men’s health vs. women’s health: why equal care means different approaches
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while men and women may present differently when having a heart attack, cardiovascular disease is still the leading cause of death for both sexes.
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health, for any sex, is important. it affects not only longevity but also quality of life. people who take control of their health in ways they can control have a higher chance of living well longer; however, differences between men and women, which extend to the level of chromosomal variation, make it difficult to apply health advice and solutions to both sexes equally.
“if we think about even basic biology or fundamental biology, we know, for example, that disease really starts at the gene level,” said dr. emily lau, cardiovascular specialist and co-director of the mass general brigham women’s heart health program. “men, for example, have xy chromosomes, women have xx. that already in and of itself contributes to differences in disease presentation.”
dr. lau notes that every step after that through the biological pathway continues to affect disease and health in various ways, with rna being made into proteins that contribute to disease phenotype, and so on and so forth.
when you reach the hormonal level, even more differences emerge, giving the divide greater traction. for example, testosterone is found more in males than females, whereas females have higher levels of estrogen, which is “a very major distinction between men and women” and their health.
key differences and similarities between men’s and women’s health
there are several key differences between men’s and women’s health, particularly with respect to certain diseases. one of the most common examples revolves around heart health.
“women are somewhat protected from developing heart attacks,” said dr. lau. “they, on average, develop heart attacks about 10 years later than men do.”
once menopause hits, though, that protective effect that’s caused by various factors, one including estrogen, and that’s when cardiovascular disease affects women most. so, while men may develop heart disease earlier, it is the leading cause of death in both sexes when looking at all ages.
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the symptoms that present in women having heart attacks also differ. symptoms such as nausea, shortness of breath and fatigue are more often present in women who are having heart attacks, alongside chest pain.
dr. lau notes that the widely accepted myth surrounding women and heart attacks is that they don’t present with chest pain, because they do, it’s just coupled with other symptoms that you won’t find in men.
“chest pain is still the most common symptom of a heart attack in both men and women,” she said. “but we’ve now started to get so primed and thinking that men and women with heart attacks are so different that we kind of blow off the chest pain, even though that’s the most common symptom.”
when thinking about prognosis following a heart attack, women are also more likely to experience worse outcomes for heart attacks because they “seem to do worse in response to both medical interventional and surgical therapies.”
autoimmune disease is another common cause of health decline in both sexes, but women are far more likely than men to develop it, with one theory being that the female immune system is far more active than the male.
females are also more likely to experience a higher level of:
- mental illness
- musculoskeletal disease
- breast cancer
- urinary tract infections (uti)
- human papillomavirus (hpv) infections
men, on the other hand, have a higher risk of:
- certain cancers, such as liver and bladder
- gout
- kidney stones
- emphysema
- ulcers
newer research has found that men tend to develop diseases that are more likely to lead to death, whereas women, who live longer than men, experience much higher rates of diseases that cause disability, reduced quality of life and health loss. genetics, biology and health-related behaviours all play a role.
dr. lau notes that these differences remain poorly understood, despite ongoing research to uncover the why behind them.
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“survival may be longer in women, (but) the number of years of disability or morbidity, decreased quality of life are actually, often times, much higher in women compared with men,” she said. “so, there’s a lot to untease and unpack there that we still don’t fully understand, but it just highlights an important point, which is that we really shouldn’t be treating men and women as the same.”
health gaps and behavioural factors
the differences in health extend far beyond biology for both men and women, and it’s due to several other factors that exist within the scope of healthcare and lifestyle behaviours.
for example, medical research has historically underrepresented women, which leads to medical interventions using “data that have been derived in men” and applying them to both sexes, according to dr. lau.
there are various medications that have been proven to act differently in males and females, including:
- sleep aids: women metabolize these drugs more slowly and require lower doses than men.
- opioids: men often require a 30 to 40 per cent higher dose to elicit the same pain relief response.
- antidepressants: women are better able to experience relief from depression by taking selective serotonin reuptake inhibitors, whereas men have better results with tricyclic antidepressants.
- aspirin: can better prevent strokes in women but heart attacks in men
several factors influence drug metabolism, including hormones, body composition, and organ function. for example, women excrete drugs from the body more slowly than men. women are also 50 to 75 per cent more likely to deal with adverse drug reactions at the same dose.
since it’s now understood that females and males have distinct biology and don’t respond to medications or treatments in the same way, these gaps in medical research continue to downplay differences in male and female health.
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another area of research that’s gaining traction involves lifestyle and socioenvironmental factors that affect health over the course of someone’s life. even something as simple as exercise to reduce cardiovascular disease risk varies between the sexes.
“one of the assumptions that we all made is that exercise is good for both men and women, and it’s equally good,” said dr. lau. “it turns out, in a few large-scale studies, it sounds like it seems like women may actually derive more benefit from exercise than men do. so, it takes a smaller or lower amount of exercise to achieve the same relative reduction in cardiovascular disease in women as it does in men.”
another aspect has to do with gender roles, which have changed drastically in recent years. men are no longer considered only providers, and women are happily in the workforce. however, women continue to play the caregiver role even in modern times, and that makes it harder for them to seek out care for themselves if something is amiss.
“women are much more likely to bring their husbands to the doctors, but not necessarily to seek care for themselves,” said dr. lau.
sex-based approaches to prevention and care are the way forward
guidelines for health approaches are generalized and “sex agnostic” to the point where both men and women may be getting the short end of the stick, depending on what’s affecting them.
dr. lau notes that while establishing a baseline for recommendations is important, learning to acknowledge the differences between men and women from all standpoints—pathophysiology, presentation, risk factors and susceptibility—isn’t enough.
“we have to take it a step further and say, ‘well, which of these differences actually matter clinically and which of these differences are we going to take forward into a clinical recommendation or a guideline?” she said. “i think that’s where we’re stuck.”
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the key is to find a balance between personalization and general recommendations.
“how much personalization can i offer to my individual patient, gender and sex being one of the individual characteristics of a patient, but how do i balance that when i’m making recommendations for a population?”
as research on sex-based approaches continues, finding that happy medium will improve health for both sexes.
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