OK, so this isn't your typical article on sex. However, it might be one of the most important and interesting ones you'll ever read!
I had the pleasure of meeting one of the great minds of the medical world, Dr. Virginia M. Miller of Mayo Clinic. Her research into sex hormones and sex differences is groundbreaking in the treatment of individuals based on how a disease affects them as either male or female.
Dr. Miller currently serves as the principal investigator for the Specialized Center of Research on Sex Differences and has written more than 250 original publications.
We discussed her research and the implications it could have on the medical treatment of men and women:
From the perspective of a non-medical professional, studying sex differences seems logical, especially given that medicine is often tied to ethnic backgrounds, lineage, and so forth. Why do you think it was overlooked?
Well, I think it depends on the discipline. For example, in the field of neurology, the idea of sex differences in the brain has been entrenched in their thinking for a long time.
When you're trying to identify a difference between two groups, the more variable a group is, the harder it is to find a difference; you want to reduce that variability as much as possible.
A significant idea that influenced taking women out of clinical trials was the idea that the studies had been conducted with Thalidomide, which was believed to create birth defects. We don't want to enroll any women in studies because what we might be intervening with could harm a fetus or create birth defects in the future. With all of these factors considered, the idea of studying pregnant women or making sure women weren't pregnant when they were included in clinical studies was just abandoned, and so women were forgotten about in the study altogether.
I would love to hear you talk about the differences between sex and gender and the definition of a sex hormone? What's estrogen? What's testosterone? The general public hears these words, but their understanding of them is potentially limited.
There is a lot of confusion about these words. Sex is biological and deals with the kinds of sex chromosomes you have. Female sex chromosomes are two X's. And the male chromosomes are an X and a Y. This is genetic material that is in every cell and dictates whether it is a male cell or a female.
So, you have all the cells of the body with these X and Y chromosomes. The cells have a sex even without talking about hormones or anything else. Now, because you have these chromosomes, they dictate the development of the sexual organs. In the males, that would be the development of the testes, and in a female, that would be the development of the ovaries and these organs, the testes and the ovaries, produce hormones called sex hormones. Although you can find sex hormones in both males and females, the balance is that in males, testosterone is the main sex hormone and in females, estrogen is the major sex hormone. Although you can measure testosterone in women and you can measure estrogen in men, they have specific biological effects.
Gender, on the other hand, is a set of sociocultural constraints in which an individual must operate. There are certain expectations if you are a biological male. There used to be expectations, for example, that men would be into physical labor and be the breadwinners of their families, and the women would be caring for the children and have more sedentary type jobs, such as being a secretary. Now, these gender expectations are beginning to not exist as one or the other. There's really a continuum, and you would find that an individual throughout his or her life or even throughout his or her day may exhibit more what was typically characterized as male characteristics (masculine) of being opinionated or aggressive or authoritative and female characteristics (feminine) to be more submissive or loving or caring or social. But now that spectrum has broadened, and you probably can identify yourself during the day, your day, when you find yourself exhibiting more or less of one of those characteristics that exist on a gender spectrum.
What can the general public do to help the medical community push this initiative forward?
Well, they can start asking their doctor what's the evidence that this treatment is best for them. I think women need to ask if the treatment was tested in women. They may say I don't know, or yes or no. Start by asking the questions.
Physicians themselves need to be educated on these kinds of issues as well. You don't take it for granted that everybody here at Mayo Clinic or anywhere else is tuned in to thinking about sex differences in what they do because it's just not there.
There has been such a culture of talking about patients in general and generalizing medicine to treat the biggest group driven by some sort of population science rather than the science of treating the individual.
What do you think people will say about studying sex differences in 20 years?
We will reach a point where people are going to say what!?, this was an issue? Because it'll just be this is how we think. This is how we operate.
Looking forward to hearing your comments below!