareness Day
May 13, 2008
11:00 am - 12:00 pm
Sherry Marts, Ph.D., vice president of scientific affairs for the Society for Women’s Health Research, will answer questions about biological health differences between women and men. What is research showing about sex differences in health? How can this knowledge be applied to current care and what does the future hold?
Indiana:
If sex differences are so obviously important, who do so many highly educated and advanced researchers not bother to look for them or even report findings?
If sex differences are so obviously important, who do so many highly educated and advanced researchers not bother to look for them or even report findings?
Sherry Marts, Ph.D.:
For a long, long time medical practice, and therefore much medical research, was based on studying the male body, and any differences found in females (outside of reproduction, of course) were written up as "atypical" or "anomalous." There are still a lot of "sex differences skeptics" out there who dismiss the idea that we need to study both sexes.
At the same time, there are a fair number of researchers have been studying sex differences, many of them for their entire careers. A lot of them are in (or started in) the field of neuroscience, mostly because they were interested in the biological basis of behavioral differences.
For a long, long time medical practice, and therefore much medical research, was based on studying the male body, and any differences found in females (outside of reproduction, of course) were written up as "atypical" or "anomalous." There are still a lot of "sex differences skeptics" out there who dismiss the idea that we need to study both sexes.
At the same time, there are a fair number of researchers have been studying sex differences, many of them for their entire careers. A lot of them are in (or started in) the field of neuroscience, mostly because they were interested in the biological basis of behavioral differences.
Columbia, MO:
Are there any organ systems or areas of health where there are not biological health differences between women and men?
Are there any organ systems or areas of health where there are not biological health differences between women and men?
Sherry Marts, Ph.D.:
I'm trying to think of one. Hmmmmm. I was going to say teeth, but then I remembered that pregnancy can cause the enamel on teeth to thin. Honestly, I can't think of any.
I'm trying to think of one. Hmmmmm. I was going to say teeth, but then I remembered that pregnancy can cause the enamel on teeth to thin. Honestly, I can't think of any.
Washington:
In what areas are we seeing the most progress on sex differences research take place?
In what areas are we seeing the most progress on sex differences research take place?
Sherry Marts, Ph.D.:
As I mentioned before, interest in sex differences in the brain and behavior is very, very high. This includes research on pain and pain relief.
Immunology is another area where interest is high. Autoimmune diseases affect many more women than men, and the biological reasons for that are not fully understood. Men and women respond differently to some vaccines, and the course of some infectious diseases is different in men and women.
As I mentioned before, interest in sex differences in the brain and behavior is very, very high. This includes research on pain and pain relief.
Immunology is another area where interest is high. Autoimmune diseases affect many more women than men, and the biological reasons for that are not fully understood. Men and women respond differently to some vaccines, and the course of some infectious diseases is different in men and women.
Arizona:
I have heard that differences between women and men get bigger as we age. Can you comment on this?
I have heard that differences between women and men get bigger as we age. Can you comment on this?
Sherry Marts, Ph.D.:
I don't think the differences get bigger, they just get, well, different. The differences between boys and girls tend to show up medically as behavioral or mental health issues, like attention deficit disorder, depression, aggression disorders. As kids go through puberty, other differences show up - more boys get severe acne, for example. From age 20-40, young men are at much higher risk than women of death from accidents and interpersonal violence - so much so that this difference explains much of the life expectancy gap between men and women. Men after age 40 are at higher risk of heart disease. For women, that risk in risk occurs after age 60. Women are at risk of osteoporosis starting in their 60's. Men get osteoporosis too, but not until their 70's or later. Those are just a few examples.
I don't think the differences get bigger, they just get, well, different. The differences between boys and girls tend to show up medically as behavioral or mental health issues, like attention deficit disorder, depression, aggression disorders. As kids go through puberty, other differences show up - more boys get severe acne, for example. From age 20-40, young men are at much higher risk than women of death from accidents and interpersonal violence - so much so that this difference explains much of the life expectancy gap between men and women. Men after age 40 are at higher risk of heart disease. For women, that risk in risk occurs after age 60. Women are at risk of osteoporosis starting in their 60's. Men get osteoporosis too, but not until their 70's or later. Those are just a few examples.
Atlanta:
What preventative measures can women in there late 20s do to stay healthy or prevent major diseases?
What preventative measures can women in there late 20s do to stay healthy or prevent major diseases?
