The fourth in a series authored by Memorial University faculty members on the value and importance of diversity, equity and inclusion policies to build a more just society. Check back next Thursday for Dr. Ashrafee Hossain’s op-ed.
The way we approach sex and gender in biomedical research has profound implications for our understanding of health and disease — and for our wallets.
Yet, progress is consistently hindered by enduring myths and misconceptions.
The recent U.S. presidential executive orders aimed at censoring and defunding such research, including research on sex differences, endocrinology and gender-diverse populations, stifles the global scientific community and risks emboldening those in our country who undervalue the importance of sex and gender research.
Though Canadian funding agencies require their inclusion in grant proposals, the reality falls short, as many researchers merely check the box without follow-through.
It’s no wonder then that eight out of 10 prescription drugs withdrawn from the U.S. market pose greater health risks for women, and that for over 90 per cent of drugs on the market, women experience worse side effects.
This reflects the longstanding focus of biomedical research on the male sex.
“Hormonal variability isn’t exclusive to the female sex.”
Further, these studies do not take into account gender-diverse populations and the interactions that may result from gender-affirming therapies or diverse lived experiences — most research continues to conflate sex and gender and/or ask about these factors but then exclude gender-diverse individuals from analysis.
So why do researchers still predominantly study the male sex and avoid analyzing results by sex and gender?
Three persistent myths holding science back follow below.
Myth one: The female sex are too variable due to their hormones, so it’s best to focus on the male sex.
Hormonal variability isn’t exclusive to the female sex.
The male sex experiences significant fluctuations in testosterone throughout the day, making them just as variable hormonally.
More importantly, changes and fluctuations in our hormones influence our health outcomes.
By ignoring this variability, we miss out on essential insights into the mechanisms driving health differences.
By excluding women and gender-diverse populations, we fail to ensure that research accurately represents the diverse population it seeks to serve.
Myth two: Sex and gender differences rarely matter for health outcomes.
In reality, sex and gender differences are highly consequential for our health.
For example, the immune system works incredibly differently based on both our sex chromosomes and gonadal hormones.
These differences are so significant that the majority of diseases show variation based on sex, and these differences can manifest in three key ways:
- Disease prevalence: Many conditions occur at greater frequency in one group than another. For example, women are more likely to develop autoimmune diseases and Alzheimer’s disease, while men are more likely to develop aortic aneurysm and Parkinson’s disease.
- Symptom presentation: Other conditions might present differently, meaning adjustments in diagnostic criteria are required based on sex and gender so no one is missed. A well-known example includes that women having heart attacks often report nausea or back pain, while men report chest pain.
- Mechanism or treatment pathways: Other conditions might seem identical at presentation, but differences exist in the underlying cause. Preclinical chronic pain research shows that males and females use different pain pathways, suggesting sex-specific treatments may be more effective.
The fact is, studying these differences uncovers vulnerabilities and protective factors across groups.
For instance, learning why a condition is less severe in one group could inspire protective treatments for another.
Myth three: Studying sex and gender differences costs too much money.
The opposite is true — ignoring these factors is far more expensive.
Excluding more than half the population wastes taxpayer-funded research.
“Ignoring sex and gender comes at a steep price.”
When drugs go out to market and they do not serve greater than 50 per cent of the population, they get pulled off the shelves and we are back to the drawing board.
Beyond the expense of repeating male-focused research, closing the women’s health gap could boost the global economy by $1 trillion and including gender-diverse populations would increase this even further.
When health-care systems and research fail to address the needs of the majority of the population, economic growth suffers.
The high cost of ignoring sex and gender
By addressing these myths, we ensure that research funding is used effectively and equitably.
The next time someone dismisses sex and gender research as “woke science,” remind them: ignoring sex and gender comes at a steep price — for your taxpayer dollars and the health of women and gender-diverse people.
