Gender Medicine
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Hiltner, Sarah
Sex- and gender-specific medicine (SGSM) is a young field that managed to recently establish itself all over the world. Though mostly called gender medicine it actually investigates sex specific differences of the two most prominent sexes: male and female. There are also aspects of the gender identity that impact the interaction of doctors and patients, as well as coping strategies, treatment suggestions and side effects of medication The following aspects will be presented in this talk: Where does this area of research come from? What does it actually do? Why is it important for women and men? And when is it appropriate to talk about sex and when to talk about gender?
 Sarah Hildner, she is research assistant at Charité Berlin. We'll introduce us in the field of gender medicine. Yes, thank you very much. We're waiting for the presentation to be set up. Till then I can just introduce myself. I'm a physical therapist and also a sociologist. And I'm currently doing my masters in sociology researching how gender medicine is being implemented all over Europe in medical studies. I help you with the... Yeah. Right there. 16. And the sex standard met. Okay. And my bachelor thesis, I looked into cardiology textbooks and how the sexes are being represented there. And it was very fascinating because the books I looked into were from late 2000s and they actually missed most of the current knowledge about heart attack in women and men and how they differentiate, which was very surprising to me because the knowledge has been researched for the past 40 years by now. And maybe now I will have a presentation as well. There's also a hashtag. I want to introduce this hashtag sex gender met as an abbreviation for sex and gender sensitive medicine. And if you want to reach me on Twitter, it's Sophie Hildner. And I will... Maybe we'll start seeing something. Yeah. Yeah, I'm a Republican. You did a session here two years ago and it was more exercise. Maybe we could do some exercises or do we get... Yeah, something to wake you all up because you've been probably sitting all day. Please follow me. This is the rabbit. Just do it yourself. And this is the hunter. Now the rabbit is a really smart cookie. So he jumps around, makes a turn and suddenly they switch the role. Yeah, yeah, yeah. Try to just do the hunter and switching the hands. Yeah, great. I see some hunters are missing the hook. Oh, there's a three-eared rabbit. Okay. Now the rabbit can usually jump. So only the rabbit jumps, of course, the hunter can't do this because then it won't work. Okay, yeah. And one more level would be the hunter is shooting, the rabbit is jumping. In case you're really frustrated with your work and you need a break and laugh about yourself, this always does the trick for me. Took me like a year to do it like I do it now. Yeah. Well, I'm excited to be here. Thank you all for being here. Is there a question in advance? If you shouted loud enough, I can repeat it. So we have it on. Okay. I will try to just do the talk, but I do need my slides for myself. So we're going to start an ancient medicine. That's where it all started because the widespread belief was that there's only one body and that actually all humankind is male, but that the females did not have enough fire inside them to turn their internal organs out. So they're the men. So women were always the imperfect version of a man. Can I continue here? And we call it the one sex model, meaning that there's only this one sex. And later on, this dominant ideal of masculinity and that the men are perfect, leading to women being imperfect and the more sexual, the more carnal versions of man. And this was supported by religious beliefs and it continued to develop hierarchical models inside society. So actually society reflected this belief and made sure that women were dominated and subordered and that most privileges were reserved for white, educated, healthy, middle and upper class men, all based on the belief that these bodies, they have a hierarchical order as well. Now I can't even look at my slides. So there was this one sex model. Everybody is the same. They're all men except the ones that are not men. They're imperfect men so they can be dominated by the perfect men. Then times changed. Whoa. Yes, times changed. Thank you very much. Thank you for your presentation. I wanted to start with this because this is one of the quotes in one of the medical textbooks I have. It is referring to a myocardial infarction and in the case of a heart attack that you have to immobilize the patient and remove restricting clothes, the tight shirt collar and the neck tie. Unfortunately, she's a woman. Having a bra while having a heart attack can be quite uncomfortable as well. So this is for me a perfect example why women are out of the picture, not only in but also explicitly when referring to diseases. So the imperfect men we already have, the privileges. In modernity, we had certain revelations. The microscope was developed. Natural science were developing as well. And they all challenged religious and traditional beliefs that there was a hierarchical order. But the one that challenged the most was Darwin when he said that the origin of the species actually was in contradiction to what the Bible was saying. So then everybody focused suddenly on genes and on hormones trying to establish the belief that men and women are so differently that it actually, from the 16th to 19th century, especially on brain studies, the belief changed rapidly. Like on one century, men were the emotional ones, then women were the emotional ones. Then men were the emotional ones again. So you see that the signs, they all backed it up by what they called signs, have helped them to show that there are difference between the sexes to actually find a validation for a social order that was dominant. Then they moved on to the two sex model. And this originated the term bikini medicine as we have it today. Like all the parts being covered by a bikini referring only to the reproductive organs of women, which are all outsourced in gynecology, but assuming that in all other areas of medical education and well as medical treatment actually are the same. Because we still, in medical tradition, it's still believed and assumed that the actual body of men and women are the same. And that is the problem we are fighting against in sex and gender sensitive medicine. So to come to the point today where we actually do research on the differences of the biological sexes, and I am referring to your genome and your setup, and if it is an XY, an XXY, or two X's, or one of the other many variations there are, you do have a genome that is influencing how your body reacts to certain aspects of nature, to make you vulnerable to certain diseases. And so that we can all do this right now has a long tradition of fighting for rights, fighting for interest in those matters, and that evolved from human rights movements, women rights movements, then came women health aspects that were very interesting. And then the women's, out of women's health, and that is one problem we always have to fight against when we're talking about sex and gender sensitive medicine, is that everybody believes it's only for women. And well, to a certain aspect, yes, we have to catch up a lot of the research that hasn't been done for women right now, but we also discover a lot of things that are very helpful for men as well, and I will come to that in a minute. Basic definition of sex and gender, actually, when I say sex, I'm talking about your biological setup of your body, the way your genome is designed, and how these hormones, for example, will influence how you metabolize medication. And women are actually having a menstrual cycle. There are three phases where they react very differently to medication, and that has not been researched properly because it's very expensive because you would need a group of women that are premenstrual, you will have a group of women that are menstruating, you will have a group of women that is postmenopause, and of all these women you also need several groups inside them due to the cycles they go through, which makes research in this area very expensive because you would have per age group at least nine groups, at least for the women. And I'm pretty sure that men have cycles as well, although don't that as obvious as maybe the female ones. When I talk about gender, I'm referring to gender roles, gender identity that is actually produced constantly in society. How we act as men, how we act as women, how we act as trans person, how we are classified by our looks and perceived and what the expectations to us are, and that also influences in medicine, for example, the way you take your medicine, how you're complying with doctors' orders. Women tend to comply a lot better than men. Women sometimes do, sometimes don't care about when they take the medication they are prescribed. I also want to make sure that it's not all men and all women, I'm talking about statistics and most prominent groups. Some results from science. In cardiology, for example, the heart attack has symptoms most people know as a strong chest pain, pain going through the left side of your body and feeling very uncomfortable. In women, nausea, vomiting and back pain, you dissociate instantly with a heart attack. Unfortunately not yet, but they are more prominent in women, but they are also men that can have only these symptoms and suffering a heart attack. So we need to catch up on research and update all the textbooks on it as well. Women have the heart attack a lot later and if you have diabetes, you're more prone to receive a heart attack in general, at least twice as likely as a healthy man and at least four times as likely as a healthy woman. So when you are diabetic and you're female, you're having a heart attack is very likely event. In therapy, yes, and when you're smoking and taking oral contraception is also endangering you of suffering a heart attack and or a stroke as well. And it was only mentioned in one book of the 10 I have investigated from the 2008 to 2012, which was a very big surprise because the amount of women smoking is increasing as well. And oral contraception is also available