Women’s History Month: The Role of Hormones in Brain Health Differences

Over the past few decades, the scientific community has shed some light on the vast differences between male and female patient health with an increasing focus on female cardiovascular disease pathology. The reason underlying varying reactions to the same diseases between men and women has been related to the brain, and in particular, sex hormones. Testosterone and estrogen are not only vital to fertility and reproductive functions, but they also play a critical role in brain health, and in particular sex-based risk factors associated with neurodegenerative disease. Emerging research reveals that the brains of males and females are much less different in structure than in how they age as well as the effects aging has on their brain health.

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Women’s History Month: Gender Disparities in the Medical Practice

Female physicians continue to make incredible progress in the practice of medicine yet gender-based disparities persist routinely leaving them underrepresented and under-compensated in the field. Despite identical workloads and responsibilities, women are still paid less than their male colleagues. They also hold fewer leadership roles in the executive suite, in organized medicine, as well as in academia; in addition, they are more likely to be passed over for tenure at major academic institutions and tend to have fewer bylines in academic journals. Efforts to address gender disparities have been successful to an extent yet female physicians continue to face gender-based barriers in their practice as a result of a variety of systemic factors.

Factors Contributing to Gender Gaps

According to a study recently published in JAMA Network Open, a lack of scheduling flexibility, availability of on-site child care, support for physician mothers returning to work, as well as expanded paid leave contribute to difficulties in balancing employment, especially in the case of working mothers.

Underrepresentation also plays a significant role as future female physicians have fewer opportunities for networking, sponsorship, and mentorship. An analysis of U.S. and Canadian conferences determined that the visibility of women as speakers at academic medical conferences is an important part of gender equity. Conferences represent opportunities for networking and mentorship yet the vast majority of speakers at these events are male.

Additionally, in low- and middle-income nations women are at an even stronger disadvantage due to lack of access to resources such as education, employment, and healthcare making it difficult for them to pursue academic and professional careers. 

The Gender Pay Gap

A recent international Medscape study female primary care physicians (PCPs) in the U.S., United Kingdom, Germany, France, Brazil, and Mexico report being compensated at rates between 20-29% lower than their male colleagues. In Brazil, pay inequity was the greatest with female providers earning up to $11,000 less annually than male primary care physicians. Although it had the smallest discrepancy among the nations,  Germany reported female physicians making a salary of $157,000 as compared to men who make $189,000 per year. Meanwhile in specialty care, providers reported even wider gaps in gender pay ranging from 19% in Spain up to 47% in Germany.

The gender pay gap in medicine, and most other professions, has often been attributed to women working fewer hours – however, evidence of this remains limited. Researchers conducting a 2020 study published in The New England Journal of Medicine found that female primary care providers generated 10.9% less revenue from office visits than their male colleagues and conducted 10.8% fewer visits over 2.6% fewer clinical days yet they spent 2.6% more observed time in visits overall.

After adjusting for PCP, patient, and visit characteristics, female physicians generated an equal amount of revenue while spending 15.7% more time with their patients. Results remained consistent in subgroup analyses regardless of gender, health status of patients and type and complexity of office visits. Overall, it was revealed that female PCPs generated less visit revenue than their male counterparts at the same medical practices due to a lower volume of visits yet they spent more time in direct patient contact per visit, day, and year.

Addressing Gender Disparities 

The factors contributing to professional gender disparities are also the ones that shape a woman’s career trajectory and compensation therefore it is crucial to identify the areas in which the system fails to support female practitioners and address them accordingly with policy updates and amendments. At the same time, strategic actions need to be taken at an institutional level to help reshape systems women work within; it is up to healthcare institutions to make gender equity a priority.

Moving forward, an essential component of initiatives addressing gender disparities will be metrics used to track gender data ranging from the number of women in editorial or executive positions to faculty salary and number of appointments. Alongside tracking the representation of women in leadership roles, institutions need to offer training in implicit bias and how it relates to institutional bias as well as advocate for sponsorship and sponsorship programs tailored to female practitioners.

