The scientific community has the urgent opportunity to produce more research on the proven health benefits of testosterone and other hormones for women.
We are often in the dark about women-specific health issues as a category of research. Female patients and their providers too often find only limited or incomplete research and, thus, a narrow spectrum of trusted healthcare and wellness options when seeking guidance for life-stage concerns, like premenstrual syndrome and menopause, and hormone-related diseases.
Left unheard and undertreated, women are turning to Google and peer forums for answers. Organizations like HysterSisters and Mesh News Desk are just two examples of online forums for women to share and read often-negative experiences related to hysterectomies, pelvic organ prolapse and hernias. And in the last two years, Facebook’s Menopause Support Grouphas grown from 11,000 to 84,000 members.
The harmful impacts of the absence of research-informed clinical insight are profound. Anecdata should no longer stand for science in women’s health.
Where does the gender gap in clinical knowledge originate? In part, with those who decide what subjects are worthy of research. Far fewer women than men are leaders of healthcare organizations and the authors of medical research. As of 2019, only 30% of U.S. healthcare C-suite teams, and specifically 13% of CEOs, are women. From 1994 to 2014, the percentage of female first authors on papers in six major medical journals (NEJM, Annals of Internal Medicine, the Lancet, JAMA Internal Medicine, JAMA, and BMJ) grew from 27 to 37%. The majority of this growth, however, occurred before 2009.
For research projects that are selected and funded, moderate progress is being made in including an equitable number of female bodies in their clinical trials. However, significant disparities still exist in the acknowledgement of gender in subsequent scholarly analysis, neglecting biological and metabolic differences between men and women. The number of studies including women has nearly doubled since 2009, yet there has been no improvement in the proportion of studies that then analyze results by sex.
As just one example of the harmful impact of ignoring such differences, the common practice of prescribing equal doses of medication to women and men risks overmedication of women and contributes to adverse drug reactions for women. Only last year were the differences in how heart attacks present in women highlighted and explored in a cardiology journal article.
Medical research objectives are largely selected by men and focused on men. Women are systemically left out of clinical trials and subsequent analysis. The result? Issues exclusive to women’s health are not even studied. The lack of scientific recognition of women’s health issues damages providers’ ability to discuss all aspects of female reproductive health with their patients, with 80% of medical residents reporting feeling “barely comfortable” discussing or treating menopause.
The issue begins in the programs through which these residents receive medical education. Only 20% of OBGYN residency programs provide menopause training, mostly through elective courses. In the field, dollars discriminate. As a subspecialty, menopause management pays less than other subspecialities.
With a systemic lack of knowledge on women’s health issues, appropriate and effective treatment options for women suffer, too. Only 57% of surveyed physicians were “up to date” on information regarding hormone replacement therapy (HRT) for menopause symptoms. The few significant pieces of HRT research that do exist are not comprehensive. The 2003 Million Women Study (MWS), which was highly publicized and drew a questionable link between HRT and breast cancer, was later deemed inconclusive by an assessment in the Journal of Family Planning and Reproductive Health. As recently as 2019, a Johns Hopkins OB/GYN collaborated to create a Menopause Guide and full curriculum for physicians, acknowledging that “very few” know how to treat its symptoms, and that “unfortunately, there has been a lot of misinformation and fear around the use of hormone therapy and other menopause treatments.” Women are left with treatment options ranging from medication that comes with pages of potentially life-changing side effects to organ removal.
The gender gap has become self-perpetuating. A lack of research and scholarly analysis on women’s health informs an insufficient medical education, which produces a field of medical professionals unprepared to appropriately understand and treat women. With the health of yet another generation of female patients at stake, I challenge the scientific community to produce more research on women’s health issues.
Terry Weber is the CEO of Biote Medical and a Founding Board Member of PreventiveMedicine.org.