and being taken very frequently. Aspirin on the other side is preventing men from having a heart attack, but not women. In women it prevents more having a stroke. Why this is? They haven't really found out, but there's still research going on, but that it is a fact has been proven by several researchers. And what you all can do to prevent a heart attack is do at least one hour of sports a week. Another thing is that when you have high blood pressure, the risk of suffering it depends not only on your age and your sex, but also on your ethnicity and of course your background. And I want to point out, can I point? I can't point. Like this? No. Can I go in? Yes, can you help me with this? What I want to point out is, I need to get this window away. I want to point out that the numbers for the people of color being 50 and 60 are actually the same as for the white people when they're 60 and 70. So when you're a person of color, you are 10 years earlier and being prone to having a heart attack, which brings me to the point that actually that the incidence of diseases is often correlated with your access to and your understanding of knowledge and the healthcare system. So poverty actually makes sick and since more women are on the poor side in all over the world, they're more likely to be sick as well. In psychiatry, depression have variations in the symptoms. Women tend to react more with anxiety while men tend more to be substance abusers and addicts and also tend to turn out their depression and show it in more aggressive behavior. And when you think about it, anxiety and aggression are like two parts of a spectrum and they're kind of also related to gender identity because aggression is also seen as a very masculine trait and being timid and rather withdrawn, a more feminine trait, at least what concerns the gender identity in our society, which I think is kind of remarkable. In the therapy of severe depression, when you need to take medication to come back to life again, tricyclical antidepressants are more helpful than men and have been proven that they have a better effect than men while SSRIs, the selective serotonin reuptake inhibitors, more helpful in women. Osteoporosis is, in most people known as a female disease, and yes, women are more endangered to having osteoporosis, but men we found out are also endangered to suffering from osteoporosis. And the most interesting thing is that the last part is the five-year survival rate after your first fracture due to osteoporosis, and that is when you're a woman, you're more likely to survive it because most times the doctors in yourself are more aware that it's actually a possibility to have osteoporosis anyway. And in men it comes often as a surprise because doctors are still not aware that it is possible, that it's likely for men to have osteoporosis. The neurology, multiple sclerosis and migraine is more prominent in women, and amyotrophic lateral sclerosis and epilepsy is more common in men. Now the trait, the treat at the end for me is always pharmacology because there's so much going on there that is very, very bad for particularly women because most test subjects are young, healthy men. And one example is the Viagra for women that had a measured effect in the trial participants of 9 to 14%, which was the same as the placebo, so you actually don't know if it had an effect. And the FDA approved it after some trials that included 25 people, and since it was a medication, for women they even had two women in the test group, which I think is so ridiculous that I don't even, I'm missing the words. So hands on, communicate with your doctor, particularly if you notice reactions with medication, especially as a woman, most of the medication has not been tried out for men and women. A lot of the side effects are heavier in women, and particularly if you're a very slender woman, the medication might be overdosed for your body weight and height. And if you want to challenge your doctor, ask them if you have to consider your menstrual cycle in any way by taking the medication at a certain point because that does have influence on how your body metabolizes it and how long it stays in your system. So ask your doctor if he or she knows about the sex differences because we all have to work together to raise awareness for the whole subject because it is still not a part of the curriculum in medical education. Only a few schools all over Europe have some courses, most of them are not mandatory but electives, and we all need to take care that our doctors stay up to date with what they know. Thank you very much. And there will be an advanced metered greet at 2 p.m. at the mattresses behind the dome with my colleagues from Hacking with Care. They're presenting on stage two right now, so please check out their talk when we are all done, and it's online because we are collaborating to help activists with their bodies and their well-being. Yes, now it's time for questions and answers. Thank you very much. So funny so that was a mic. Any questions? I'm wondering, like every now and then you get to read some articles about actually the oral contraception for men has been