Although the field of medicine has expanded greatly, much more remains to be accomplished in terms of gender equality in practice, pay equity, and the lack of institutional support for women who now represent over half of all medical students in the United States. Recognizing the multitude of factors that impedes career development for female practitioners is the first step toward fixing the prevailing problem, many more will need to be taken before gender gaps can be successfully bridged in all facets of the medical industry.

Brain Awareness Week: Brain Health and the Female Patient 

Taking place between March 15-21, 2021, Brain Awareness Week is a global campaign aimed at promoting brain science and research while working to further public awareness of brain health. As a field of medicine, brain health belongs at the forefront of patient health, especially in the case of women as it is considered a vital marker of female health. However, the female brain has been largely overlooked in research efforts and by the scientific community in the past spotlighting a pressing need for increased consideration of the aspect as a facet of overall health.  

Currently, it is estimated that 3.3 million women aged 65 and above have Alzheimer’s disease (AD) in the United States – comprising approximately 67% of the AD patient population comprising approximately 67% of AD patients. Overall, women face an increased risk of developing AD due to hormonal shifts that occur during menopause which can increase the risk of neurological changes. Furthermore, women above the age of 60 are twice as likely to develop Alzheimer’s disease over the course of the rest of their lives as they are to develop breast cancer yet the condition is not widely recognized as a women’s health issue. As current and emerging clinical data indicate, the disproportionate prevalence of neurodegenerative diseases in female patients necessitates more comprehensive medical intervention and the development of targeted prevention initiatives.

The Female Brain and Alzheimer’s Disease

According to recent research from investigators at Weill Cornell Medicine  women in mid-life have approximately 30% more Alzheimer’s-related plaques than men of the same age. As part of their study, researchers evaluated 121 middle-aged participants without AD symptoms and with the presence of some risk factors such as genetic risk or a family history of disease. They discovered that women also had a 22% lower brain glucose metabolism indicative of lower energy levels in the brain, as well as 11% more brain shrinkage. Both of these neurological biomarkers were associated with menopause.

Noting the significantly increased brain changes associated with AD in female participants, the team of researchers set out to identify relevant risk factors, including age, education, cholesterol levels, smoking status, dietary habits, exercise levels, diabetes, menopause, hormonal therapy, and hysterectomy among others. They found that menopause was the primary predictor of Alzheimer’s disease-related changes in women’s brains and while hormonal therapy was also associated with the condition, women undergoing treatment exhibited fewer negative brain changes.

Although additional research in this field is necessary, the latest findings point to the need to address Alzheimer’s disease-related risks in female patients at an earlier age and with more strategic interventions. Further study is needed to determine what types and doses of hormonal therapeutics may prove beneficial for brain function while also minimizing the potential for adverse health effects.

Menopause, Hormonal Risk Factors, and Neurological Health

Although menopause is not often associated with the brain, approximately 80% of women going through menopause experience at least some neurological symptoms ranging from insomnia and memory loss to depression and anxiety. Left unaddressed, these changes may escalate to serious neurological conditions.

Despite being the only neurodegenerative condition that affects more women than men, Alzheimer’s disease in the female patient remains under-recognized. Gaps in knowledge and scientific literature highlight the need to explore the specific factors that contribute to women’s increased vulnerability to a number of conditions that negatively impact overall brain health. A growing understanding of the varying reasons underlying cognitive changes in both women and men as well as the sex differences in neurological aging and function will likely change the way AD and other neurodegenerative conditions are treated.

Due to advances in research, there are newly discovered opportunities to identify, address, and act upon telling risk factors before clinical symptoms of neurological conditions emerge. Doing so will require comprehensive training and medical education for physicians, enhanced public awareness, and strategic prevention initiatives. Compelling evidence exists revealing the significant benefit of specific medical and lifestyle practices on female brain health; lifestyle interventions can be both safer and better tolerated than traditional pharmacologic approaches while also being just as effective. Most importantly, prevention and treatment protocols should be tailored to each patient’s unique risk profile and needs and incorporate brain health as part of a holistic view of patient care.