Sex and Gender-Specific

Health Care

GT Intern/Mentor Program
Rebecca Kaminsky
January 14, 2016

Lindsey Schweigert, a Missouri businesswoman, was tremendously fatigued during her

three-month excursion around the country selling security software to Pentagon officials.
Wishing to get a good nights sleep for her early start to her work day, she had dinner, put on her
warm pajamas, took Ambien, and went to bed. After that, her memories are a blur. The next
thing she remembers is sitting in the back of a police car, still wearing her pajamas, her hands
handcuffed behind her (Falkenburg 1). Schweigert was put under arrest for driving while
intoxicated. She was confined in a small cell with a dozen other inmates until she was finally
released at 4:30 a.m. In the following weeks, she then recognized that her use of Ambien, a
sedative, caused her to crash her car while driving to Steak n Shake at 8 in the evening. Her
disoriented state gave her a glassy-eyed appearance and caused her to fall three times while
walking in a straight line in front of the police. Her adverse reactions caused her to experience
abnormal thinking, sleep driving, and hallucinations. As a result, her license was immediately
suspended, and her career was put into serious jeopardy.
Ambien is an FDA approved sedative that is frequently distributed among the American
population who suffer from insomnia. It is more frequently distributed to females, for women
suffer more sleep disorders than men (McGregor 1). Alyson McGregor, an emergency medicine
doctor at Rhode Island Hospital, discusses the drawbacks of this sedative for female patients. She
notes that Ambien has been prescribed for millions of women during the past twenty years
despite the fact that little research in the past took into account that women react differently to
Ambien than their male counterparts. But just this past year, the Food and Drug Administration
recommended cutting the dose in half for women only, because they just realized that women
metabolize the drug at a slower rate than men, causing them to wake up in the morning with
more of the active drug in their system (1). Doctor McGregor speculates that many of these

female patients taking Ambien may be at greater risk for motor vehicle accidents when they get
behind the wheel in the morning. She further deduces that many of these potential accidents
could have been prevented during the past twenty years if researchers had considered gender
differences in experimental and clinical analysis before Ambien was first released to the public.
This is only one of the many cases where lack of gender analysis put female patients at risk.
Sex and gender-specific medicine is crucial for both male and female patients. There are
differences in sex and gender. For example, sex refers to the biological differences between men
and women. This includes chromosomes, hormones, and anatomy. Females are composed of XX
chromosomes and males are composed of XY chromosomes that are responsible for determining
how the body will develop in a fetus and later through puberty. These sex cells stimulate the
secretion of certain types of hormones such as testosterone for males and estrogen for females. In
addition, this pack of sex-determined cells are directly responsible for DNA repair and epigenetic
mechanisms. As a result, neurotransmitters and the internal functions of females and males
therefore construct into different metabolisms of varying neurotransmitters and hormones
released. In addition to the internal physiology of either sex, the anatomy of the inlet of the
pelvis, weight and length of bones, percentage of fat, and width of cardiovascular arteries differ
between men and women. Gender, on the other hand, involves social constructs and behaviors
that are influenced by historical and cultural factors over the centuries in a society (Jenkins 3).
Despite the wealth of data on differences, medical practice does not sufficiently take gender into
account in diagnosis, treatment or disease management (Regitz-Zagrosek 598). Medical
researchers and practitioners should implement effective individualized medical care based
on sex and gender because of anatomical, physiological, and psychological variants between
the two sexes.

Throughout the history of most cultures and societies, women have existed in subservient
positions in relation to men. This situation was reinforced not only by custom but also by laws
developed in patriarchal systems. As Western medicine advanced from the 18th through the 20th
centuries, medical practitioners and researchers seldom if ever considered the female side of the
equation. When conducting experimental research, whether on animals or humans, male subjects
were the only sample source. Therefore, conclusions and assumptions could only be made on
that specific population males. It was simply assumed that men and women were the same
despite the reproductive organs (McGregor 1) Medications depend on manipulating the internal
functions to alleviate pain and balance chemical imbalances. Since the hormones and complexity
of chemical imbalances differ between both sexes, the same medication dosages and components
can be potentially harmful for half of the United States population-women.
The period right after World War II demonstrated a number of patterns in medical
research that would continue until the last quarter of the twentieth century. The atrocities
committed in the German concentration camps against the Jews stimulated interest in protecting
patients from becoming victims of medical research without their informed consent (McGregor
1). In addition, there was fear that if women were used as experimental subjects, the unborn fetus
might be harmed. Laws were passed for the protection of the fetus; therefore few if any women
were included in clinical trials. Males are much more homogenous hormonally than women, so
collecting data from male specimens would offer cleaner data and require less resources. So it
was decided: medical research was performed on men, and the results were later applied to
women (2). During experimental testing, many scientists attempted to remove extraneous
data to make the results of experiments more reliable. However, for many years the female rats
would be excluded due to their wide range of fluctuating hormones. These differences present in

