Diagnosing Gender Differences in Health


When Bonadel Enloe collapsed in a store and found she couldn’t use her arms and legs, doctors said the 66-year-old woman was depressed.

Her daughter called Dr. Marianne Legato, an internist who has written several books on women’s health, and described her mother’s symptoms. “Your mother has a brain aneurysm,” she said.

The diagnosis proved correct.

Legato uses the story to illustrate the problems women often face when physicians dismiss their symptoms as hormonal, emotional or imagined.

Now she has formed an organization she hopes will help change the way women are diagnosed and treated: The Partnership for Women’s Health, sponsored by Columbia University’s College of Physicians and Surgeons with financial support from Procter & Gamble.

The partnership will study “the science of how normal human biology differs between men and women, and of how the manifestations, mechanisms and treatment of disease vary as a function of gender,” Legato said at a news conference Feb. 13.


The partnership has already set up a website answering common questions about women’s health. It is about to start a database called Genspec that features the latest medical studies involving women or emphasizing differences in how men and women manifest disease and respond to treatment.

Legato calls the field of study “gender-based medicine.”

Dr. Vivian Pinn, director of the National Institutes of Health’s Office of Research on Women’s Health, said the partnership’s goal of establishing a clearinghouse for information was greatly needed.

“We can do all the research in the world we want, but if it doesn’t reach the practicing health care provider and the consumer, we’re not going to make a difference,” Pinn said.

Legato said the partnership will also identify areas where more research is needed and then try to match corporate funding with capable scientists. Procter & Gamble is starting the research off with $1 million for two studies, one on how gender differences in heart cell membranes may affect cardiac rhythm, and the second on how sex hormones in men and women affect bone metabolism and osteoporosis.

The partnership will also try to collect data and spur research on why women live longer than men; why women are more likely to develop autoimmune diseases like lupus; differences in how men and women metabolize certain drugs like Valium; differences in saliva flow rates, which may have implications for tooth and gum disease; and differences in brain tissue, which may influence mood, behavior and a variety of disorders.

For years, many clinical trials for drugs and other treatments were carried out on men without consideration that women might respond differently. Federally funded clinical studies must now include women, and the American Medical Assn.'s policies state that “results of medical testing done solely on males should not be generalized to females without evidence that results apply equally to both genders.”

“How do you know there is a difference?” asked Pinn. “In some cases we don’t know. The whole scientific approach here is to give us more knowledge.”

Legato would also like to see the average woman’s health concerns taken more seriously by practicing physicians. For women like Bonadel Enloe, whose aneurysm was misdiagnosed as depression, that will make a tremendous difference.

“If that had been a man who collapsed and couldn’t move,” she said, recalling her ordeal, “I’m sure they would have moved heaven and Earth to find out what was wrong with him.”

The website for Partnership for Women’s Health is: