What role do biology and gender have in influencing chronic disease?

An X chromosome is displayed in front of X and Y chromosomes

A review in The Lancet, partially funded by the National Heart, Lung, and Blood Institute, examines the role biological sex and gender have on influencing behavior, disease progression, and treatment among 10 chronic disease conditions. The researchers also profile emerging sex- and gender-based distinctions in response to the novel coronavirus, COVID-19.

Heart disease, for example, is the leading cause of death for men and women, but affects men and women differently. Estrogen, a female sex hormone, may provide a protective cardiovascular effect for premenopausal women. Androgen, a male sex hormone, may increase heart disease risk. Social factors, including gender, influence symptom recognition, screening, and treatment.

Asthma and COVID-19 are also influenced by hormones, genes, and behavior. Before puberty, boys are more likely to have asthma. Lung development, sex hormones, and preferences for outdoor play influence these variables. After puberty, women have higher asthma rates. Frequent health screenings and progesterone, a female sex hormone, may explain these rates. Generally, estrogen is thought to inflame asthma symptoms, while androgen has the opposite effect. This immune response switches in pneumonia and COVID-19.

Women have more genes on the X chromosome, including genes for immunity, which, in addition to estrogen, may explain why they produce stronger antibodies following flu vaccines and are less likely to have severe COVID-19 infections. Precautions, such as hand-washing and vaccination, are important. Men are more likely to get flu shots and less likely to have severe reactions to influenza, including death. Women are more likely to wash their hands and 1.5-times less likely to be hospitalized or die from COVID-19.

To support disease prevention, detection and treatment, the authors recommend prioritizing biological sex- and gender-based distinctions in research and its applications, including clinical guidelines, medical school curriculum, and academic publishing.

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