Sex Matters How Male Centric Medicine Endangers Women's
Health and What We Can Do About It
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Copyright
Note: The information in this book is true and complete to the best of our
knowledge. This book is intended only as an informative guide for those
wishing to know more about health issues. In no way is this book intended
to replace, countermand, or conflict with the advice given to you by your
own physician. The ultimate decision concerning care should be made
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disclaim all liability in connection with the use of this book. The names and
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have been changed. Any similarity to actual persons is coincidental.
Copyright © 2020 by Alyson J. McGregor, MD
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CONTENTS
Cover
Title Page
Copyright
Dedication
Introduction
PART ONE
HOW WE GOT HERE
CHAPTER ONE Modern Medicine Is Male-centric Medicine
CHAPTER TWO Sex Is More Than Skin Deep
PART TWO
THE SIX BIGGEST ISSUES FACING WOMEN’S HEALTH TODAY
CHAPTER THREE Women’s Hearts (and Brains) Break Differently
CHAPTER FOUR Drugs for Different Bodies: The Female Side of
Pharmaceuticals
CHAPTER FIVE “Honey, It’s All in Your Head”: Women’s Intuition
Versus Women’s Imagination
CHAPTER SIX A Deeper Sensitivity: The Female Relationship to
Pain
CHAPTER SEVEN Beyond Hormonal: Female Biochemistry and
Hormone Therapy
CHAPTER EIGHT A New Perception: Gender, Culture, and Identity
Medicine
PART THREE
WHERE WE’RE HEADED—AND WHAT YOU CAN DO
CHAPTER NINE A Changing Conversation: The Future of Sex and
Gender Research in Medicine
CHAPTER TEN Your Voice, Your Medicine: How to Have Helpful
Conversations with Your Providers
Afterword
Acknowledgments
Discover More
About the Author
APPENDIX A Your Personal Medical Reconciliation (Med Rec)
APPENDIX B Quick Reference Questions
Resources
Praise for Sex Matters
Notes
THIS BOOK IS DEDICATED TO
All the women I have had the pleasure to care for,
who taught me about their illnesses and insight.
All the women whose struggles I have witnessed
through our medical system, through everything
from lack of understanding, to questioning self-
reflection, to endless testing that leaves them
feeling dismissed, they have persevered.
AND ALSO TO
My mother and sister, with immense love and
gratitude. As I studied medicine, I watched the two
of you navigate our medical system from the
outside; you helped me see the full circle.
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INTRODUCTION
AS AN UNDERGRADUATE in the University of New Hampshire’s premed
program, I took only one elective that wasn’t directly related to my major
(or, at least, I thought at the time that it wasn’t related). That course was
women’s studies. I loved circling up with other women to talk about the
history of women in society and the gender-related issues we faced both
individually and collectively. It was illuminating and truly inspiring. When
the class ended, and our spirited discussions were replaced in my schedule
by yet another biology lab, I felt like a bit of the spark had gone out of my
collegiate life.
I didn’t know it at the time, but that course—and the questions about
sex, gender, and the female experience it sparked in me—would have a
profound influence on the trajectory of my career.
When I finished medical school at the Boston University School of
Medicine, I applied for a residency at Brown University in my hometown of
Providence, Rhode Island. When my residency ended, I wanted to stay on
and work there. Because Brown is an academic institution, I needed to
choose a research focus in order to apply for a long-term position. When I
sat down and thought about it, the only path I wanted to take was one that
would improve the lives and health of women. I wanted to know about
women’s bodies and how those bodies affected (and were affected by)
modern medicine—in particular, emergency medicine.
At the time, sex and gender research didn’t even exist. My choice to
pursue a specialty in women’s health felt like a nod to my feminist beliefs
and personal philosophy, a way to keep feeding my passion for women’s
issues.
I had no idea just how deep an ocean I was diving into or how many
challenges I would face in bringing women’s unique health concerns into
the medical mainstream.
When I mentioned to my advisors that I’d like to explore fields related
to women’s health, the immediate reaction was, “Oh. You want to do
OB/GYN.”
“No,” I’d reply. “I want to study women’s health holistically. As in, the
overall health of women.”
No one seemed to know what I meant. That was my first clue about
what was really happening in our medical establishment.
As I discovered, and as I’ll share in this book, there is far more to
“women’s health” than pelvic exams and mammography. Women are
different from men in every way, from their DNA on up. The medical
practice of differentiating women from men according to their reproductive
organs alone is both reductionist and, as it turns out, hugely problematic—
but the male-centric model of medicine is so pervasive in our healthcare
systems, procedures, and philosophy that many don’t even realize it exists.
Most people simply assume that women’s differences are already being
taken into account—yet nothing could be further from the truth.
