Saving Lives: Why Sex and Gender-Specific Medicine Will Transform Healthcare For Men and Women

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Part 1

“We’ve had a unisex vision of the human genome. Men and women are not equal in our genome and men and women are not equal in the face of disease.”

David C. Page, MD, Massachusetts Institute of Technology

            In September 1965 checked into my room at U.C. San Francisco Medical School. I had just graduated with honors from U.C. Santa Barbara and had received a four-year, full-tuition, fellowship to study medicine. I had planned to become a psychiatrist and secretly hoped I would learn why my father took an overdose of sleeping pills when I was five years old and why my mother was preoccupied with death, hers as well as mine. Though neither my father nor my mother died back then (they have since passed on), I never lost my desire to understand men’s and women’s physical, emotional, and relational illness and health.

            However, medicine at the time was too restrictive for me. It assumed that the only differences between males and females had to do with our genitals and it totally neglected any psychosocial factors  that impacted our health and wellbeing. I soon dropped out of medical school, graduated from U.C. Berkeley’s school of Social Welfare, and began working in the healthcare field in 1968. I later returned to school and earned a PhD in International Health.

            Following the birth of our first son in 1969 and our daughter in 1972, I stared MenAlive.com as my “window to the world” for improving the health and well-being of men and their families. I read widely and shared what I was learning in books and articles. My first book, Inside Out: Becoming My Own Man was published in 1983. My seventeenth book, Long Live Men! The Moonshot Mission to Heal Men, Close the Lifespan Gap, and Offer Hope to Humanity will launch later this year.

The Emergence of Gender-Specific Medicine

            Marianne J. Legato, M.D. is regarded by both the medical and scientific communities as one of the foremost experts on gender differences in the world. I first became acquainted with Dr. Legato and her work in 2002 following the publication of her book, Eve’s Rib: The New Science of Gender-Specific Medicine and How It Can Save Your Life. “Until now,” said Dr. Legato,

“we’ve acted as though men and women were essentially identical except for the differences in their reproductive function.”

            Research findings and Dr. Legato’s own experience as a clinician and scientist were showing that these assumptions were not true.

“In fact, information we’ve been gathering over the past ten years tells us that this is anything but true and that everywhere we look, the two sexes are startingly and unexpectedly different not only in their normal function but in the ways they experience illness.”

            Dr. Legato notes that it wasn’t only the medical and scientific communities that were challenging the old paradigms, but women were calling for changes as well.

“It has been women themselves,” says Dr. Legato, “who have demanded a change in the way American scientists and doctors do business. With an increasingly more coherent and powerful voice, women have forced the federal government and the biomedical establishment it supports to define the differences between males and females.”

There Are 10 Trillion Cells in Human Body and Every One is Sex Specific

            I learned in biology class that all humans have 23 pairs of chromosomes. The first 22 are identical. The 23rd set are the sex chromosomes. If we are biologically male, our 23rd pair are XY. If we are biologically female they are XX. The scientific assumption until recently was that any differences between males (XY) and females (XX) were limited to differences related to our sex organs.

            Another biomedical researcher who has been working to better understand sex differences is David Page, M.D. Dr. Page is a biologist and professor at the Massachusetts Institute of Technology (MIT). After Dr. Page won the MacArthur “Genius Grant” in 1986, he was promoted to the faculty of the Whitehead Institute and the MIT Department of Biology in 1988. In 1990, Page was named a Howard Hughes Medical Institute Investigator. In 2005 he was named as director of the Whitehead Institute where he and his colleagues have been studying the genetic differences between men and women.

            His particular interest and expertise has been in studying the Y chromosome.

“There are 10 trillion cells in human body and every one of them is sex specific,”

says Dr. Page.

I first heard about Dr. Page’s research when I viewed a TED talk called “Why Sex Matters,” which has now been viewed by more than 2 million people. He contends that medical research is overlooking a fundamental fact with the assumption that male and female cells are equal and interchangeable in the lab, most notably because conventional wisdom holds that the X and Y chromosomes are relevant only within the reproductive tract.

“It has been said that our genomes are 99.9% identical from one person to the next,”

says Dr. Page.

“It turns out that this assertion is correct as long as the two individuals being compared are both men. It’s also correct if the two individuals being compared are both women. However, if you compare the genome of a man with the genome of a woman, you’ll find that they are only 98.5% identical. In other words, the genetic differences between a man and a woman are 15 times greater than the genetic difference between two men or between two women.”

            If we think that a 1.5% difference in our genomes, isn’t a big deal, think again. Dr. Page says I am as different from my wife genetically as I am from a male chimpanzee, and so are all other men. And my wife is as different from me genetically as she is from a female chimpanzee, and so are all other women. Being aware of our differences and similarities are important.

“Men and women are also not equal in the face of disease,”

says Dr. Page.

“For instance, take the case of rheumatoid arthritis. For every man with rheumatoid arthritis, there are two to three women that are affected by this disorder. Is rheumatoid arthritis a disease of the reproductive tract? No. Let’s flip the tables and consider Autism Spectrum Disorders. For every girl with this disorder there are about five boys. Let’s look at Lupus, a long term, autoimmune disorder with devastating consequences that can result in death. For every man suffering from Lupus there are six women suffering from this disorder.”

            Dr. Page goes on to say,

“Even when disease occurs in both men and women with equal frequency, that disease can have more severe consequences in one sex or the other.”

We know, for instance, that with the Covid epidemic, although both men and women could become infected, men were more likely to require hospitalization and more men died.

            “So, all your cells know on a molecular level whether they are XX or XY,” says Dr. Page.  “It is true that a great deal of the research going on today which seeks to understand the causes and treatments for disease is failing to account for this most fundamental difference between men and women. The study of disease is flawed.”

“We’ve had a unisex vision of the human genome,”

says Dr. Page. 

“Men and women are not equal in our genome and men and women are not equal in the face of disease.”

Dr. Page concludes saying,

“We need to build a better tool kit for researchers that is XX and XY informed rather than our current gender-neutral stance. We need a tool kit that recognizes the fundamental difference on a cellular, organ, system, and person level between XY and XX. I believe that if we do this, we will arrive at a fundamentally new paradigm for understanding and treating human disease.”

The Future of Healthcare:

            I believe that gender-specific health care will transform our world. I will be offering a training program later this year for healthcare practitioners who want to improve their skills and expand their practice. If you are interested in learning more, please send me an email to Jed@MenAlive.com and put “Gender-Specific Healthcare” in the subject line.

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