Women and men not only differ in how frequently they develop disease but also exhibit distinct symptoms, disease trajectories, and responses to treatment across many internal medicine conditions. Failure to account for these differences risks systematic undertreatment and misdirected care.

Speaking at a DGIM press conference, Dagmar Führer-Sakel, MD, PhD , a professor and president of the German Society for Internal Medicine (DGIM), and director of the Clinic for Endocrinology, Diabetology, and Metabolism at Essen University Hospital, Essen, Germany, said, “We are currently experiencing a wealth of scientific findings, new therapies, and technologies that represent a revolution in diagnostics and treatment, changing our perspective on health, illness, and the human being as a whole.”

In internal medicine, care must shift from assuming a standard patient or rigid protocol to addressing each individual’s unique risk profiles. In this context, personalized medicine — particularly gender-sensitive medicine — is coming sharply into focus, she emphasized. She added that the success of modern internal medicine hinges on translating scientific insights into superior patient outcomes.

Gaps in Gender Specific Care

Despite growing awareness, gender-sensitive aspects remain insufficiently integrated into daily practice. “If we fail to consider or continue to ignore differences between women and men, we risk undertreatment and misdirected care,” warned Petra Maria Schumm- Draeger, MD, PhD, endocrinologist, and medical director of the Center for Internal Medicine Fünf Höfe in Munich, Germany.

Type 2 diabetes illustrates this issue. Biologically, women initially have advantages over men, including a lower risk for cardiovascular (CV) disease at younger ages. However, if women develop type 2 diabetes before menopause, the pattern is reversed. The risk for CV disease increases markedly. When additional risk factors, such as hypertension or dyslipidemia, are present, women may have an even higher risk for CV disease than men. Complications such as kidney disease, depression, and anxiety disorders also occur more frequently in women.

Not Optional Knowledge

In clinical practice, these differences have only been partially addressed in the past. “Especially in such cases, early action and intensive guideline-based treatment would be essential, yet our clinical reality often shows the opposite,” said Schumm-Draeger, who also serves as a spokesperson for the DGIM Commission on Gender-Sensitive Medicine. Established in 2024, the commission aims to consolidate and critically evaluate scientific evidence on gender-specific mechanisms in the epidemiology, diagnosis, therapy, and prevention of internal medicine conditions; stimulate research activity; and develop practical gender-specific treatment recommendations and guidelines.

“Gender-sensitive medicine is not only about women. It also concerns situations in which men are treated too late, as is often the case with osteoporosis,” Schumm-Draeger emphasized. Therefore, gender-sensitive medicine is not an optional add-on but a prerequisite for contemporary personalized care. Internal medicine bears the responsibility of systematically integrating this knowledge into research, guidelines, and daily clinical practice in the interest of more equitable care.

CV Risk Underestimated

Education and income in Germany strongly influence healthcare access, scope, and use. According to Ute Seeland, MD, PhD, a professor of gender- and sex-specific medicine and prevention at the medical faculty of the Otto-von-Gutenberg-University Magdeburg, Magdeburg, Germany. The lower average income of women creates a more challenging starting position than that of men. She also noted that functional symptoms during puberty and perimenopause have long been insufficiently addressed. In addition, women were underrepresented in earlier clinical studies, resulting in gaps in gender-specific evidence, as recalled by Georg Ertl, MD, secretary general of the DGIM.

Seeland pointed out that among 16 European countries, Germany ranks 15th for male life expectancy (78.8 years) and 14th for female life expectancy (83.5 years). One contributing factor is the elevated CV mortality among individuals aged 50-79 years. “This age group is often diagnosed too late in Germany, and prevention overall receives too little attention,” Seeland stated. The comparatively low life expectancy sharply contrasts with the level of investment in the healthcare system.

The CV protection in women is frequently overestimated. However, postmenopausal women with ischemic heart disease or valvular heart disease have higher mortality than men, Seeland reported.

Data from the MONICA/KORA Project Augsburg, analyzed by Seeland and colleagues, further showed that 30-day in-hospital mortality after acute myocardial infarction is higher in younger women than in men of the same age. Thirty-day mortality was 30% in women and 18% in men. “In countries where gender-sensitive medicine is more firmly implemented, this ratio is more favorable,” Seeland said.

She added that health systems in Scandinavian countries, such as Sweden, which invested earlier in prevention and gender-sensitive personalized medicine, now perform better in terms of population satisfaction.

More Precise Diagnosis

Gender-sensitive medicine also accounts for interactions between sociocultural determinants and known gender and biological sex. Biological sex is determined by the X and Y chromosomes, whereas gender is a construct describing individual, nonbinary sociocultural identity, including socially defined roles, behaviors, expressions, and identities.

To better leverage sex differences in disease prevention, Seeland argued that sociocultural gender should be systematically recorded. Therefore, gender scores were used in her academic outpatient clinic. Each individual is characterized not only by biological sex but also by sociocultural gender norms.

According to Seeland, sex-sensitive medicine may reduce misdiagnosis, adverse effects, and hospital admissions through more precise diagnoses and more individualized therapies; however, direct comparative studies are still lacking. In the long term, a systems biology approach could lower treatment costs and increase the gross domestic product through higher workforce participation among women. This may also make the potential of marginalized groups more visible and accessible for targeted solutions to be developed.

With the recent investment boost in women’s health research by the German Federal Ministry of Health and the Federal Ministry of Education and Research, opportunities are expanding to study sex differences nationwide rather than at isolated universities. This broader effort could help close the gender data gap, Seeland noted.

This story was translated from Medscape’s German edition.