rats are very similar to humans and therefore influenced the creation of drugs, such as Ambien,
that blindly disregards the female population.
Until the 1980s womens health care mainly focused on the female reproductive organs.
Little was known about the special needs of female patients as a result. In the decades following
much evidence demonstrated that women were experiencing adverse reactions to medication in
comparison to men. For example, a very commonly used drug, Aspirin, is beneficial in
preventing heart attacks in men. However, women have smaller blood vessels, and the drug can
actually harm healthy women (McGregor 2). Doctor Yang from UCLA discovered that the sexdetermining chromosomes in body cells are responsible for the differences for dosing of drugs
and susceptibility and severity of diseases in women and men (3). If social gender factors
influenced womens health, then they must also influence mens health (Jenkins 2). The goal of
gender medicine should be to improve the health of both sexes biologically and socially (RegitzZagrosek 602).
Time, commitment, and political support are vital to implement gender-equitable
treatment (Regitz-Zagrosek 602). Before 1990, the physicians of internal medicine did not think
of womens health as a different practice from internal medicine. Then, later in that decade,
Congress supported research and public awareness for the campaign in womens health of
primary care in internal medicine. Women need more than a Pap smear and a yearly breast
examination (Kwolek 1). This growing awareness for female needs helped demonstrate the
discomfort women have experienced in certain medical treatments compared to men. Internists
felt less well trained to perform bimanual examinations, were less likely to think that performing
Pap smears was a good use of their time, and were less likely to report that their clinics were

equipped to perform gynecologic examinations that were their family physician counterparts
(1).
Men and women consume dozens of new chemicals developed by the growing
pharmaceutical industry to fix various physiological and psychological diseases. Society now
accepts the concept of one size fits all and one pill can cure any imbalance in the body. This
strong presence of drugs that have been tested mainly on male subjects therefore strongly affects
lives. Between 1995 and 2000, drugs have shown substantial differences in how they were
absorbed, metabolized, and excreted by men and women[they] had no sex-specific dosage
recommendations on their labels. This might be one reason why women are 1.5-2 fold more
likely to develop an adverse reaction to prescription drugs than men (Regitz-Zagrosek 601).
Much more research is needed so the dosing of drugs can be individualized for men and women
in order to achieve their optimal effects.
With an overwhelming plethora of anatomical, physiological, and psychological
differences based on sex and gender, the medical profession should create a separate practice that
mainly focuses on either gender in order to significantly advance the effect of medicine for both
sexes of the Americas population. The 17th century was the first time period in which physicians
took a step to create a new separate medical specialty, called Pediatrics. Children were no longer
recognized as little adults. Instead, this Pediatric field was developed to care for children
suffering from infectious diseases and to focus on normal growth and development. Pediatric
medicine then expanded to incorporate the study of behavioral, social, and medical aspects of a
childs health. The same thing can be said for woman and men for they have their own anatomy
and physiology that deserves to be studied with the same intensity (McGregor 1). Just like the

field of Pediatric medicine, there should be separate medical fields to address the concerns of
both males and females individually.
More than 10,000 articles deal with sex and gender differences in clinical medicine,
however little action is taken to truly defend the rights and acknowledge the differences in the
medicines and procedures that are appropriate for either gender. (Regitz-Zagrosek 596).
Important implementation techniques to start integrating sex and gender in clinical practice is
crucial to embed throughout education and training. An important organization called, SGWHC,
The Sex and Gender Womens Health Collaborative can help coordinate this effort. This
organization recognizes the statistically significant divide between data collection in experiments
and recommends investigators report analysis of data by sex. This evolving understanding of
women and mens health can create better equipped physicians who can treat the internal
imbalances of both sexes objectively, free of historical subjectivity and influence that creates
biased views of female internal anatomy and physiology. Pharmaceutical industries and medical
school institutions must therefore take into account the anatomical, physiological, and
psychological variations between males and females to implement sex and gender specific health
care.

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