Male laboratory animals, male study participants – the male patient is still the norm. The federal government wants to eliminate this imbalance by reforming medical training.
By Christina Sticht
More than half of the population in Germany are women, yet in medicine the male patient is the norm. Often only male mice are used in research. When new drugs are tested, this is usually done with healthy men in the first study phase. “In German, the patient is male, and that’s how everyone is treated initially,” says Leipzig heart surgeon Sandra Eifert, who wrote a book about why women’s hearts beat differently. “There is a lot going on in this area at the moment,” she observes. This is a positive development that gives hope.
The traffic light government’s coalition agreement states: “We take gender-related differences into account in care, health promotion and prevention and in research and reduce discrimination and access barriers.” One of the federal government’s goals is to make “gender medicine” part of medical studies and training and further education in the health professions. According to the German Medical Association, the licensing regulations are currently being changed to make the subject of gender-sensitive medicine mandatory. Everyone should benefit, because even in men, supposedly typical female diseases such as osteoporosis or depression are often not recognized and treated early.
Gender-sensitive medicine
“When births occur, the first question is: Is it a girl or a boy?” says Eifert. Later it will be pretended that everyone is the same. Doctors in particular know how different men and women are in their biology. And that a distinction must be made between biological sex (sex) and socio-cultural sex (gender). Gender-sensitive medicine not only sees the two categories, but also takes trans people and non-binary people into account, for example.
The “Gender in Medicine” institute has been an independent institution of the Berlin Charité since 2007, but the majority of universities do not yet have such institutes. In Magdeburg, the doctor Ute Seeland took over a new endowed professorship for gender-sensitive medicine on March 1st, according to the University of Magdeburg, the first full-time professorship of this kind with a clinical connection.
To this day, the female gender is underrepresented in studies, criticizes Zealand. “Involving women is considered complicated because their reactions to medications can vary depending on hormones,” she explains. However, there is now a growing awareness that it is important to adapt diagnosis, therapy and prevention to the different hormonal phases. “There is no such thing as one woman,” emphasizes Seeland. Thanks to social media, many people are now better informed, for example about the topics of pregnancy and menopause.
Hormonal differences
Because of their hormonal differences, women and men get sick differently, show different symptoms and are particularly at risk for certain diseases at different ages. This has already been relatively well researched for cardiovascular diseases or heart attacks, for example.
Heart surgeon and author Eifert complains that because conventional diagnostics are oriented towards men, women are often diagnosed with delays: “Although mortality after heart attacks has fallen significantly in Germany in the last ten years due to improved diagnostics and therapy, it still affects women almost twice as high as men.” The background could be that students have spent many years getting to know the typical symptoms of a heart attack in men – namely severe chest pain that can radiate and shortness of breath. However, women often have very unspecific symptoms such as fatigue, pain in the upper abdomen, nausea or weakness.
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Hormones influence the development or prevention of diseases. “Women are well protected against cardiovascular diseases for many years by the female sex hormones. With menopause, the levels of these hormones decrease and so does this protection,” explains Eifert.
Testosterone versus estrogen
Men tend to have another biological advantage from testosterone. “They are better able to block out emotional stress and process it better. They are more stress-resistant,” explains the doctor. Women, on the other hand, reacted more strongly to emotional stress. “In broken heart syndrome, 95 percent of those affected are women and 90 percent are over 50 years old.” According to Eifert, women usually have a better immune system due to the estrogen in the fertile phase, but after menopause the risk of high blood pressure, among other things, increases enormously. Cholesterol levels also often go up during menopause.
Ute Seeland, who is also chairwoman of the German Society for Gender-Specific Medicine, sees, among other things, historical reasons for male-centered medicine. “In the 16th and 17th centuries, women were still the wise men and healers, then they were burned at the stake as witches. Only men were admitted to the first medical colleges.” This is certainly one reason why medicine is male-dominated both in terms of research results and the distribution of leadership positions, says Seeland.
In several federal states, the state medical associations have put the topic of gender-sensitive medicine on the agenda. The Lower Saxony Medical Association, with two women at the top, wants to ensure that the topic is increasingly offered in further training courses. The President of the Medical Association, Martina Wenker, is a pulmonologist and sleep doctor. Women have also been given too little attention in her field for years, she says. Snoring with pauses in breathing was long considered a male disease. “We’ve now noticed that women snore just as often, they’re just on average ten years older.” In conversations with their doctor, the women often only reported fatigue, says Wenker. This is often dismissed as typical menopausal symptoms and not properly diagnosed.