New Center Focuses on Sex Disparities in Medicine

At the outset of 2013, Stanford launched the Center for Health Research on Women and Sex Differences in Medicine, known as the Stanford WSDM ("wisdom") Center. The Center's goal is to encourage scientists to study the role of sex in cells, tissues, animal models and human health outcomes across the lifespan, with an emphasis on women's health, for which research has lagged. The Center also aims to understand and reduce health disparities experienced by men, who continue to have a substantially shorter lifespan than women worldwide, and by individuals whose gender identity or sexual orientation might pose unique health risks.

For decades, research on women's health has focused on reproduction and fertility and diseases associated with "female" sex hormones or anatomy. Basic medical research, in all other areas, has been and continues to be conducted predominantly in males. "For most medical science, we are very male-focused," says Marcia Stefanick, PhD, co-director of the Stanford WSDM Center. "The WSDM Center is eager to advance the basic science of sex differences and similarities – something we believe Stanford geneticists, stem cell researchers and developmental biologists would excel at," she adds. "We expect such research would translate into better clinical practice for both women and men, and greater health in all age groups across the population."

The WSDM Center evolved from Women's Health at Stanford, a multidisciplinary program that was started in 2001 within the Departments of Obstetrics and Gynecology. Moving the program out of the OB/GYN department reflects its widening scope. "We are eager to highlight the fact that every cell in your body has 'sex' as part of its chromosomal make-up; not just your reproductive organs and genitalia," says Stefanick, professor of medicine (SPRC) and obstetrics and gynecology.

The Center will unite the many Stanford faculty members conducting health research on women and sex differences in basic biology and the influence of gender on health and disease. The goal is to raise awareness of sex and gender across the Stanford community when designing research and to integrate and disseminate that consciousness into clinical practice.

Stefanick likens the WSDM Center to a start-up, with a small amount of initial funding to support unique educational venues and promote innovative, multidisciplinary research that will lead to larger and more comprehensive programs. For example, the WSDM seed grant program will be launched at a special workshop on September 27. Representatives from every department of medicine will present how their department's vision and mission interface or overlap with the WSDM Center’s vision and mission and the group will identify questions regarding sex/gender and women's health that need more study.

In other efforts, the Center will continue to raise awareness of the prevalence of gender biases in medicine. As Stefanick explains, even in cardiology, which has done more than other areas of medicine to raise awareness of its prevalence among women and its differing symptoms and pathophysiology between the sexes, the general population, including many health care providers, still think of heart disease as a "man's disease." "The 'door to balloon time' is longer for women than men," says Stefanick, "as is the time it takes an ambulance to arrive when a woman calls 9-1-1 with chest pain."

"This gender bias works in reverse, as well," she adds. One out of every three hip fractures occurs in a man, but most doctors consider osteoporosis a "women's disease" and guidelines regarding bone mineral density testing of older men are vague because of "insufficient evidence" (i.e. research data) regarding its usefulness.

"We are trying to increase awareness that gender-biases are a real and major factor in every age, race and socio-economic group," Stefanick says. "It is not a question of nature versus nurture. The influence of the biological (sex) and socio-cultural (gender) interface on health is very powerful and should be investigated."

Co-directing the Center with Stefanick is Lynn Westphal MD, associate professor of obstetrics and gynecology. Both directors feel strongly that the Center's emphasis should not be solely on women, but also on their male counterparts. "As we provide more personalized medical care, there is nothing more basic than looking at differences between men and women," says Westphal. Women have better outcomes than men in many disease categories, but worse outcomes in others. Investigating why, for example, men have more all-cause cancers and more heart disease, and die at higher rates than women in every age category until age eighty and older, could be of clinical benefit to both sexes, they say, as will learning why women suffer more from autoimmune diseases.

At the core of the sex disparity in medicine is the sex disparity in research; most basic research is still done on males. According to a paper published in Neurosciences in 2011, 90 percent of animal research is conducted on male rodents. In human research, that number is better at 60 percent male subjects. "Our basic understanding in medicine is often missing two key ingredients," says Stefanick, "first, whether there are sex differences and second, the role of gender."

By Grace Hammerstrom