«We need to learn that medicine isn’t one-size-fits-all»

When you buy medication, you get a formulation with a specific dosage. It doesn’t matter how tall, heavy or old you are or if you’re a man or a woman. Everyone gets the same pack. So, it should come as no surprise that many people end up under- or overdosing active ingredients. How did this come to be? And what can be done to improve the situation? Doctor Tanja Volm, physician and head of the gender medicine module at the University of Lucerne, is investigating just that. In our interview, she explains that there are many more distinguishing features to take into account than just biological or social gender.

Dr Volm, why is gender medicine so important?

Tanja Volm: The idea is to realise that medicine, which for various reasons is tailored primarily to white men, can’t automatically be transferred to women. We need to learn that humans are different and medicine isn’t one-size-fits-all. Gender medicine focuses on men and women, but there are other differences that should also be taken into account, such as age, ethnicity, body weight, social environment and so on. Gender medicine is a domain pointing in the direction of individualised medicine. It has three core themes. Classic gender medicine is the one that deals with the differences between men and women in the diagnosis and treatment of illnesses, as well as in the perception of health services. This also includes taking into account all genders in pharmacological research.

And the other two core themes?

The second focus is on people who can’t clearly assign themselves a gender or can’t identify with their biological gender. In this case, gender medicine is concerned with integrating these people into medicine and defining appropriate services for them. Then there’s the psychosocial aspect, making it part of a broader view of diversity. The focus here lies on examining cultural narratives of health and medicine as well as on topics such as domestic violence and the role of women and men in medicine.

What projects and research are you currently involved in?

The University of Lucerne takes this issue very seriously. There’s already a module on gender medicine for advanced medical students, which was first offered in 2022. In autumn 2023, a gender medicine course will be launched for students of the Health Sciences Bachelor programme. For students of the Master’s degree course in Health Sciences, a course titled «Advanced Gender Medicine» will be offered from 2024. These courses are being evaluated as part of research work, and a number of research projects in this domain are also underway. One example is a study of gender-specific differences in the burden on family caregivers of dementia patients. The study also examines how the doctor’s gender influences how patients perceive the services offered and how results are communicated.

Why in Lucerne, of all places?

We’re a modern and innovative university. Our focus on economics, theology, medicine, health sciences and psychology allows for a broad view of the topic of gender and diversity. By founding the new Faculty of Health Sciences and Medicine, we were able to incorporate new aspects into the curriculum, something that’s much more difficult for established faculties to do.

What are the differences between men and women?

There are, in fact, differences in all relevant clinical pictures – in the frequency, symptoms, type of therapy and the effect of medication. In addition to heart disease, differences are also very common in mental and psychiatric illnesses as well as in immunological diseases. There are even major differences in infectious diseases.Men and women have a different chromosomal make-up. Women have 2 X chromosomes, while men only have 1 X chromosome and 1 a Y chromosome . Women have a different hormonal make-up than men, which leads to differences in physique, metabolism, drug effects and the like. This is the starting point for many topics of gender medicine. Women also often experience a different socialisation than men.

So the difference between men and women isn’t just in size and weight?

No, definitely not. Even a tall woman experiences health and sickness differently to a man.

Let’s talk about drug and therapy research. Why is it more difficult to conduct clinical trials with female test subjects?

Women aren’t optimal participants for clinical trials as part of the approvals process for medicines. They may be pregnant, and their cyclical changes in hormone levels need special attention. However, there being difficulties shouldn’t mean drugs aren’t tested on women. If the drug is to be used in women, the trials must include women, too.

Does gender medicine also help men?

It’s not only women who are sometimes incorrectly diagnosed or treated. This can also happen to men. For example, depression is diagnosed less frequently in men. One reason for this is that depression is considered a «women’s disease», and men are less likely to go to the doctor when they have symptoms. But doctors also interpret symptoms of depression differently in men than in women. This can lead to men with undetected and untreated depression committing what would have been preventable suicides.In other words, gender medicine is definitely not women’s medicine. Rather, it’s medicine that does justice to the differences between people with a focus on their sex.It’s not its own speciality, but a supplement to existing ones. Our students and doctors learn to consider gender within their speciality. They also learn to recognise gender-related inequalities in health and medicine, for example when it comes to social and ethnic origin, and to deal with them appropriately.

Can you give another example that showcases just how important gender medicine is?

Heart attacks. Our society seems to be convinced that heart attacks are a male disease. There’s the image of a stressed man who sleeps too little and works too much. Consequently, the typical symptoms – chest pain that radiates into the left arm – are derived from the male clinical picture. When a woman suffers a heart attack, it tends to manifest itself as abdominal pain and general malaise. However, precisely because the focus is so strongly on the male clinical picture, heart attacks in women are often discovered late.

P.S.: Many studies – most recently this one – have confirmed that women are still more likely to die after a heart attack than men. But according to this study, the mortality rate of women who suffer a heart attack decreases when they’re treated by male physicians who practise with female colleagues or who have treated more female patients in the past.