Sex and gender: modifiers of health, disease, and medicine

Franck Mauvais-Jarvis; Noel Bairey Merz; Peter J Barnes; Roberta D Brinton; Juan-Jesus Carrero; Dawn L DeMeo; Geert J De Vries; C Neill Epperson; Ramaswamy Govindan; Sabra L Klein; Amedeo Lonardo; Pauline M Maki; Louise D McCullough; Vera Regitz-Zagrosek; Judith G Regensteiner; Joshua B Rubin; Kathryn Sandberg; Ayako Suzuki

doi:10.1016/S0140-6736(20)31561-0

Sex and gender: modifiers of health, disease, and medicine

Lancet. 2020 Aug 22;396(10250):565-582. doi: 10.1016/S0140-6736(20)31561-0.

Authors

Franck Mauvais-Jarvis¹, Noel Bairey Merz², Peter J Barnes³, Roberta D Brinton⁴, Juan-Jesus Carrero⁵, Dawn L DeMeo⁶, Geert J De Vries⁷, C Neill Epperson⁸, Ramaswamy Govindan⁹, Sabra L Klein¹⁰, Amedeo Lonardo¹¹, Pauline M Maki¹², Louise D McCullough¹³, Vera Regitz-Zagrosek¹⁴, Judith G Regensteiner¹⁵, Joshua B Rubin¹⁶, Kathryn Sandberg¹⁷, Ayako Suzuki¹⁸

Affiliations

¹ Diabetes Discovery & Sex-Based Medicine Laboratory, Section of Endocrinology, John W Deming Department of Medicine, Tulane University School of Medicine and Southeast Louisiana Veterans Health Care System Medical Center, New Orleans, LA, USA. Electronic address: fmauvais@tulane.edu.
² Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA.
³ National Heart & Lung Institute, Imperial College London, London, UK.
⁴ Department of Pharmacology and Department of Neurology, College of Medicine, Center for Innovation in Brain Science, University of Arizona, Tucson, AZ, USA.
⁵ Department of Medical Epidemiology and Biostatistics and Center for Gender Medicine, Karolinska Institutet, Stockholm, Sweden.
⁶ Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁷ Neuroscience Institute and Department of Biology, Georgia State University, Atlanta, GA, USA.
⁸ Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA.
⁹ Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA.
¹⁰ W Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
¹¹ Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy.
¹² Department of Psychiatry, Department of Psychology, and Department of Obstetrics & Gynecology, University of Illinois at Chicago, Chicago, IL, USA.
¹³ Department of Neurology, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA.
¹⁴ Berlin Institute of Gender Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Cardiology, University Hospital Zürich, University of Zürich, Switzerland.
¹⁵ Center for Women's Health Research, Divisions of General Internal Medicine and Cardiology, University of Colorado School of Medicine, Aurora, CO, USA.
¹⁶ Department of Medicine, Department of Paediatrics, and Department of Neuroscience, Washington University School of Medicine St Louis, MO, USA.
¹⁷ Center for the Study of Sex Differences in Health, Aging and Disease, Georgetown University, Washington, DC, USA.
¹⁸ Division of Gastroenterology, Duke University Medical Center Durham, NC, USA; Durham VA Medical Center, Durham, NC, USA.

Abstract

Clinicians can encounter sex and gender disparities in diagnostic and therapeutic responses. These disparities are noted in epidemiology, pathophysiology, clinical manifestations, disease progression, and response to treatment. This Review discusses the fundamental influences of sex and gender as modifiers of the major causes of death and morbidity. We articulate how the genetic, epigenetic, and hormonal influences of biological sex influence physiology and disease, and how the social constructs of gender affect the behaviour of the community, clinicians, and patients in the health-care system and interact with pathobiology. We aim to guide clinicians and researchers to consider sex and gender in their approach to diagnosis, prevention, and treatment of diseases as a necessary and fundamental step towards precision medicine, which will benefit men's and women's health.

Publication types

Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.
Review

MeSH terms

Acute Disease / epidemiology
Betacoronavirus
COVID-19
Cause of Death*
Chronic Disease / epidemiology
Coronavirus Infections / epidemiology
Female
Health Status*
Humans
Male
Pandemics
Pneumonia, Viral / epidemiology
Precision Medicine / standards*
SARS-CoV-2
Sex Characteristics
Sex Distribution*
Sex Factors

Abstract

Publication types

MeSH terms

Grants and funding