invented, but there's no interest in introducing it to society. Do you have a stand on that? Or statistics even, maybe? I don't have a statistics on it, but it is difficult to bring contraception to men because it is, although there are some voices that cry out and say I want it, I need it, as far as I know, they haven't had an impact yet to actually develop it and bring it to the main market. I would think it would be great to be responsible and take care of your own fertility in that way, particularly as a man. Any other questions? We have time for another question. Who's next? There's a mic. Lady over there. Can you raise your hand to show funny where you are? The rabbit is running again. I was wondering, because you closed by saying we should all kind of question decisions our doctors make or at least kind of ask for reasons why they do that. Don't you think this issue has to be tackled at a different level? Because I feel like at first doctors are technically in a hierarchical position because we assume they have knowledge that we don't have, which is the reason why we go to them in the first place. And then if we say generally they're not aware of this or of many aspects of this, how can we rely on them giving us a reasonable explanation for something that they don't really know about? So don't you think at what other level do you think is necessary to kind of tackle the problem in that case? One thing I think is important is approach. And that's what I'm also doing or what we're doing in gender medicine societies is approaching specialist societies like the cardiologist society and the society of the neurologists and approach them and tell them how about that you start at least offering courses where medical doctors, I mean every medical doctor at least in Germany has to collect a certain amount of education classes a year and they're required to do it or otherwise they lose the license. But as far as I know none of the big associations have yet introduced a course for gender sensitive treatment or information for the doctors. So that is one part that's really rigid and what I experienced from the medical system because you said it's hierarchical when you come as a patient but the medical system inside itself has also a strong hierarchy and it hasn't been yet so gender friendly and sex sensitive so far. And there's still only little rules asking researchers to proclaim the sex of their cells but every cell has a sex as well and reacts accordingly and every mouse and rat they use also has a sex at least I wouldn't call it gender in their case but they have a sex. So there's so much to be done yes and I'm not so optimistic that I will actually benefit from it in a couple of years it's more that the generation after us or even that generation after that will actually benefit from all of us working together being aware and even just slightly questioning like are you sure I have to take the whole pill or should I take half a pill twice a day instead of one pill at one time at a day. I mean little things like that can actually help everyone and if your doctor doesn't know with you he hopefully looks it up and gives you information on it. Do we have time for a question? We have time for a question no problem. Who's next? Are you all specialists in gender medicine or not? Probably. Are there any more questions? Ah yeah. Please take some mic too. You have recording. Okay so the other thing I was wondering is because you said in the beginning you know female health was kind of pushed into the gynecology sphere where I am wondering did you look at that at all because from my experience for example prescribing the pill as a contraceptive in a lot of cases at least with the people I know and with myself also was also connected to me not being entirely informed of what kind of long term effect that has. Die ist schneller fertig. On my body. Sorry so you're asking about. Geht du da lang? Geht du noch? That your doctor wasn't informing you about long term effects of contraception because it was just a golden standard. Kind of yeah. Kind of yes. If you say I have problems with my skin people will tell you you know you could take the pill but they don't tell you what's you know it's much bigger than. Exactly. Exactly. I was just interested if you kind of looked into that issues around gynecology as well or. Not particularly but you have to assume that that medical system I mean it is very complex to treat a human being and to be aware of all these things going on so by adding the dimension of sex and gender it will make it even more complicated but I think we are all suited to actually understand this kind of complexity and yes this oh there's this new medication let's give it to everyone hasn't worked out in the past and unfortunately several examples and like this Viagra for women how medication is approved still is very questionable at least if not endangering many people and a lot of medication for treating heart disease in elderly people have led to several women dying because the medication was overdosed for their bodies in particular now yes so. Okay thank you very much. It's a new upcoming question or otherwise I would say thank you very much for this insight in gender medicine it was very very interesting thank you very much. Thank you thank you all for listening and the interesting questions.