My research on and passion for this issue has placed me at the forefront
of a medical revolution. As a researcher, educator, speaker, and physician, I
—and my colleagues in this cutting-edge field—are tasked with integrating
emerging information about women’s health into the mainstream medical
culture. We are advocates for women and their unique bodies in a system
that has largely ignored them, marginalized them, and minimized them. We
are women (and a few good men) taking a stand for women in a way that
has never been done before.
Awareness Is the First Step to Change
As a nationally recognized expert on sex and gender medicine, I have made
researching and bringing awareness to health disparities between men and
women across all areas of medicine my life’s work. In addition to my “day
job” seeing patients in the emergency department of an urban trauma center
—and dealing with everything from colds to car accidents, headaches to
heart attacks, and broken bones to overdoses—I wear a few other hats: I’m
the division director for the first program in sex and gender emergency
medicine at the Alpert Medical School of Brown University and a
cofounder of the Sex and Gender Women’s Health Collaborative. I am also
a sought-after visiting professor and Grand Rounds speaker at medical
institutions across the country, and I’m a keynote speaker for community
advocacy groups, including the Laura Bush Institute for Women’s Health,
the Barbra Streisand Women’s Heart Center, the National Aeronautics and
Space Administration, the Society for Women’s Health Research, the
Organization for the Study of Sex Differences, and the Office of Women in
Medicine and Science at Brown University, among others. I’ve written or
cowritten over seventy peer-reviewed publications in scientific journals on
the topic of sex and gender, and I’m the lead editor for the medical textbook
Sex and Gender in Acute Care Medicine.
While much of my work is accomplished within the medical community
itself—through educating medical students and professionals, advocating
for changes in research guidelines and pharmaceutical prescribing
standards, and conducting research on sex and gender issues—changing the
system from within is only half the battle. The other half is educating the
women whose lives and health are being impacted by that system every
single day. My TEDx talk, “Why Medicine Often Has Dangerous Side
Effects for Women,” was intended to open the eyes of women around the
world to the issues discussed in this book.
Every time I talk about sex and gender issues in medicine, I hear stories
from women about how the system has ignored, minimized, or outright
failed them. This failure of care may not be intentional on the part of
women’s doctors and providers—but neither is it acceptable.
How to Use This Book
While this book contains facts and observations that you may find
revelatory or even shocking, my intention is for it to serve as far more than
an exposé.
Ultimately, information is more useful when it’s actionable. It’s not
enough for us to merely observe the scope of the problems women face in
our modern medical system or even to voice our feelings of anger and
betrayal at what we see; we need to always be asking, “What can we do
about this?”
This book is intended to be both informative and prescriptive. By the
time you turn the last page, I hope that you will understand not only how
male-centric medicine affects women in both broad and specific terms but
also exactly what steps you, personally, can take right now to begin to
reduce your personal risk factors and make grassroots changes in your local
medical community.
In Part I of this book, we will look at the broad picture of male-centric
medicine: how it came to be, how it works in practice, and how its lack of
recognition of women’s physiological differences is jeopardizing the health
of women across America and the world.
In Part II, we will look at specific disease patterns and areas of health
that impact millions of women across the country—including heart attacks,
strokes, pain disorders, pain management, and pharmaceuticals. We’ll also
look at the role of women’s hormones and biochemistry in various areas of
health, as well as at how issues and biases related to gender, race, ethnicity,
and religion affect medical treatment and outcomes both subtly and
explicitly.
In Part III, I’ll write you a prescription for action! We will look at how
the landscape of medicine is changing for the better and how you can tap
into existing resources to take a more active role in your own health care. In
Chapter 10, I’ll share specific questions you can ask your providers to help
you get the answers you need, as well as resources to assist you in your own
research.
By picking up this book, you have become part of a movement for
change. You have chosen to educate yourself about the realities of how
modern medicine treats women and their bodies. Throughout this book, I
will give you tools to translate your new awareness into advocacy—for
yourself and for other women like you.
As a patient and as a woman, you have a voice—and your voice matters.
This book will equip you to use your voice effectively in a medical setting.
You’ll learn what questions to ask, what pitfalls to look out for, what tests to
request or avoid, and what resources to employ so that you can receive the
quality of care you need and deserve. Effectively, you will become a more
equal partner in your own health care.
ON THE NEXT PAGE, you will begin your journey into the discovery of
women’s health as it stands in our current medical system. You will learn
things that will surprise you and many that may distress you. But in the end,
I hope that you will find in these pages a feeling of empowerment and the
knowledge you need to become a voice for your own health and the health
of women everywhere.
Are you ready to get started?
PART ONE
HOW WE
GOT HERE
CHAPTER ONE
MODERN MEDICINE IS MALE-CENTRIC
MEDICINE
I’LL NEVER FORGET THE DAY that a thirty-two-year-old woman almost
walked out of my emergency department while having a heart attack.