Sherry Marts, Ph.D.:
The number one answer is DON'T SMOKE! Smoking increases your risk for heart disease, lung cancer, bladder cancer, cervical cancer, oral cancers, gum disease, skin wrinkles. Not to mention it makes you smell bad.
I would say number two is maintain a healthy weight through good diet and exercise. Healthy means not too heavy, and not too thin either. Being significantly underweight is bad for your bones.
Exercise is key for building and maintaining bone. A famous orthopedic surgeon once told me "Osteoporosis is a disease of childhood that manifests in old age." What she meant was that diet and exercise in childhood and young adulthood are key to building bone, so that when bone loss occurs later in life, we have more in reserve.
The number one answer is DON'T SMOKE! Smoking increases your risk for heart disease, lung cancer, bladder cancer, cervical cancer, oral cancers, gum disease, skin wrinkles. Not to mention it makes you smell bad.
I would say number two is maintain a healthy weight through good diet and exercise. Healthy means not too heavy, and not too thin either. Being significantly underweight is bad for your bones.
Exercise is key for building and maintaining bone. A famous orthopedic surgeon once told me "Osteoporosis is a disease of childhood that manifests in old age." What she meant was that diet and exercise in childhood and young adulthood are key to building bone, so that when bone loss occurs later in life, we have more in reserve.
Lawrence, Kansas:
Even doctors and some researchers use the words sex and gender interchangeably. And the public is never going to understand your use of “sex.” They’ll always think you’re talking about reproduction. Why not just give up the fight and call it gender, even though you know technically that’s not scientifically accurate.
Even doctors and some researchers use the words sex and gender interchangeably. And the public is never going to understand your use of “sex.” They’ll always think you’re talking about reproduction. Why not just give up the fight and call it gender, even though you know technically that’s not scientifically accurate.
Sherry Marts, Ph.D.:
Because I am a stickler for accuracy. : )
OK, the real answer is that both sex (whether we have XX or XY chromosomes and thus ovaries or testes) and gender (the social and cultural expression of being male or female) have effects on health. Using "gender" as a euphemism for "sex" because people get nervous about saying or hearing the word "sex" has generated enormous confusion in the medical literature. We need to get comfortable using both terms, and using each of them correctly.
Because I am a stickler for accuracy. : )
OK, the real answer is that both sex (whether we have XX or XY chromosomes and thus ovaries or testes) and gender (the social and cultural expression of being male or female) have effects on health. Using "gender" as a euphemism for "sex" because people get nervous about saying or hearing the word "sex" has generated enormous confusion in the medical literature. We need to get comfortable using both terms, and using each of them correctly.
Bethesda:
Sex is a crude variable. Isn't science jumping over this level of analysis and going straight to personalized medicine through genomics?
Sex is a crude variable. Isn't science jumping over this level of analysis and going straight to personalized medicine through genomics?
Sherry Marts, Ph.D.:
Sex seems like a simple variable because it is, for the most part, dichotomous. One is either male or female. It may seem simple, but it is an important difference at all levels, even down to genes.
Scientists who are doing genomic analyses are starting to find evidence that males and females differ even at the level of gene expression - that is, at the level of which genes get used when, how much, and how often. Estimates from early studies are that there are anywhere from several thousand to several tens of thousands of genes that are differentially expressed in males and females, depending on the tissue or cell type you study.
Sex seems like a simple variable because it is, for the most part, dichotomous. One is either male or female. It may seem simple, but it is an important difference at all levels, even down to genes.
Scientists who are doing genomic analyses are starting to find evidence that males and females differ even at the level of gene expression - that is, at the level of which genes get used when, how much, and how often. Estimates from early studies are that there are anywhere from several thousand to several tens of thousands of genes that are differentially expressed in males and females, depending on the tissue or cell type you study.
Georgetown University, Washington D.C.:
I was shocked to learn that women were not allowed in most medical studies until 15 years ago! What is the state of research now? How well are women included and are we learning what we need to give women the right care?
I was shocked to learn that women were not allowed in most medical studies until 15 years ago! What is the state of research now? How well are women included and are we learning what we need to give women the right care?
Sherry Marts, Ph.D.:
The answer is - it depends. In some areas the inclusion of women has increased to be in proportion with the occurrence of the disease in women. In others - cardiovascular disease, for example - the numbers of women are still pretty low. We are starting to see the results coming out on drug labels, and even in the development of drugs that work better for one sex or the other. However, those of us doing advocacy around this are not yet satisfied that there is enough being done to analyze results by sex. Essentially, we want to see the answers to two separate questions: Is this safe and does it work in men? Is this safe and does it work in women? We're not there yet.
The answer is - it depends. In some areas the inclusion of women has increased to be in proportion with the occurrence of the disease in women. In others - cardiovascular disease, for example - the numbers of women are still pretty low. We are starting to see the results coming out on drug labels, and even in the development of drugs that work better for one sex or the other. However, those of us doing advocacy around this are not yet satisfied that there is enough being done to analyze results by sex. Essentially, we want to see the answers to two separate questions: Is this safe and does it work in men? Is this safe and does it work in women? We're not there yet.
Michigan:
Do you find that Canadian and European researchers and scientists are more adept at correctly using the word "sex" and distinguishing it from "gender," because their societies have few hangups on the words?
Do you find that Canadian and European researchers and scientists are more adept at correctly using the word "sex" and distinguishing it from "gender," because their societies have few hangups on the words?
Sherry Marts, Ph.D.:
No, they are just as confused as we are. In fact, in international settings this is even more challenging because most international meetings are conducted in English, adding another level of confusion during translation.
No, they are just as confused as we are. In fact, in international settings this is even more challenging because most international meetings are conducted in English, adding another level of confusion during translation.
Washington, DC:
How much of an effect do the different hormones that men and women have have on sex differences?
How much of an effect do the different hormones that men and women have have on sex differences?
Sherry Marts, Ph.D.:
It's pretty big, as you might imagine. The interesting questions have to do with which hormone and which effects. For example, there are big sex differences in the development of the brain, many of which are due to the effects of estrogen in the male brain. Yep, that's not a typo. Testosterone that reaches the brain gets converted to estrogen before it has its effects there.
An even bigger question is: Is it hormones, or is it genes? Remember that XX and XY difference? Turns out that difference has effects that are not due to hormones.
It's pretty big, as you might imagine. The interesting questions have to do with which hormone and which effects. For example, there are big sex differences in the development of the brain, many of which are due to the effects of estrogen in the male brain. Yep, that's not a typo. Testosterone that reaches the brain gets converted to estrogen before it has its effects there.
An even bigger question is: Is it hormones, or is it genes? Remember that XX and XY difference? Turns out that difference has effects that are not due to hormones.
College Park, Md.:
I just wanted to say that the Society for Women's Health Research is doing a great job of educating the public about sex differences!
I just wanted to say that the Society for Women's Health Research is doing a great job of educating the public about sex differences!
Sherry Marts, Ph.D.:
Gee, thanks!
Gee, thanks!
Moderator:
I considered deleting this question and response, but decided to allow it as part of our modest self promotion/pat-self-on-back program.
I considered deleting this question and response, but decided to allow it as part of our modest self promotion/pat-self-on-back program.
Sandusky:
Can you give some examples of health differences between women and men that are sex based and some that are gender based?
Can you give some examples of health differences between women and men that are sex based and some that are gender based?
Sherry Marts, Ph.D.:
A good example is in HIV transmission. Women are more likely to get infected with a single exposure to HIV, in part because of anatomical differences - there are more cells exposed to more virus in any given exposure. That's a sex difference.
Women in many countries are placed at risk of infection because although they may be monogamous their partners are not. In addition, it is often not safe for them to request that their partner use a condom. That's a gender difference.
A good example is in HIV transmission. Women are more likely to get infected with a single exposure to HIV, in part because of anatomical differences - there are more cells exposed to more virus in any given exposure. That's a sex difference.
Women in many countries are placed at risk of infection because although they may be monogamous their partners are not. In addition, it is often not safe for them to request that their partner use a condom. That's a gender difference.
California:
Your group only seems to be interested in sex differences that affect women. What about sex differences that impact men's health, like neurological developmental disorders that affect more boys than girls. There's the Kennedy Krieger Institute up the road from you in Baltimore that works exclusively on this stuff. You should partner with them.
Your group only seems to be interested in sex differences that affect women. What about sex differences that impact men's health, like neurological developmental disorders that affect more boys than girls. There's the Kennedy Krieger Institute up the road from you in Baltimore that works exclusively on this stuff. You should partner with them.
