Gender health gap: "There is a lack of basic research"

To date, the gender-specific differences between men and women in medical treatment have hardly been investigated. While there is a lot of data on men, this is not the case for women. There is therefore an imbalance in the medical treatment of women compared to men ("gender health gap").

Although there have been more and more publications on gender-specific differences recently, there has been a lack of basic research to date. To keep data bias to a minimum, the people who curate them must be made aware of this, as Prof. Sylvia Thun explained in an interview with heise online. In her opinion, the gender health gap is not only a social problem, but also a data-driven one.

"Without structured and interoperable health data, gender-specific research often remains incomplete. In the last two years, we have made progress – especially through better standardization and data availability. But only when gender-specific differences are systematically considered in medical research and care can we achieve true equality in healthcare", said Thun when asked about the latest developments.

BMBF supports research

Due to the gender health gap, the Federal Ministry of Education and Research (BMBF) is funding research into gender-specific health. This was preceded by an analysis according to which "only a small proportion of the funded studies have so far carried out gender-specific analyses", a spokesperson explained to heise online. However, a reduction in the "gender data gap through evidence-based clinical research is of great importance" for "precisely tailored diagnostics and treatment of patients".

On July 12, 2024, the BMBF therefore also published the funding guideline "Interactive Technologies for Gender-Specific Health", which aims to "anchor gender aspects in medical research and care using interactive digital technologies". To close data and knowledge gaps on gender-specific aspects in medicine, around 15 million euros will be made available "for multi-year research and development projects" by 2028, according to the spokesperson.

We spoke to Christiane Groß about the causes of the deficits in gender-specific research and what has happened since the 1990s.

What are the causes of the gender health gap?

First of all, it has historical reasons. Traditionally, research was mainly carried out on male animals and male test subjects to reduce costs and complexity. The female cycle requires additional adaptations, which makes research pricier and time-consuming. In addition, more data is required. For this reason, basic research is still usually carried out with male animals, and experiments are usually also carried out with men.

In the field of pharmacology, i.e. drug development, this of course also has to do with the fact that women run the risk of harming a child if pregnancy prevention was not ensured. Just think of the thalidomide scandal. Thereafter, women were rigorously excluded from drug trials. Since the beginning of the 1990s, things have been moving in the other direction, so to speak: women had to be included in studies. But there are still an incredible number of drugs that were only tested on men back then. The gender-specific effects of many "old" drugs are therefore often unknown.

What are the benefits of gender-specific medicine?

Both the diagnosis and the treatment can be specifically different for the different genders. If gender is considered, for example, medicines can be dosed much better and more safely, making treatment more effective. For me, gender-specific medicine is also the path to individualized medicine. This should not only differentiate between men and women, but also in terms of age and other individual factors. This means that not only men and women benefit, but also children, adults, old people and even trans people whose physiology is altered by external hormone administration.

What needs to happen for gender-specific medicine to be given more consideration?

Since the 1990s, efforts have been made to integrate gender-specific aspects into medical research. The training regulations for doctors already take these aspects into account. This knowledge has long been included in medical studies, but the licensing regulations have yet to be passed by politicians.

It is important to raise awareness of gender-specific differences, not only in research but also in medical practice. Apps and other technologies could help if it is clearly defined that gender specificity is considered. If we raise awareness in society that there are differences between men and women, that they can have different symptoms and sometimes need to be treated differently, then we will have already achieved a great deal.

But we have already achieved a lot. In the German Medical Women's Association, we had the first congress in 1987 with the title "Do women's hearts beat differently". Something is happening, but it took a long time for the topic to reach society. Meanwhile, the public discourse is there and that makes me personally very happy.

What is still missing?

As previously mentioned, new training regulations for doctors were passed at the 2018 German Medical Congress. This includes gender-specificity in the basic principles. This means that the issue is clear for the further training of male and female doctors. The proposals for the licensing regulations are on the table and politicians must decide on them. It would also be helpful if women and men were to ask more questions during treatment. That would also increase awareness.

And more research would surely help too?

Foremost, we need basic research that systematically takes gender-specific differences into account to gain well-founded insights into possible differences or similarities in diseases. It would be helpful if research funds were only made available for studies that take gender specificity into account.

(mack)