Gender gap in medical context

Challenge
One of my (@panahi1353) favorite topics is the study of gender differences in medical research. I have read a lot of articles in which there are either no references to the sexes of the studied subjects, Or, if they reported, the number of females was much lower than that of males.
In terms of definition, Sex is different from Gender. The difference in Sex means that women and men are different based on their anatomy and secondary sexual characteristics. But the difference in Gender is that they differ in terms of social and cultural characteristics. But in medical research, both compounds are used in combination.
It is known that animal-based research has been playing a crucial role in medicine and science. But by the 1960s, the species of animals used was rarely reported, except in the case of fertility investigations. Even in some cases, the sex of tested animals is eliminated in 22 to 42 percent of the articles.
The analysis of the studies in which the animal was reported showed that in the majority of medical-affiliated disciplines except for the biology of fertility and immunology, female animal species have been used less.

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Most investigators do their research for just one gender to reduce the cost of experiments or to reduce the contradictions in the results. In examining the phenomena in which sex is specific (such as uterine cancer or prostate cancer), single-sex tests are the only possible option. This method is also useful in cases where a gender is not sufficiently studied or there is evidence that the results are not affected by the sex. But most single-sex experiments on animals do not include these. Female animals are not sufficiently used when studying the conditions affecting both sexes. Even, according to evidence, it is less likely to be found in research that females affect the outcome.
what are the effects of sex differences in research?

The word Bias is a form of systematic error that can affect the results of medical research and cause deviations in the findings. The deviation can occur in any form of medical research, but the goal is to minimize it until the results are reliable. Sex bias refers to errors that occur due to the difference between male and female subjects in medical research.
Unfortunately, in some studies, women, and men, who are used in a study, are unequal from cell research to clinical trials. Even in terms of the number needed to show differences between men and women, they are not used. For this reason, since 2004, the Center for Women's Health Studies at the University of Colorado has changed this situation through its support of research and community educations that have involved the women in their investigations.

Gender discrimination in drug research
Because drug research is more likely to be done on men, it can result in harmful effects for women who will receive the drug. For decades’ investigators to conduct his/her research, have traditionally focused on male models for a variety of reasons. Because they believed that women's menstrual cycles and hormonal oscillations could affect the comparison between the subjects. Therefore, it led to greater trust in male animals as a standard of research. Until the late 1980s, Gender and Sex-based understanding became revolutionized. The National Institutes of Health (NIH) has linked the lack of knowledge about women's health issues to the non-use of women in medical research. To this end, in 1993, by presenting a clinical criterion, it was determined that men's results should no longer be attributed to female subjects, but should be scientifically determined by engaging female subjects in research.
For example, you can name the Ambien (Zolpidem) drug. In 2013, the FDA recommended, that women should be given half of the dose. Because women metabolize drug at low rates due to physiological differences. Unfortunately, this report was submitted after 20 years of drug misuse in women. This medication is prescribing for insomnia. By mistake prescribing, many of these women, their children, and families were affected.
This has raised a lot of questions including, really how much treatments and prescriptions are right?
In fact, by incorporating gender in clinical studies as well as the development of personalized medicine, one hopes that in the future prescribing medicinal substances and therapies will be based on the physiological conditions of the individual and in proportion to their genetic makeup.

Gender gap in the expression of genes
Another issue that sex can affect is the expression of genes. As new studies have shown, genes are expressed in terms of sex difference, Same Genes act differently in males and females. One of the reasons for the difference in the expression of genes in both sexes is attributed to Estrogen and Androgen hormones. that is one of the reasons that can lead to a difference in the incidence of disease in men and women.
For example, women are more likely to have asthma, MS and immune system diseases. Some cancers such as bladder, liver cancer, and cardiovascular disease are more common in men.

Sex differences in the age of the occurrence of death
Other issues of gender disparity are age of death. It has been shown that males die earlier than females on average. One of the hypotheses in this regard is the length of telomeres, which is shorter in male than female subjects, and this is the cause of premature aging, followed by premature death in males.
Many assumptions have been made that justify the short length of telomeres in male subjects or their lengthening in females. Testosterone is one of the factors that, due to the increased oxidative stress, further reduces the length of the telomere. But on the other hand, estrogen up to menopause protects female subjects (protective effect) and overcomes oxidative stress, resulting in women with long telomeres and, consequently, longer life spans than men. Another assumption is having an extra chromosome X in the female sex.
On the other hand, long telomeres in women may have a direct relationship with fewer incidence of diseases in women.

Conclusion
According to the above, it seems that the inclusion of female subjects in clinical trials is an urgent need for the development of medical research, because, with the information it receives, the doctor can make better decisions for the treatment of his patients. That is why we should pay attention to the gender difference in medical investigations.

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References

Gender and telomere length Systematic review and meta-analysis (2014) Gardner M. et al.

Gender bias in drug research

The healthcare gender bias: do men get better medical treatment?

Than you for your consideration