 Sarah Hildner, she is research assistant at Charité Berlin.  We'll introduce us in the field of gender medicine.  Yes, thank you very much.  We're waiting for the presentation to be set up.  Till then I can just introduce myself.  I'm a physical therapist and also a sociologist.  And I'm currently doing my masters in sociology researching how gender medicine is being implemented  all over Europe in medical studies.  I help you with the...  Yeah.  Right there.  16.  And the sex standard met.  Okay.  And my bachelor thesis, I looked into cardiology textbooks and how the sexes are being represented  there.  And it was very fascinating because the books I looked into were from late 2000s and they  actually missed most of the current knowledge about heart attack in women and men and how  they differentiate, which was very surprising to me because the knowledge has been researched  for the past 40 years by now.  And maybe now I will have a presentation as well.  There's also a hashtag.  I want to introduce this hashtag sex gender met as an abbreviation for sex and gender  sensitive medicine.  And if you want to reach me on Twitter, it's Sophie Hildner.  And I will...  Maybe we'll start seeing something.  Yeah.  Yeah, I'm a Republican.  You did a session here two years ago and it was more exercise.  Maybe we could do some exercises or do we get...  Yeah, something to wake you all up because you've been probably sitting all day.  Please follow me.  This is the rabbit.  Just do it yourself.  And this is the hunter.  Now the rabbit is a really smart cookie.  So he jumps around, makes a turn and suddenly they switch the role.  Yeah, yeah, yeah.  Try to just do the hunter and switching the hands.  Yeah, great.  I see some hunters are missing the hook.  Oh, there's a three-eared rabbit.  Okay.  Now the rabbit can usually jump.  So only the rabbit jumps, of course, the hunter can't do this because then it won't work.  Okay, yeah.  And one more level would be the hunter is shooting, the rabbit is jumping.  In case you're really frustrated with your work and you need a break and laugh about  yourself, this always does the trick for me.  Took me like a year to do it like I do it now.  Yeah.  Well, I'm excited to be here.  Thank you all for being here.  Is there a question in advance?  If you shouted loud enough, I can repeat it.  So we have it on.  Okay.  I will try to just do the talk, but I do need my slides for myself.  So we're going to start an ancient medicine.  That's where it all started because the widespread belief was that there's only one body and  that actually all humankind is male, but that the females did not have enough fire inside  them to turn their internal organs out.  So they're the men.  So women were always the imperfect version of a man.  Can I continue here?  And we call it the one sex model, meaning that there's only this one sex.  And later on, this dominant ideal of masculinity and that the men are perfect, leading to women  being imperfect and the more sexual, the more carnal versions of man.  And this was supported by religious beliefs and it continued to develop hierarchical models  inside society.  So actually society reflected this belief and made sure that women were dominated and  subordered and that most privileges were reserved for white, educated, healthy, middle  and upper class men, all based on the belief that these bodies, they have a hierarchical  order as well.  Now I can't even look at my slides.  So there was this one sex model.  Everybody is the same.  They're all men except the ones that are not men.  They're imperfect men so they can be dominated by the perfect men.  Then times changed.  Whoa.  Yes, times changed.  Thank you very much.  Thank you for your presentation.  I wanted to start with this because this is one of the quotes in one of the medical textbooks  I have.  It is referring to a myocardial infarction and in the case of a heart attack that you  have to immobilize the patient and remove restricting clothes, the tight shirt collar  and the neck tie.  Unfortunately, she's a woman.  Having a bra while having a heart attack can be quite uncomfortable as well.  So this is for me a perfect example why women are out of the picture, not only in but also  explicitly when referring to diseases.  So the imperfect men we already have, the privileges.  In modernity, we had certain revelations.  The microscope was developed.  Natural science were developing as well.  And they all challenged religious and traditional beliefs that there was a hierarchical order.  But the one that challenged the most was Darwin when he said that the origin of the species  actually was in contradiction to what the Bible was saying.  So then everybody focused suddenly on genes and on hormones trying to establish the belief  that men and women are so differently that it actually, from the 16th to 19th century,  especially on brain studies, the belief changed rapidly.  Like on one century, men were the emotional ones, then women were the emotional ones.  Then men were the emotional ones again.  So you see that the signs, they all backed it up by what they called signs, have helped  them to show that there are difference between the sexes to actually find a validation for  a social order that was dominant.  Then they moved on to the two sex model.  And this originated the term bikini medicine as we have it today.  Like all the parts being covered by a bikini referring only to the reproductive organs  of women, which are all outsourced in gynecology, but assuming that in all other areas of medical  education and well as medical treatment actually are the same.  Because we still, in medical tradition, it's still believed and assumed that the actual  body of men and women are the same.  And that is the problem we are fighting against in sex and gender sensitive medicine.  So to come to the point today where we actually do research on the differences of the biological  sexes, and I am referring to your genome and your setup, and if it is an XY, an XXY,  or two X's, or one of the other many variations there are, you do have a genome that is influencing  how your body reacts to certain aspects of nature, to make you vulnerable to certain  diseases.  And so that we can all do this right now has a long tradition of fighting for rights, fighting  for interest in those matters, and that evolved from human rights movements, women rights  movements, then came women health aspects that were very interesting.  And then the women's, out of women's health, and that is one problem we always have to  fight against when we're talking about sex and gender sensitive medicine, is that everybody  believes it's only for women.  And well, to a certain aspect, yes, we have to catch up a lot of the research that hasn't  been done for women right now, but we also discover a lot of things that are very helpful  for men as well, and I will come to that in a minute.  Basic definition of sex and gender, actually, when I say sex, I'm talking about your biological  setup of your body, the way your genome is designed, and how these hormones, for example,  will influence how you metabolize medication.  And women are actually having a menstrual cycle.  There are three phases where they react very differently to medication, and that has not  been researched properly because it's very expensive because you would need a group of  women that are premenstrual, you will have a group of women that are menstruating, you  will have a group of women that is postmenopause, and of all these women you also need several  groups inside them due to the cycles they go through, which makes research in this area  very expensive because you would have per age group at least nine groups, at least for  the women.  And I'm pretty sure that men have cycles as well, although don't that as obvious as  maybe the female ones.  When I talk about gender, I'm referring to gender roles, gender identity that is actually  produced constantly in society.  How we act as men, how we act as women, how we act as trans person, how we are classified  by our looks and perceived and what the expectations to us are, and that also influences in medicine,  for example, the way you take your medicine, how you're complying with doctors' orders.  Women tend to comply a lot better than men.  Women sometimes do, sometimes don't care about when they take the medication they are prescribed.  I also want to make sure that it's not all men and all women, I'm talking about statistics  and most prominent groups.  Some results from science.  In cardiology, for example, the heart attack has symptoms most people know as a strong  chest pain, pain going through the left side of your body and feeling very uncomfortable.  In women, nausea, vomiting and back pain, you dissociate instantly with a heart attack.  Unfortunately not yet, but they are more prominent in women, but they are also men that can have  only these symptoms and suffering a heart attack.  So we need to catch up on research and update all the textbooks on it as well.  Women have the heart attack a lot later and if you have diabetes, you're more prone to  receive a heart attack in general, at least twice as likely as a healthy man and at least  four times as likely as a healthy woman.  So when you are diabetic and you're female, you're having a heart attack is very likely  event.  In therapy, yes, and when you're smoking and taking oral contraception is also endangering  you of suffering a heart attack and or a stroke as well.  And it was only mentioned in one book of the 10 I have investigated from the 2008 to 2012,  which was a very big surprise because the amount of women smoking is increasing as well.  And oral contraception is also available and being taken very frequently.  Aspirin on the other side is preventing men from having a heart attack, but not women.  In women it prevents more having a stroke.  Why this is?  They haven't really found out, but there's still research going on, but that it is a  fact has been proven by several researchers.  And what you all can do to prevent a heart attack is do at least one hour of sports a  week.  