As efforts to achieve health equity gain momentum in the medical field, so too does the understanding that diseases can manifest differently in men and women.

That’s right: Diseases may discriminate based on sex. While further research is needed for better understanding of how this occurs, doctors can note how three common diseases present differently in men and women—both for diagnostic and prevention purposes.

Rexrode KM, Madsen TE, Yu AYX, Carcel C, Lichtman JH, Miller EC. The impact of sex and gender on stroke. Circulation Research. 2022;130(4):512–528.

 

 

Cardiovascular disease

According to an article published by Medicine in Novel Technologies and Devices, some healthcare professionals (HCPs) believe women are “more protected” against CVD than men.

Gao Z, Chen Z, Sun A, et al. Gender differences in cardiovascular disease. Medicine in Novel Technology and Devices. 2019;4:100025.

However, although women have a lower risk of developing this disease, they’re actually more likely to have poorer prognoses and higher mortality rates as a result of it.

 

This may be due, in part, to the fact that some doctors believe that forms of CVD (like coronary heart disease) don’t typically affect women like they do men. Therefore, they may ignore the risks of CVD in female patients, leaving women without management strategies—and ultimately, higher mortality.

Regarding strokes, men have a higher likelihood of suffering lacunar strokes, while women tend to experience cardioembolic strokes. Women, on the other hand, are more likely to suffer heart failure and subsequent hospitalization.

When diagnosing, doctors can look out for gender-specific risk factors of CVD: hypertension, age, total cholesterol and low-density lipoprotein-cholesterol are the key players for men, while diabetes, smoking, triglyceride and high-density lipoprotein-cholesterol levels significantly impact women.

Pregnancy also poses risks to individuals’ cardiovascular health, according to the Medicine in Novel Technologies and Devices authors, who wrote, “pregnancy-related complications are often the result of mothers’ inability to adapt to [these] vascular and metabolic changes.”

 

Alzheimer disease

An article published by Women’s Health states that two-thirds of individuals diagnosed with the most prevalent form of dementia, AD, are women.

Andrew MK, Tierney MC. The puzzle of sex, gender and Alzheimer’s disease: Why are women more often affected than men? Women's Health. 2018;14:174550651881799.

A potential contributing factor is the way in which estrogen operates.

 

Estrogen is thought to be a neuroprotective hormone. As women age, their estrogen levels decrease. After undergoing menopause, women often have lower levels of estrogen than men, due to the conversion pathways created by testosterone in men’s bodies (testosterone is converted into estrogen in the brain via aromatase).

Pregnancy complications also poses risks to cognitive health, especially for those who have a history of preeclampsia. Bearing and raising children is also known to influence the biological and social health of those who choose to do it, which could increase risk of dementia in ways that have yet to be studied.

There are a number of other biological factors—brain structure and function, inflammation and metabolism, genetics and epigenetics—as well as cognitive and social factors that may influence how AD develops in people. For now, doctors can keep an eye on developing research about the gendered aspects of AD.

 

Osteoporosis

However, it is still prevalent in men, who have a high likelihood of experiencing complications associated with osteoporosis.

According to a study published by Medicine, women may face a greater risk of developing osteoporosis, but men are still subject to its health dangers.

Choi KH, Lee JH, Lee DG. Sex-related differences in bone metabolism in osteoporosis observational study. Medicine. 2021;100(21):e26153.

A decrease in estrogen plays a vital role in the development of osteoporosis for both men and women, and it is more pronounced for women and at younger (menopausal) ages compared with men.

 

The study, which looked at differences in bone metabolism between men and women using bone biomarkers, found that women with osteoporosis showed higher reductions in bone mineral density than men. Men and women tend to lose bone, but women tend to lose bone at younger age and at a more rapid pace than men. They also have higher bone resorption markers.

The average osteocalcin level (bone formation biomarker) was reportedly lower in men than in women—especially compared with women aged between 65-80. The rate of bone formation relative to bone absorption was also slower in men than in women, suggesting age-related differences in bone metabolism.

According to a 2017 study published in Journal of Clinical Medicine Research, women ≥ 50 years of age have a two times higher rate of osteopenia and four times higher rate of osteoporosis. They also are prone to have fractures 5–10 years earlier than men.

Alswat KA. Gender disparities in osteoporosis. J Clin Med Res. 2017;9(5):382–387.

Men typically get fractures at a higher bone density, particularly at the lumbar spine. Post-hip fracture mortality risk tends to be higher in men.

 

Men are under-screened for osteoporosis and they are also undertreated, even when they have fractures.

Again, further research is necessary to solidify effective treatment strategies for men with osteoporosis. For now, clinicians can lean on the available research for guidance.