Sherry Marts, Ph.D.:
Our focus on women's health is because that's where we come from - the Society for Women's Health Research was founded to address this issues of lack of inclusion of women in research studies, and the consequent lack of knowledge about how to best care for women. That said, we are very much aware of the sex differences that affect men's health, and nearly all of the programs we have done on sex differences have included information on both men and women. Your example - neurological developmental disorders - is a great one, and I do know about the fabulous work at Kennedy Krieger. We are learning more and more about those disorders and about human brain development from studying the "how" and the "why" of the sex differences in their occurrence, symptoms, and response to treatment.
Our focus on women's health is because that's where we come from - the Society for Women's Health Research was founded to address this issues of lack of inclusion of women in research studies, and the consequent lack of knowledge about how to best care for women. That said, we are very much aware of the sex differences that affect men's health, and nearly all of the programs we have done on sex differences have included information on both men and women. Your example - neurological developmental disorders - is a great one, and I do know about the fabulous work at Kennedy Krieger. We are learning more and more about those disorders and about human brain development from studying the "how" and the "why" of the sex differences in their occurrence, symptoms, and response to treatment.
Baltimore:
What is the role of the National Institutes of Health in promoting and advancing sex differences research?
What is the role of the National Institutes of Health in promoting and advancing sex differences research?
Sherry Marts, Ph.D.:
The Office of Research on Women's Health (ORWH) at NIH has primary responsibility for advancing sex differences research at NIH. In addition, several of the institutes have offices or individuals who monitor what that institute is doing in this area, interact with groups like us, and generally work to advance this research.
The Office of Research on Women's Health (ORWH) at NIH has primary responsibility for advancing sex differences research at NIH. In addition, several of the institutes have offices or individuals who monitor what that institute is doing in this area, interact with groups like us, and generally work to advance this research.
Ohio:
I know that most government funded health research has to include proportional numbers of women and men, but what about private corporations, like drug companies? Is there any sex-ratio standard that they have to pass in order to be approved for general sale? What about medical devices?
I know that most government funded health research has to include proportional numbers of women and men, but what about private corporations, like drug companies? Is there any sex-ratio standard that they have to pass in order to be approved for general sale? What about medical devices?
Sherry Marts, Ph.D.:
Yes, the FDA guidelines now require that women be included in the clinical trials that companies submit to FDA for marketing approval for drugs and for devices. How well that is being enforced is hard to say, although from what we see coming out in the published literature, things have gotten better. Inclusion is the start, and we would like to see more evidence that FDA is asking companies to break the results out by sex.
Yes, the FDA guidelines now require that women be included in the clinical trials that companies submit to FDA for marketing approval for drugs and for devices. How well that is being enforced is hard to say, although from what we see coming out in the published literature, things have gotten better. Inclusion is the start, and we would like to see more evidence that FDA is asking companies to break the results out by sex.
Athens, OH:
Most of the sex differences research I see is at a very basic level. How far off are we from a time when we'll start to see more clinical applications from this?
Most of the sex differences research I see is at a very basic level. How far off are we from a time when we'll start to see more clinical applications from this?
Sherry Marts, Ph.D.:
We are starting to see some clinical applications already. For example, there is a treatment for some types of lung cancer that works in women because it interacts with estrogen. Another example is that we now have different guidelines for prevention of heart disease in men and in women. We now know a bit more about which pain relieving drugs work better in women and in men. And certainly we will be seeing more and more of this in the next few years.
We are starting to see some clinical applications already. For example, there is a treatment for some types of lung cancer that works in women because it interacts with estrogen. Another example is that we now have different guidelines for prevention of heart disease in men and in women. We now know a bit more about which pain relieving drugs work better in women and in men. And certainly we will be seeing more and more of this in the next few years.
Wisconsin:
What role do IRBs play in helping push sex differences research forward? And for the gaps, do you know of any high level efforts to educate IRBs (I know they're so scattered) about the importance of ensuring the studies they approve appropriately include both sexes and conduct appropriate sex analysis?
What role do IRBs play in helping push sex differences research forward? And for the gaps, do you know of any high level efforts to educate IRBs (I know they're so scattered) about the importance of ensuring the studies they approve appropriately include both sexes and conduct appropriate sex analysis?
Moderator:
IRB stands for Institutional Review Board. All research involving human subjects must be reviewed by IRBs to ensure they are properly conducted. Right now, IRBs lack the training to fully recognize and respond to the shortcomings of research protocols they review when it comes to things like the inclusion of women and minority research subjects.
