Sex and Gender in Blood and Bone

This week, I want to address a pet peeve, and another common pitfall in gender analysis. It’s the idea that gender is just another word for women.

We saw this a few weeks in the case study on knees. The “Zimmer Gender Solutions Knee” was really a knee designed with female data. “Gender” seems just to be a fancy way of saying “female” or “woman” (who knew that we needed a euphemism for that!).

Of course, many gendered innovations I’ve highlighted here do focus on women and female-bodied people, but only because, in so many fields, men have been the default research subject. Medicine is one such field. But, in reality, gendered innovations benefit everyone.

So, let’s look at innovations for two “gendered” diseases: osteoporosis, a classic “woman’s disease,” and heart disease, long considered a disease of men.

Heart disease has been the leading cause of death worldwide for the past two decades, but for many years, doctors focused their efforts on men. Exhibit A: the Multiple Risk Factor Intervention Trial, a landmark, long-term study of coronary heart disease risk factors begun in 1973. Acronym MRFIT (get it?), it included 12,866 men and 0 women.

We’ve come a long way since then. The Gendered Innovations project now describes 7 separate gendered innovations in the treatment of heart disease in diverse populations. Some of these have to do simply with recognizing heart disease in women. Women having heart attacks often show up to the emergency room with nausea and dizziness, symptoms that used to be overlooked or mistaken by doctors trained to see chest pain as the ultimate sign of heart trouble.

Doctors have developed new diagnostic tools, as well. Angiograms—long considered the gold standard—often fail to pick up on serious conditions in women. As with all gendered innovations, these developments benefit men who don’t show the ‘typical’ signs and symptoms, too.

Osteoporosis is the mirror image. Though it primarily affects postmenopausal women, men suffer almost a third of osteoporosis-related hip fractures after age 75. And, even though women with osteoporosis suffer more fractures than men, the outcomes are often worse for men.

As in heart disease, the first gendered innovation was simply learning to recognize this “women’s disease” in men. Starting in the late 1980s, the CDC began collecting data on healthy men’s bone density to create a diagnostic reference chart based on male bodies (previously, diagnosis for everyone had been based on data from women).

Researchers have also been reassessing diagnostic procedures to consider risk factors besides bone density. Men with fragility fractures are more likely than women to have been previously diagnosed with risk factors like tobacco and alcohol use, certain medications, a history of falls, and so on. These factors can give an early indication of possible bone trouble even when bone density readings are normal.

Gendered innovations are also as simple—or perhaps, as difficult—as training doctors and men in general to understand osteoporosis as a disease that affects everyone.

When it comes to heart disease, researchers are also beginning to investigate heart disease beyond the gender binary. For example, many trans people seek hormone therapy as part of gender-affirming medical care. Hormones are typically prescribed at a higher dosage than previously studied (for example, for contraceptives or hormone therapy in postmenopausal women) and may increase a patient’s cardiovascular risk. This kind of research is in its infancy, but it’s an encouraging trend.

Other researchers are beginning to tease apart the effects of sex and gender in cis folks. Recent studies showed that women and men who scored high on measures associated with women’s gender roles—such as hours spent on housework—were more likely to be re-admitted to the hospital and had worse prognosis after heart attacks.

As for many gendered innovations, this kind of work depends not just on individual researchers and doctors making it a priority, but also policy. In the past, the WHO, NIH, FDA, and European Society of Cardiology have all encouraged sex and/or gender analysis in research. But there is still work to be done. Women are well represented in research on some forms of heart disease but not others. Female-predominant forms of the disease need more research, as does pregnancy and populations that have been entirely excluded in the past, like transgender people.

As always, there’s much more to say! Check out the full reports on heart disease and osteoporosis on the Gendered Innovations website.

Published by Hannah LeBlanc

Researcher and writer with Gendered Innovations.

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