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Men and women never similarly ill

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(Globalpost/GlobalPost)

While psychologists warn against men-are-from-Mars-women-are-from-Venus gender stereotypes that hinder us from looking at our partners as equals, it seems health researchers agree that men and women are poles apart.

We know very little about gender-specific differences in ailments, especially when it comes to disease symptoms, and the consequences of these differences for treatment and prevention. Here's the bummer: Medical research in the last 40 years has almost exclusively focused on male patients.

Giovannella Baggio of Italy's Padua University Hospital, who published the findings of a study she and her team conducted, in the Clinical Chemistry and Laboratory Medicine journal, highlights the most striking example when she explains how men and women exhibit varied symptoms of a heart attack. While men feel a constriction in their chest, and pain that radiates through the left arm - classic and widely known signs of a cardiovascular attack - in women, it's pain in the lower abdomen and nausea that are common. The latter are unfortunately seen as vague symptoms, and there's a chance that the female patient may not be sent for a necessary examination, such as a coronary angiography or an ECG.

Dr Dev Pahlajani, consultant cardiologist at the Breach Candy Hospital and Research Centre says, these atypical symptoms - fatigue, nausea and lower abdominal pain - are often attributed to acidity or gall bladder problem. That diabetes is more common in women than men (eight per cent of Indian women above the age of 40 are diabetic), adds to female woes. Long periods of elevated glucose levels can injure vessels that supply the body's nerves with adequate nutrition and oxygen. Years of depravation can cause nerves to become numb. Hence, the body is unable to send out the usual signals of distress that take the form of typical symptoms. "It also doesn't help," he adds, "that typically, women tend to ignore pains, believing it's part of the body's function and fail to seek help at the right time." This leads to a delay in diagnosis, leaving them with a lower chance of survival. The difference, say doctors, isn't restricted to cardiovascular disease.

Right and left of colon cancer

Dr Tejinder Singh, consultant medical oncologist at Mulund's Fortis Hospital, says strangely, cancer also carries a gender bias, most often in favour of men. He cites data from American studies in the area when he says that while colon (bowel) cancers are most often seen in men at age 65, women tend to be diagnosed at around 70. The key words here are 'be diagnosed'.

Dr Singh explains why. Men exhibit colon cancer symptoms such as blood in the stool or irregular bowel movement. In women, the bleeding is 'invisible' (it is termed occult bleeding). "No one will consult a doctor if they pass black stool. It's when they see blood in the stool that they jump. Which is why colon cancer in women goes largely undetected," he says.

The reason is the location of the cancer. While in men, the cancer appears on the right side, in women, it's on the left. Common symptoms, such as bloody stools are more likely to appear in right-side colon cancers.

But Dr Singh suggests a way to beat the bias. Since colon cancer also causes anaemia, women who suffer from a haemoglobin deficiency should get themselves checked for it, no matter what their age.

Women also run a higher risk of lung cancer than men, he shares. "Men have a higher content of the enzyme Glutathione S-Transferase ( GST), an anti-oxidant, in their body. Thus, they are able to break down the free radicals from smoke better than women."

Bone to pick with men

While women may have drawn the shorter stick in cardio-vascular diseases and cancers, men are unlucky when it comes to osteoporosis. Perceived as a women's disease, osteoporosis not only occurs in men, it also goes undetected. In her study, Professor Baggio says, "Far more epidemiologic, diagnostic and therapeutic studies have been carried out in women than in men". In clinical practice, if this disease remains underestimated in women, patients' and physicians' awareness is even lower for male osteoporosis, for which diagnostic and therapeutic strategies are at present less defined.

Consultant endocrinologist Dr Archana Juneja says that it's up to the hormone oestrogen to protect the body's bones. "It promotes the production of more bone cells and inhibits their absorption by the body. When oestrogen levels fall, bone cells are produced at a slightly lower rate. But the rate of absorption increases, thus leading to a fall in bone density, leading to osteoporosis," she says.

Women gain here, because menopause, or the abrupt end of the menstruation cycle, is a clear sign of fall in oestrogen levels. In men, andropause sets in over a period of time - as long as a decade - with the gradual fall of testosterone and oestrogen levels, leaving them prone to osteoporosis without a visible marker.

Most men don't realise they have hit andropause, says Dr Sachin Bhonsle, a joint replacement and arthroscopic surgeon. "They attribute the loss of sexual appetite to age, but it is in fact, andropause that eventually leads to osteoporosis."

When popping pills

Gender differences also play out in the way men and women respond to medication. Here again, balance is skewed in favour of men as most clinical trials for new drugs are conducted on males. A 1999 study conducted by G K Ciccone and A Holdcroft, titled Drugs and sex differences: a review of drugs relating to anaesthesia, published in the British Journal of Anaesthesia, says that women have a higher incidence (twofold) of adverse "events to medication". This difference, says the report, may arise because drugs are not weight-controlled and thus women may get a larger dose per kilogramme of body weight.

Dr Urmila Thatte, Head of the Department of Clinical Pharmacology at Parel's KEM Hospital, says in most cases, women require lower doses of the same medication under the same risk factors. While treating depression for instance, men respond better to tricyclic antidepressants while women take a liking to selective serotonin reuptake inhibitors. Women also require a lower dosage of antipsychotic medication to control symptoms.

This is influenced by gender-specific factors such as body build, BMI, Basal Metabolic Rate (BMR), body fat, muscle mass, diet, smoking, concurrent medications, exercise, substance use, and hormonal transitions.

http://www.globalpost.com/dispatch/news/asianet/130409/men-and-women-never-similarly-ill