Women's Health, Men's Health: Why Gender Matters
Given the differences in anatomy, it’s not really a surprise that many common diseases look different in men and women.
“They often present with different symptoms, and require different workups and treatments,” says Marianne Legato, M.D., director of the Partnership for Gender-Specific Medicine at Columbia University in New York City.
Yet physicians and patients often still don’t know about those variations, which can cause them to misdiagnose potentially serious health problems or fail to treat them properly.
Here are six diseases that frequently look different in men and women—and how to make sure you get treated right.
Colon Cancer: Occurs Earlier in Men
About 35 percent more men than women are diagnosed with and die from colon cancer, according to the American Cancer Society. Men also tend to get the disease at a younger age: 69 compared with 73 in women. One factor: “We think the female hormones estrogen and progesterone may be protective,” says Durado Brooks, M.D., at the American Cancer Society. But after menopause, women start to narrow the gap.
How symptoms differ: Both men and women often have symptoms such as rectal bleeding and diarrhea or constipation. But women are slightly more likely to have tumors located on the right side of the colon. Those cancers tend to be more aggressive, Brooks says.
How care differs: People should start colon cancer screening at age 50. But research suggests that men are more likely to delay testing. “People put it off because they find it embarrassing, and as a result cancers aren’t found till later stages,” says Cathy Eng, M.D., director of the department of gastrointestinal medical oncology at the University of Texas MD Anderson Cancer Center in Houston. Our medical experts say colonoscopy is the preferred test for both sexes, but it’s especially important for women because it can better spot aggressive tumors.
Heart Attack: More Often Overlooked in Women
Heart attacks tend to strike women later in life (average age of 72 compared with 65 for men) but tend to be deadlier: 26 percent of women age 45 and older die in the year after their first heart attack compared with 19 percent of men, according to the American Heart Association.
How symptoms differ: Women often present with more subtle signs, such as jaw or back pain, nausea, and shortness of breath, according to the AHA, so they may be less likely to seek medical help.
How care differs: When a doctor suspects a heart attack, one of the first steps is to perform an angiogram, which checks for blocked coronary arteries. But the test may miss a type of heart disease that’s more common in women, called coronary microvascular disease—which damages the smaller arteries in the heart—according to research from the National Institutes of Health. So when an angiogram is normal in women, the doctor could consider adding in another test, called an intravascular ultrasound, to assess the health of those smaller arteries, says Suzanne Steinbaum, D.O., director of women’s heart health at Northwell Lenox Hill Hospital in New York City.
Men or women who have had a heart attack should be prescribed medications to protect their heart, such as low-dose aspirin as well as blood pressure and cholesterol-lowering drugs, and be referred to an exercise and counseling rehab program. But women are less likely than men to get referred to that rehab program or to go when referred, Steinbaum says.
Depression: More Common in Women but Deadlier in Men
Women are about twice as likely as men to be diagnosed with depression, says Philip R. Muskin, M.D., professor of psychiatry at Columbia University Medical Center and chair of the American Psychiatric Association’s Scientific Program Committee. But men are much more likely to kill themselves. “Women attempt suicide more, but men use more lethal means, like firearms,” Muskin says.
How symptoms differ: It can be more difficult to recognize depression in men, because it often appears not as sadness but as complaints of being tired and irritable, or as a loss of interest in their work, family, or hobbies. “Much of this may be due to cultural expectations of how men think they should behave,” Muskin says. And though depressed women are more likely to overeat, men tend to lose their appetite and drop weight, according to a University of Michigan review. Men also may use drugs and alcohol to self-medicate, thus masking signs of depression.
How care differs: Women may respond better than men to a common class of antidepressants called selective serotonin reuptake inhibitors (SSRIs), especially sertraline (Zoloft and generic). And in either gender, SSRIs have been linked to sexual side effects, such as erection problems in men and reduced libido in women. In fact, side effects are the most popular reason people decide to discontinue antidepressants, according to a 2015 study in the journal Psychiatric Services.
Based on a large-scale, government-funded 2016 analysis by the Agency for Healthcare Research and Quality, Consumer Reports Best Buy Drugs recommends that men and women suffering from depression consider cognitive behavioral therapy (CBT)—a talk-based therapy—before turning to antidepressants.
Smoking Cessation: Harder for Women to Quit
Women are less likely than men to succeed at quitting smoking. One reason may be that women don’t respond as well to nicotine replacement methods, such as nicotine gum or the patch, says Andrea Weinberger, Ph.D., a smoking-cessation expert at Yeshiva University in the Bronx, N.Y. “We think for them, smoking is less about fulfilling a nicotine craving but more about its sensory aspects: smelling or seeing the smoke, or even the social aspect of smoking with others,” she says.
How symptoms differ: More women report suffering severe withdrawal symptoms, such as depression, cravings, anxiety, and difficulty concentrating.
How care differs: If you’re a menstruating woman, time your quit day to your period; withdrawal is often worse in the second half of the menstrual cycle, according to Weinberger. Among the drugs used to help people stop smoking, varenicline (Chantix) works equally well in both genders, but the antidepressant bupropion (Wellbutrin) seems less effective in women.
Alzheimer’s Disease: Faster Onset in Men
About two-thirds of Americans with Alzheimer’s are women, but that may be because women tend to live longer, says Michelle Mielke, Ph.D., associate professor of neurology at the Mayo Clinic in Rochester, Minn. In men Alzheimer’s tends to begin in the 60s, a decade or so earlier than in women, and it progresses faster, according to Mayo Clinic research.
How symptoms differ: Men with Alzheimer’s are less likely to have obvious memory loss, possibly because their hippocampus (the brain’s memory center) is less likely to be affected by the disease, according to Mayo Clinic research. Instead, they may be more likely to have behavioral symptoms such as aggressiveness and agitation, Mielke says.
How care differs: Women who go through menopause before age 45 have a higher chance of developing the disease, Mielke says. So women with early menopause could consider hormone replacement therapy until they’re 51, the average age of natural menopause. In addition, being overweight is more likely to contribute to dementia in women than in men, according to an article in the journal Gender Medicine, so controlling weight may be especially important for females. (Read about drugs used to treat Alzheimer's.)
Parkinson’s Disease: Undertreated in Women
Men are more likely than women to develop Parkinson’s. Researchers aren’t sure why, though some suspect estrogen may have a protective effect in women.
How symptoms differ: It often takes longer to diagnose the disease in women, partly because their early symptoms are more subtle, according to Boston University research. Women with Parkinson’s are more likely to present with tremor (unlike men, who display bradykinesia, or unusually slow or rigid movement) and are more likely to report depression.
How care differs: Perhaps because it’s easier to miss the early stages of Parkinson’s in women, they are less likely to get proper treatment. For example, they are 22 percent less likely to see a neurologist. And they need more close monitoring while on levodopa, the most effective drug, because they’re prone to shaking and other side effects, says Irene Malaty, M.D., director of the National Parkinson Foundation Center of Excellence at the University of Florida in Gainesville. Women also tend wait longer for deep brain stimulation—electrodes surgically implanted into the brain—though that can help them, too.
Editor's Note: This article also appeared in the November 2016 issue of Consumer Reports on Health.
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