Several compelling reasons demonstrate why focusing on sex and gender medicine within the emergency department holds significant value. I recently interviewed Alyson McGregor, MD, an emergency physician, a sex and gender medicine expert, and author of the book, Sex Matters: How Male-Centric Medicine Endangers Women’s Health and What We Can Do About It, who provided additional insight.

First, Dr. McGregor emphasized that we can improve our clinical accuracy. Men and women often present with different symptoms and respond differently to treatments for the same condition. Understanding these sex-based differences can help emergency clinicians arrive at a faster and more accurate diagnosis, leading to quicker and more effective interventions.

Second, we may be able to avoid some adverse drug reactions. Studies have shown that women experience adverse drug reactions, including nausea and seizures, at nearly twice the rate of men.² These reactions are significantly more likely to lead to hospitalization in women as well.⁹ The practice of prescribing equal drug doses to women and men fails to account for sex differences in pharmacokinetics, body fat percentages, and weight, ultimately leading to overmedication of women.¹²

Third, we can create a more equitable and effective health care system. Historically, medical research and practice have often overlooked or minimized the unique health needs of women and people of diverse genders. Gender medicine helps close this gap by providing a more comprehensive understanding of health and disease across the gender spectrum.

For what kinds of diagnoses should we consider gender differences when seeing patients on shift?

1. Cardiac disease—Although females are affected by the traditional risk factors for ischemic heart disease, such as hypertension and smoking, there are sex-specific non-Framingham risk factors that put certain females at higher risk. For example, if a female had pre-eclampsia in her pregnancy, this doubles the risk of future strokes and quadruples the risk of hypertension later in life. Thus, when considering a females cardiac risk, it is important to obtain a pregnancy history.^8,11
2. Atrial fibrillation and stroke—Several studies have shown a higher risk of stroke in females than in males who have atrial fibrillation. American atrial fibrillation guidelines have included female sex as part of risk stratification models, including the CHA2DS2-VASc score.^4,10
3. Seizures—Catamenial epilepsy, which is characterized by seizures that worsen during certain phases of the menstrual cycle, affects around 40 percent of females with epilepsy.^6,7 Circulating levels of estrogen and progesterone play a role in seizure susceptibility. Females with these types of seizures may require hormonal adjuncts or a temporary increase in their anti-epileptic drug during a specific part of the menstrual cycle to control their seizures. Furthermore, as Dr. McGregor noted, the pharmacokinetics of some anti-epileptic medications such as lamotrigine may play a role in seizure activity around the time of menstruation in epileptic females.³
4. Pain management—Studies have shown sex differences in nociception across multiple stimulus modalities. Women tend to have higher pain sensitivity compared with males and perceive more pain than men. Estrogen and progesterone’s roles in this finding are multifactorial, but studies have also shown that testosterone may have an anti-nociceptive effect.¹

We now understand that gender medicine is essential in our practice. What can we do about it? Dr. McGregor provided a few resources: