Sex Cells: A Scientific Argument for Equitable Research on Women

For millennia, the diagnosis for almost every female complaint — from chronic pain to digestive woes, palpitations, fainting, headaches, and aching joints — was singular and it was “hysteria” (from the Greek word for uterus).

It was believed for far too long that strenuous activity — physical or mental — would enflame the ovaries and uterus and imperil a female’s delicate constitution. In fact, it wasn’t until 1980 that hysteria neurosis — the catchall for every female ailment — was finally deleted from the American Psychiatric Association’s bible for diagnosis of psychiatric disorders, the Diagnostic and Statistical Manual of Mental Disorders (DSM-III).

The Long History of Gender Bias in Medicine

As President and CEO of the Society for Women’s Health Research (SWHR), I and my staff advocated for more than 30 years for equitable research into women’s health conditions. Along the way, we discovered that not only were women’s health issues exclusive to women not being studied (e.g. fibroids, endometriosis), but women (especially minority women) were not included in clinical trials to determine toxicity, safety and effectiveness of therapies.

The reason, apparently, was the assumption that men and women were the same except for their reproductive organs. Additionally, women were more complicated because of their menstrual cycles and, of course, there was fear of liability if a woman was found to be pregnant during a study and the fetus was harmed. In those days, no early pregnancy tests existed.

It required two Congressionally requested investigations of the NIH and the FDA, several pieces of legislation, and intense lobbying and scientific meetings at various medical schools and research institutions throughout the country to educate and convince researchers and physicians of sex differences continuing to this day.

[Join Our Call for Greater Research on Women with ADHD]

Ending Systemic Bias Against Women

I recently wrote a book titled Sex Cells: The Fight to Overcome Bias and Discrimination in Women’s Healthcare (#CommissionsEarned) (Mayo Clinic Press; April 2, 2024). The title is important because it is necessary to distinguish the difference between biological sex and gender.

Biological sex and gender are not synonymous or mutually exclusive, and both influence health. Sex is considered a biological component; gender is a social construct that involves cultural, environmental, and societal expectations and assumptions. Biological sex is more likely to be related to how disease occurs and develops, while gender may have a significant impact on the manifestations and reporting of symptoms and on healthcare providers’ recognition of symptoms. Gender also influences treatment recommendations and options, and it effects what kind of care is made available.

My book is a natural extension of the work ongoing at SWHR, which has learned that including women and minorities in clinical trials was not enough. It’s clear now that research should begin at the basic biological level with female cells. This, of course, is more complicated and, apparently, it’s more costly include female animals in mammal studies. But it’s also critical work that must be done.

Why Sex Cells Matter

Sex differences as well as expressions of gender result from hormones. Hormones trigger a specific ordering of cells in a fetus and are linked to a wide range of sex-specific conditions and disorders. They are implicated in the prevalence of autoimmune disorders, osteoporosis, some cardiometabolic disorders, and perhaps Alzheimer’s disease in women.

[Read: We Demand Attention on Sex Differences in ADHD]

For example, some vaccines demonstrate higher efficacy in premenopausal women. Sex also influences transplant rejection, and fluctuating hormones may explain why autoimmune conditions are more common in women.

Heart disease, once believed to affect only men, is the Number One killer of white women in the U.S.; among American Indian and Alaska Native women, heart disease and cancer cause roughly the same number of deaths each year. For Hispanic and Pacific Islander women, heart disease is second only to cancer as the cause of death. Still, women with heart disease continue to be dismissed, overlooked, undertreated, and under-studied due to outdated medical preconceptions. The same could be said about women with ADHD.

A small 2021 study titled “Gender Bias in Estimation of Others’ Pain” revealed that, when male and female patients express the same amount of pain, members of the general population of all genders believe that the female pain is less intense than male pain and more likely to benefit from psychotherapy versus medication.

Despite all this evidence of substantial health variations based on biological sex, the scientific community is slow to recognize sex differences in the brain.

Profound differences in men’s and women’s brains influence everything from mental health to autism spectrum disorder. Sex differences exist everywhere in neuroscience, however scientists continue to study the male in animal studies, implying that results apply to biological men and women.

“To make real progress in improving both men’s and women’s health,” wrote Larry Cahill, Ph.D., in his groundbreaking 2014 study “Equal ≠ The Same: Sex Differences in the Human Brain”, “we need neuroscientist and non-neuroscientist alike to determine whether they too operate on the false assumption that ‘equal’ means ‘the same.’ If so, toss that assumption aside. True equality for the sexes demands it.”

On a practical level, no one should be surprised that medications and devices may work differently on biological women and men. We know that many medications cause women problems that were never anticipated or revealed in studies. This is because there are many factors in female biology that impact how a particular medicine works or doesn’t work.

I could go on and on about the discrepancies, but if you are interested in learning more, I urge you to read Sex Cells and to join the movement to eliminate sex biases in medical research. Our lives depend on it.

Gender Bias in Medicine: Next Steps

• Read: The Fate of Females with ADHD Is Improving Too Slowly
• Read: The Grave Consequences of Persistent Gender Role Expectations in ADHD
• Read: ADHD in Women and Girls — Why Female Symptoms Slip Through Diagnostic Cracks
• Hub: ADHD in Women Deserves Equal Attention!

Phyllis E. Greenberger, MSW is winner of the U.S. Department of Health and Human Services Women’s Health Trailblazer Award and Senior Vice President of Science & Health Policy for HealthyWomen. She is author of Sex Cells: The Fight to Overcome Bias and Discrimination in Women’s Healthcare (Mayo Clinic Press).

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

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