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At the 131st Congress of the German Society for Internal Medicine in 2025, leading experts highlighted the urgent need for truly personalised medicine that recognises the unique backgrounds and identities of each patient.

Marie von Lilienfeld-Toal, MD, PhD, director of Diversity Medicine at Ruhr University Bochum, Bochum, Germany, set the tone by declaring, “If you want to treat me, you have to know who I am,” a statement that encapsulates her institute’s mission to integrate diversity into clinical care.

She was joined by Livia Prüll, MD, of Johannes Gutenberg University Mainz, Mainz, Germany, who explored the historical and societal influences shaping medical practice, and Uwe Koppe, PhD, an epidemiologist at the Department of Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany, who addressed the specific health needs of transgender and nonbinary individuals.

The panel highlighted the importance of understanding each patient’s identity and context as a foundation for effective and equitable healthcare.

Medical evidence is typically based on studies involving highly selected patient populations. The more an individual’s characteristics differ from those of the groups, the weaker the evidence for those individuals.

Gender-Specific Biologic Differences

Disease severity and progression depend on several factors. For instance, individuals with a biologic male sex have a 5-year shorter life expectancy, a higher risk of developing cancer, and a greater risk of dying from cancer than those with a biologic female sex.

Women with colorectal cancer (CRC) tend to have more active immune systems and less inflammation than men with CRC. This may be linked to their two X chromosomes, which carry tumour suppressor genes that are either lost or downregulated on the Y chromosome in men.

Treatment Variability

Men were overrepresented in most CRC studies. In a pooled analysis of CRC treatment with bevacizumab, age did not affect treatment efficacy in men. In contrast, age made a significant difference in women; postmenopausal women over 60 years of age benefited from the treatment, whereas the treatment was ineffective in premenopausal women.

Women are also more likely to experience certain side effects than men. For instance, women often develop neutropenia and leukopenia with various CRC chemotherapies, whereas men more frequently experience thrombocytopenia.

Socio-Economic Impact

A study conducted in Hamburg, Germany, found that approximately 70% of patients with CRC who had fewer social disadvantages were still alive 5 years after diagnosis compared with just 60% in the most disadvantaged group. This difference may be linked to insurance type, as privately insured patients are more likely to receive specific treatments.

These regional socio-economic disparities affect men more strongly than women.

von Lilienfeld-Toal and colleagues are currently studying the diverse characteristics patients bring with them such as mental health, physical limitations, religion, and place of birth.

“The task is to truly put this knowledge about individual circumstances that are relevant in a medical context into practice. We can achieve this by systematically becoming aware of these factors and learning from them so that we can close these blind spots,” she explained.

Medical Challenges

Prüll emphasised the urgent need for greater knowledge and awareness of transgender individuals, who remain underrepresented in medical research.

“The lack of information, even in the medical field, leads to transgender individuals not receiving adequate treatment,” she said.

This gap begins with an understanding of the biologic and emotional experiences of transgender individuals. The term “transsexuality” is outdated and misleading, as it refers to sexual orientation rather than a person’s perceived gender identity.

In transgender individuals, gender identity does not align with the biologic sex assigned at birth. For instance, biologic sex refers to the physical traits assigned at birth, such as being male, female, intersex, or transgender. Gender identity describes how a person understands themselves, including cisgender men and women, transgender men and women, and non-binary individuals. Sexual orientation refers to who a person is attracted to, such as gay, lesbian, heterosexual, bisexual, pansexual, or asexual individuals.

In transgender individuals, there is a mismatch between their perceived gender and the biologic sex assigned at birth.

Over the past century, the medical and social treatment of transgender individuals has evolved significantly.

Pathologisation has decreased, social acceptance has grown, and the Self-Determination Act now allows individuals to freely choose their first name and marital status. Medical advances include the following:

• Improved access to psychological and psychotherapeutic counselling.
• Availability of physical gender-affirming treatments, such as hormone therapy and surgery.
• Development of medical guidelines such as the Association of Scientific Medical Societies in Germany for collaborating with transgender individuals. However, several major challenges remain.
• Health insurance coverage for gender-affirming treatment remains unregulated.
• Trans-identity is not widely included in medical education or professional training.
• Acceptance and proper medical care for transgender individuals are limited in clinics and practice.

These gaps are reflected in the findings of a large participatory study led by Koppe.

Conducted by the German AIDS Aid and the RKI, with input from community representatives and funding from the German Ministry of Health, the study addresses a critical data gap in Germany.

International research has shown that transgender individuals are at an increased risk for HIV infection.

Guidelines recommend pre-exposure prophylaxis (PrEP) for HIV prevention in this population; however, prior to this study, data on transgender individuals in Germany, particularly non-binary individuals, were insufficient.

The study found significant gaps in care and access to healthcare.

Approximately 1 in 5 participants had potential HIV risks, but only 44% had been tested in the past 5 years, and 8% had used PrEP. People in large cities and those who had received counselling were more aware of PrEP.

Although 45% of respondents wanted to seek counselling on HIV or sexually transmitted infections in the past 5 years, only 27% received counselling. Of those who did not, 17% said it was due to fear or past discrimination as the reason for not seeking counselling.

Among those who received counselling, satisfaction with the counselling service was higher, particularly tailored for transgender and non-binary individuals.

The complete results can be found in the full research report from the RKI and in a brochure published by German AIDS Aid.

This story was translated from Coliquio.