One group, EDICT (Eliminating Disparities in Clinical Trials) has recommended that the Office of Human Research Protections (OHRP) in the U.S. Department of Health and Human Services should issue policy guidelines to enhance IRBs' knowledge as to the appropriate inclusion of underrepresented populations in clinial trials.
IRB stands for Institutional Review Board. All research involving human subjects must be reviewed by IRBs to ensure they are properly conducted. Right now, IRBs lack the training to fully recognize and respond to the shortcomings of research protocols they review when it comes to things like the inclusion of women and minority research subjects.
One group, EDICT (Eliminating Disparities in Clinical Trials) has recommended that the Office of Human Research Protections (OHRP) in the U.S. Department of Health and Human Services should issue policy guidelines to enhance IRBs' knowledge as to the appropriate inclusion of underrepresented populations in clinial trials.
Washington, DC:
I agree sex differences matter. How do I bring up this subject with my doctors? Most seem receptive and interested but the majority know nothing: i.e. to tell me anything useful about the medications I take, the tests I should take, etc. How do we get the word out to physicians, and, by extension, insurance companies or other care providers.
I agree sex differences matter. How do I bring up this subject with my doctors? Most seem receptive and interested but the majority know nothing: i.e. to tell me anything useful about the medications I take, the tests I should take, etc. How do we get the word out to physicians, and, by extension, insurance companies or other care providers.
Sherry Marts, Ph.D.:
You are so right - this is a very big challenge. One thing you can do is to keep asking - the more doctors hear these questions (and hear them from more and more of their patients) the more interested they will be in finding the information, asking drug companies for it, and so on. "What can you tell me about how this (drug, device, diagnostic test) works for women?" may be one of the most powerful tools we have in getting these changes.
You are so right - this is a very big challenge. One thing you can do is to keep asking - the more doctors hear these questions (and hear them from more and more of their patients) the more interested they will be in finding the information, asking drug companies for it, and so on. "What can you tell me about how this (drug, device, diagnostic test) works for women?" may be one of the most powerful tools we have in getting these changes.
Richmond, VA:
What have been some of the landmark events over the years in sex differences research? When did scientists realize there were truly some significant differences between women and men, and when did the scientific community start taking this stuff seriously?
What have been some of the landmark events over the years in sex differences research? When did scientists realize there were truly some significant differences between women and men, and when did the scientific community start taking this stuff seriously?
Moderator:
One of the most significant events was the publication of a report by the Institute of Medicine called "Exploring the Biological Contributions to Health: Does Sex Matter?" Initiated by Society for Women's Health Research efforts, this groundbreaking 2001 report confirmed the existence of biological sex differences at all levels of health. This report has been the springboard for much of the Society’s work this decade. You can download and read the full text of impressive 267-page report from the National Academies Press Web site.
One of the most significant events was the publication of a report by the Institute of Medicine called "Exploring the Biological Contributions to Health: Does Sex Matter?" Initiated by Society for Women's Health Research efforts, this groundbreaking 2001 report confirmed the existence of biological sex differences at all levels of health. This report has been the springboard for much of the Society’s work this decade. You can download and read the full text of impressive 267-page report from the National Academies Press Web site.
Moderator:
That concludes our time for live discussion today. I want to thank Dr. Marts for taking time out of her busy schedule to provide some insightful and in-depth answers. Thank you to everyone who logged on to follow the discussion or ask a question.
A full archive of today's discussion will be available here on the Society’s Web site for future viewing. To learn about upcoming chats and other women’s health information, sign up for our e-newsletter.
If you had questions about specific areas of health that were not addressed, visit the “Health & Science” section of our Web site, where you will find fact sheets about sex differences in specific diseases and conditions.
That concludes our time for live discussion today. I want to thank Dr. Marts for taking time out of her busy schedule to provide some insightful and in-depth answers. Thank you to everyone who logged on to follow the discussion or ask a question.
A full archive of today's discussion will be available here on the Society’s Web site for future viewing. To learn about upcoming chats and other women’s health information, sign up for our e-newsletter.
If you had questions about specific areas of health that were not addressed, visit the “Health & Science” section of our Web site, where you will find fact sheets about sex differences in specific diseases and conditions.
Please Note: Guests and hosts retain editorial control over discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions. Society for Women’s Health Research is not responsible for any content posted by third parties.
