Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts.
Harvard Medical School, Boston, Massachusetts.
JAMA Intern Med. 2020 Apr 1;180(4):574-583. doi: 10.1001/jamainternmed.2019.7194.
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.
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.
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.
生物性别和社会文化性别代表了患者多样性的主要来源，最近的研究表明性别与健康之间存在关联。越来越多的文献描述了性别与细胞、器官以及个体患者与医疗保健系统相互作用的方式之间的广泛关联。基于这些文献，性别和性别医学是一种新的临床实践和医学研究模式，它考虑了性别与疾病过程的每个元素的关联，从风险到表现，再到对治疗的反应。
构成性别和性别的特征既涉及内在因素，也涉及贯穿整个生命过程的外在因素。这篇综述详细介绍了具有广泛适用性的临床实例，突出了性别在遗传学、表观遗传修饰物、激素环境、免疫功能、神经认知衰老过程、血管健康、对治疗的反应以及与医疗保健系统的相互作用等关键领域的差异。这些领域以多维关联相互作用，导致性别和性别的多样性。新的研究已经确定了具有临床相关性的差异，有可能改善所有患者的护理。
临床医生应考虑将性别纳入其决策中，以实践整合患者个体基本要素的精准医学。认识到影响疾病过程的生物和环境因素对于优化每位患者的护理至关重要。研究强调了性别在健康和疾病中发挥作用的无数方式。然而，这些具有临床相关性的见解尚未系统地纳入护理中。本综述中描述的框架可作为指导临床医生在实践精准医学时考虑性别的指南。