In emergency medicine, there are many algorithms by which we
evaluate risk factors and stratify incoming patients. Not everyone who
walks through the doors of the emergency department is on death’s door, so
we treat the most urgent cases first. For example, someone who’s
asphyxiating or suffering from a stab wound will be regarded as a higher
priority than someone suffering from nonspecific pain or who “just doesn’t
feel quite right.”
This risk assessment makes sense theoretically and works fairly well in
practice too. But once the obvious cases have been dealt with, we’re
navigating a large gray area. Unfortunately, the subtle (and often subjective)
strata by which we prioritize patients who don’t appear to be at immediate
risk are far from perfect—particularly when those patients are women.
Women are different from men in more ways than merely the obvious—
and nowhere is this more apparent than in the halls of the hospital where I
work and teach every day.
For example, the research upon which our stratification procedures are
based cites things like the “estrogen-protective effect” (meaning, the way in
which blood estrogen levels appear to reduce or modify traditional risk
factors like oxidative stress, arrhythmia, and fibrosis in premenopausal
women) and the supposedly low statistical likelihood of premenopausal
women presenting with acute heart conditions. In other words, even if a
young woman were to come into the ED and say, “I think I’m having a
heart attack,” unless she displayed blatant and very specific symptoms,
most doctors would immediately look for another explanation.
Julie, the young woman I met that day, had visited her primary care
doctor several times prior to coming to the emergency department and had
also seen at least two other physicians in the previous forty-eight hours. She
was experiencing discomfort in the region of her chest and shortness of
breath that worsened markedly the more agitated she became.
I was working in the critical care area when she came in. Immediately, I
thought to myself, This woman doesn’t look good. I had a gut feeling that
something was really wrong.
Her other doctors had attributed Julie’s symptoms to a combination of
anxiety and stress to her heart due to her obesity. The vagueness of her
descriptions when she talked about her symptoms, combined with her age
and the fact that she had been clinically diagnosed with anxiety several
years before, made her current discomfort seem like a no-brainer for her
doctors. She was having panic attacks, and her weight was compounding
the issue. End of story.
However, as a specialist in sex and gender medicine, I knew that during
myocardial infarction (MI)—aka, a heart attack—and other cardiovascular
events, women often present much differently than men. In fact, women’s
cardiac symptoms are often described as “atypical” and “unusual” in
medical literature. While men might experience pain radiating down the left
arm, chest heaviness, or other stereotypical signs of a heart attack, women
often present with only mild pain and discomfort, possibly combined with
fatigue, shortness of breath, and a strong feeling that “something isn’t
right.”
Julie was very pleasant, but I could tell she was scared. I calmly
explained that, while her current issue might be exactly as other doctors had
described, I would be more comfortable if we ordered an electrocardiogram
(EKG) and blood work to make sure things looked normal.
When we got the results, I caught my breath. There was something very
wrong here. This could actually be a myocardial infarction, I thought.
I immediately called our attending cardiologist. “I believe this woman is
having an MI and needs to go to the cath lab,” I told him. The cath lab is the
medical suite where a procedure to fix blocked arteries is performed.
“A thirty-two-year-old woman?” There was a slight pause, then a sigh.
“Oh, all right. I’ll send someone down to take a look.”
Like Julie’s previous doctors, the cardiologist’s assessment was that she
was displaying symptoms of anxiety. But her EKG was slightly abnormal,
so he finally agreed to take her to the cath lab.
About an hour later, I got a call from the cardiologist. “Dr. McGregor,”
the attending cardiologist began, sounding a bit astounded, “I wanted to let
you know that your patient, Julie, had a 95-percent occlusion of her main
coronary artery. We placed a stent to restore blood flow to her heart.”
An occlusion of the main coronary artery, in a man, is often called a
“widow maker.” We see it all the time in men over fifty and in a number of
postmenopausal women. And yet, here was sweet, thirty-two-year-old Julie
presenting with a condition that was likely to kill her in weeks, if not days,
if left untreated—and no one had thought to look for it because her
symptoms and risk factors weren’t consistent with the classic male model of
a heart attack.
Thankfully, Julie pulled through the procedure and recovered. I didn’t
see her in the ED again, but her story has stayed with me. Sometimes, I
wonder how many other women like her walk out the doors of other
emergency departments every day without receiving the lifesaving
treatment they need and deserve. Even one is too many—but I have a
feeling the number is much, much higher than that.
Our Modern Medical System Is Failing Women
The human mind built the automobile. It built televisions and computers
and smartphones. When these things break, we understand how to fix them;
we have an inventory of all the relevant components, diagrams of all the
working parts.
But we didn’t create our bodies. In some sense—whether you believe in
evolution, natural selection, or intelligent design—our bodies are mystical.
We are not developing them; we are merely trying to reveal how they work.
And, in many ways, they are still beyond our ability to fully comprehend.
When we approach our bodies from a scientific perspective, we are
therefore limited in our ability to hypothesize, study, test, and evolve our
