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Review
February 10, 2020

Clinical Advances in Sex- and Gender-Informed Medicine to Improve the Health of All: A Review

Author Affiliations
  • 1Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women’s Hospital, Boston, Massachusetts
  • 2Harvard Medical School, Boston, Massachusetts
  • 3Mary Horrigan Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital, Boston, Massachusetts
  • 4Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts
  • 5Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
  • 6Division of Women’s Health, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
  • 7Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts
  • 8Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
  • 9Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts
  • 10Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts
  • 11Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
JAMA Intern Med. Published online February 10, 2020. doi:10.1001/jamainternmed.2019.7194
Abstract

Importance  Biological sex and sociocultural gender represent major sources of diversity among patients, and recent research has shown the association of sex and gender with health. A growing body of literature describes widespread associations of sex and gender with cells, organs, and the manner in which individual patients interact with health care systems. Sex- and gender-informed medicine is a young paradigm of clinical practice and medical research founded on this literature that considers the association of sex and gender with each element of the disease process from risk, to presentation, to response to therapy.

Observations  Characteristics that underlie sex and gender involve both endogenous and exogenous factors that change throughout the life course. This review details clinical examples with broad applicability that highlight sex and gender differences in the key domains of genetics, epigenomic modifiers, hormonal milieu, immune function, neurocognitive aging process, vascular health, response to therapeutics, and interaction with health care systems. These domains interact with one another in multidimensional associations, contributing to the diversity of the sex and gender spectra. Novel research has identified differences of clinical relevance with the potential to improve care for all patients.

Conclusions and Relevance  Clinicians should consider incorporating sex and gender in their decision-making to practice precision medicine that integrates fundamental components of patient individuality. Recognizing the biological and environmental factors that affect the disease course is imperative to optimizing care for each patient. Research highlights the myriad ways sex and gender play a role in health and disease. However, these clinically relevant insights have yet to be systematically incorporated into care. The framework described in this review serves as a guide to help clinicians consider sex and gender as they practice precision medicine.

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