Another thing is that when you have high blood pressure, the risk of suffering it depends  not only on your age and your sex, but also on your ethnicity and of course your background.  And I want to point out, can I point?  I can't point.  Like this?  No.  Can I go in?  Yes, can you help me with this?  What I want to point out is, I need to get this window away.  I want to point out that the numbers for the people of color being 50 and 60 are actually  the same as for the white people when they're 60 and 70.  So when you're a person of color, you are 10 years earlier and being prone to having  a heart attack, which brings me to the point that actually that the incidence of diseases  is often correlated with your access to and your understanding of knowledge and the healthcare  system.  So poverty actually makes sick and since more women are on the poor side in all over the  world, they're more likely to be sick as well.  In psychiatry, depression have variations in the symptoms.  Women tend to react more with anxiety while men tend more to be substance abusers and  addicts and also tend to turn out their depression and show it in more aggressive behavior.  And when you think about it, anxiety and aggression are like two parts of a spectrum and they're  kind of also related to gender identity because aggression is also seen as a very masculine  trait and being timid and rather withdrawn, a more feminine trait, at least what concerns  the gender identity in our society, which I think is kind of remarkable.  In the therapy of severe depression, when you need to take medication to come back to  life again, tricyclical antidepressants are more helpful than men and have been proven  that they have a better effect than men while SSRIs, the selective serotonin reuptake inhibitors,  more helpful in women.  Osteoporosis is, in most people known as a female disease, and yes, women are more endangered  to having osteoporosis, but men we found out are also endangered to suffering from osteoporosis.  And the most interesting thing is that the last part is the five-year survival rate after  your first fracture due to osteoporosis, and that is when you're a woman, you're more likely  to survive it because most times the doctors in yourself are more aware that it's actually  a possibility to have osteoporosis anyway.  And in men it comes often as a surprise because doctors are still not aware that it is possible,  that it's likely for men to have osteoporosis.  The neurology, multiple sclerosis and migraine is more prominent in women, and amyotrophic  lateral sclerosis and epilepsy is more common in men.  Now the trait, the treat at the end for me is always pharmacology because there's so  much going on there that is very, very bad for particularly women because most test subjects  are young, healthy men.  And one example is the Viagra for women that had a measured effect in the trial participants  of 9 to 14%, which was the same as the placebo, so you actually don't know if it had an effect.  And the FDA approved it after some trials that included 25 people, and since it was a medication,  for women they even had two women in the test group, which I think is so ridiculous that  I don't even, I'm missing the words.  So hands on, communicate with your doctor, particularly if you notice reactions with medication,  especially as a woman, most of the medication has not been tried out for men and women.  A lot of the side effects are heavier in women, and particularly if you're a very slender  woman, the medication might be overdosed for your body weight and height.  And if you want to challenge your doctor, ask them if you have to consider your menstrual  cycle in any way by taking the medication at a certain point because that does have influence  on how your body metabolizes it and how long it stays in your system.  So ask your doctor if he or she knows about the sex differences because we all have to  work together to raise awareness for the whole subject because it is still not a part of  the curriculum in medical education.  Only a few schools all over Europe have some courses, most of them are not mandatory but  electives, and we all need to take care that our doctors stay up to date with what they  know.  Thank you very much.  And there will be an advanced metered greet at 2 p.m. at the mattresses behind the dome  with my colleagues from Hacking with Care.  They're presenting on stage two right now, so please check out their talk when we are  all done, and it's online because we are collaborating to help activists with their bodies and their  well-being.  Yes, now it's time for questions and answers.  Thank you very much.  So funny so that was a mic.  Any questions?  I'm wondering, like every now and then you get to read some articles about actually the  oral contraception for men has been invented, but there's no interest in introducing it  to society.  Do you have a stand on that?  Or statistics even, maybe?  I don't have a statistics on it, but it is difficult to bring contraception to men because  it is, although there are some voices that cry out and say I want it, I need it, as far  as I know, they haven't had an impact yet to actually develop it and bring it to the  main market.  