GENDER DIFFERENCES IN PHYSIOLOGY Refresher Course sponsored by: The American Physiological Society Education Committee EB2006 APS 2006 Refresher Course

Martha L. Blair, Ph.D. University of Rochester What do we know, and what should we teach... about gender differences in physiology? Martha L. Blair, Ph.D. University of Rochester APS 2006 Refresher Course

Sex-Based Differences in Heart Disease Leading cause of death in men and women Heart disease starts 10 years later in women than men Stroke more common in women than men Multiple sex-based differences in co-morbidities, symptoms, progression, outcomes APS 2006 Refresher Course

Diseases that occur more frequently in women than in men: Osteoporosis 80% of patients with osteoporosis are women Autoimmune Disease ~3-fold more common in women than men Depression 2-3 times more common in women than men Possibly linked to lower production of serotonin in women Sex-based differences also present in incidence and expression of schizophrenia, post-traumatic stress disorder, panic disorder, other mental illnesses APS 2006 Refresher Course

Sex-Based Differences in Disease: found in most (all?) organ systems Respiratory Gastrointestinal Renal Skin Reproductive/GU and more... APS 2006 Refresher Course

Potential Causes of Sex-Based Differences in Normal Physiology and Disease Societal Lifestyle/behavior Environmental Healthcare Genetic Linked to x- or y-chromosome Effects of the sex steroids Androgens, Estrogens, Progestins All present in both male and female Estrogens & androgens physiologically important in both males and females APS 2006 Refresher Course

Sex Hormones and Life Stages Prenatal development Sexual differentiation Maturation: child, adolescent, young adult Variation with menstrual cycle in women Pregnancy Abrupt drop in estrogen & progesterone at menopause Gradual decline in testosterone with aging Both men and women APS 2006 Refresher Course

Sex-based Differences in Body Composition and Structure Well-known differences: in comparison with women, males have Greater bone mass Greater muscle mass Lower percent body fat Males and females also have structural differences in Heart Brain Gastrointestinal system and more... APS 2006 Refresher Course

Differences in “Normal Values” Cardiovascular Blood Pressure 5-10 mmHg higher in men than women Difference abolished after menopause Heart rate lower in men than age-matched women Q-T interval longer in women Renal Glomerular filtration rate Slightly lower in young women than age-matched men May decline more rapidly with aging in men than women APS 2006 Refresher Course

Sex-Based Differences in Normal Physiological Function Cardiovascular system Liver Lipid metabolism Drug metabolism Central nervous system Other: Gastrointestinal system, immune system, kidney, lung, skin...and more. APS 2006 Refresher Course

Sex-based differences in normal physiological function... A “Work in Progress”! APS 2006 Refresher Course

Monographs on Sex-Based Differences in Health and Disease Exploring the biological contributions to human health : does sex matter? editors, T.M. Wizemann & M-L. Pardue; National Academy Press, 2001 Proceedings of the Institute of Medicine Committee on Understanding the Biology of Sex and Gender Differences  Principles of gender-specific medicine editor, Marianne J. Legato; Elsevier Academic Press, 2004   Principles of sex-based differences in physiology Advances in Molecular and Cell Biology, vol. 34; editors, V. Miller & M. Hay; Elsevier, 2004 APS 2006 Refresher Course

Websites on Sex-Based Differences in Health and Disease Society for Women’s Health Research: Overview of sex-based differences Links to additional sources of information http://www.womenshealthresearch.org/hs/links.htm http://www.womenshealthresearch.org/hs/healthfacts.htm Centre for Research in Women’s Health http://www.crwh.org/ National Center for Gender Physiology at the University of Missouri http://www.genderphysiology.org Partnership for Gender-Specific Medicine http://cpmcnet.columbia.edu/dept/partnership/ APS 2006 Refresher Course