I would think it would be great to be responsible and take care of your own fertility in that  way, particularly as a man.  Any other questions?  We have time for another question.  Who's next?  There's a mic.  Lady over there.  Can you raise your hand to show funny where you are?  The rabbit is running again.  I was wondering, because you closed by saying we should all kind of question decisions our  doctors make or at least kind of ask for reasons why they do that.  Don't you think this issue has to be tackled at a different level?  Because I feel like at first doctors are technically in a hierarchical position because we assume  they have knowledge that we don't have, which is the reason why we go to them in the first  place.  And then if we say generally they're not aware of this or of many aspects of this, how can  we rely on them giving us a reasonable explanation for something that they don't really know  about?  So don't you think at what other level do you think is necessary to kind of tackle the  problem in that case?  One thing I think is important is approach.  And that's what I'm also doing or what we're doing in gender medicine societies is approaching  specialist societies like the cardiologist society and the society of the neurologists  and approach them and tell them how about that you start at least offering courses where  medical doctors, I mean every medical doctor at least in Germany has to collect a certain  amount of education classes a year and they're required to do it or otherwise they lose the  license.  But as far as I know none of the big associations have yet introduced a course for gender sensitive  treatment or information for the doctors.  So that is one part that's really rigid and what I experienced from the medical system  because you said it's hierarchical when you come as a patient but the medical system inside  itself has also a strong hierarchy and it hasn't been yet so gender friendly and sex  sensitive so far.  And there's still only little rules asking researchers to proclaim the sex of their cells  but every cell has a sex as well and reacts accordingly and every mouse and rat they use  also has a sex at least I wouldn't call it gender in their case but they have a sex.  So there's so much to be done yes and I'm not so optimistic that I will actually benefit  from it in a couple of years it's more that the generation after us or even that generation  after that will actually benefit from all of us working together being aware and even  just slightly questioning like are you sure I have to take the whole pill or should I  take half a pill twice a day instead of one pill at one time at a day.  I mean little things like that can actually help everyone and if your doctor doesn't know  with you he hopefully looks it up and gives you information on it.  Do we have time for a question?  We have time for a question no problem.  Who's next?  Are you all specialists in gender medicine or not?  Probably.  Are there any more questions?  Ah yeah.  Please take some mic too.  You have recording.  Okay so the other thing I was wondering is because you said in the beginning you know  female health was kind of pushed into the gynecology sphere where I am wondering did  you look at that at all because from my experience for example prescribing the pill as a contraceptive  in a lot of cases at least with the people I know and with myself also was also connected  to me not being entirely informed of what kind of long term effect that has.  Die ist schneller fertig.  On my body.  Sorry so you're asking about.  Geht du da lang?  Geht du noch?  That your doctor wasn't informing you about long term effects of contraception because  it was just a golden standard.  Kind of yeah.  Kind of yes.  If you say I have problems with my skin people will tell you you know you could take the  pill but they don't tell you what's you know it's much bigger than.  Exactly.  Exactly.  I was just interested if you kind of looked into that issues around gynecology as well  or.  Not particularly but you have to assume that that medical system I mean it is very complex  to treat a human being and to be aware of all these things going on so by adding the  dimension of sex and gender it will make it even more complicated but I think we are all  suited to actually understand this kind of complexity and yes this oh there's this new  medication let's give it to everyone hasn't worked out in the past and unfortunately several  examples and like this Viagra for women how medication is approved still is very questionable  at least if not endangering many people and a lot of medication for treating heart disease  in elderly people have led to several women dying because the medication was overdosed  for their bodies in particular now yes so.  Okay thank you very much.  It's a new upcoming question or otherwise I would say thank you very much for this insight  in gender medicine it was very very interesting thank you very much.  Thank you thank you all for listening and the interesting questions.
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