151
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de Souza Santos R, Frank AP, Nelson MD, Garcia MM, Palmer BF, Clegg DJ. Sex, Gender, and Transgender: Metabolic Impact of Cross Hormone Therapy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1043:611-627. [PMID: 29224113 DOI: 10.1007/978-3-319-70178-3_27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Most preclinical and clinical, animal, and human research has been biased with respect to sex and even more so with respect to gender. In fact, little is known about the impact of sex and even less about the influence of gender on overall metabolic processes. The National Institutes of Health has recognized this gap in scientific knowledge and now mandates that studies be conducted in both sexes and to include gender as variables influencing physiological processes such as metabolism. It is therefore critical to understand and appreciate how to incorporate sex and gender in preclinical and clinical research in order to enhance our understanding of the mechanisms by which metabolic processes differ by sex and gender. In this chapter, we define sex and gender and discuss when sex and gender are not aligned, such as that which occurs in transgender individuals, and how this impacts metabolic processes. We discuss the importance of understanding the influence and interactions between sex hormones and sex chromosomes rather than focusing on their relative contributions to metabolism in isolation. This knowledge will optimize therapies specific for individuals which need to encompass sex and gender.
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Affiliation(s)
- Roberta de Souza Santos
- Biomedical Research Department, Diabetes and Obesity Research Division, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Aaron P Frank
- Biomedical Research Department, Diabetes and Obesity Research Division, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michael Douglas Nelson
- Applied Physiology and Advanced Imaging Lab, University of Texas, Arlington, TX, USA.,Kinesiology, University of Texas, Arlington, TX, USA.,Bioengineering, University of Texas, Arlington, TX, USA.,Cedars-Sinai Medical Center, University of Texas, Arlington, TX, USA
| | - Maurice M Garcia
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Cedars-Sinai Medical Center Transgender Surgery and Health Program, Los Angeles, CA, USA.,Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Biff F Palmer
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Deborah J Clegg
- Biomedical Research Department, Diabetes and Obesity Research Division, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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152
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Bale TL, Epperson CN. Sex as a Biological Variable: Who, What, When, Why, and How. Neuropsychopharmacology 2017; 42:386-396. [PMID: 27658485 PMCID: PMC5399243 DOI: 10.1038/npp.2016.215] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/22/2016] [Accepted: 09/16/2016] [Indexed: 12/22/2022]
Abstract
The inclusion of sex as a biological variable in research is absolutely essential for improving our understanding of disease mechanisms contributing to risk and resilience. Studies focusing on examining sex differences have demonstrated across many levels of analyses and stages of brain development and maturation that males and females can differ significantly. This review will discuss examples of animal models and clinical studies to provide guidance and reference for the inclusion of sex as an important biological variable relevant to a Neuropsychopharmacology audience.
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Affiliation(s)
- Tracy L Bale
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn PROMOTES Research on Sex and Gender in Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry,Perelman School of Medicine at the University of Pennsylvania Philadelphia, PA, USA
| | - C Neill Epperson
- Penn PROMOTES Research on Sex and Gender in Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry,Perelman School of Medicine at the University of Pennsylvania Philadelphia, PA, USA
- Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania Philadelphia, PA, USA
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153
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Tannenbaum C, Greaves L, Graham ID. Why sex and gender matter in implementation research. BMC Med Res Methodol 2016; 16:145. [PMID: 27788671 PMCID: PMC5084413 DOI: 10.1186/s12874-016-0247-7] [Citation(s) in RCA: 173] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/14/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There has been a recent swell in activity by health research funding organizations and science journal editors to increase uptake of sex and gender considerations in study design, conduct and reporting in order to ensure that research results apply to everyone. However, examination of the implementation research literature reveals that attention to sex and gender has not yet infiltrated research methods in this field. DISCUSSION The rationale for routinely considering sex and gender in implementation research is multifold. Sex and gender are important in decision-making, communication, stakeholder engagement and preferences for the uptake of interventions. Gender roles, gender identity, gender relations, and institutionalized gender influence the way in which an implementation strategy works, for whom, under what circumstances and why. There is emerging evidence that programme theories may operate differently within and across sexes, genders and other intersectional characteristics under various circumstances. Furthermore, without proper study, implementation strategies may inadvertently exploit or ignore, rather than transform thinking about sex and gender-related factors. Techniques are described for measuring and analyzing sex and gender in implementation research using both quantitative and qualitative methods. The present paper describes the application of methods for integrating sex and gender in implementation research. Consistently asking critical questions about sex and gender will likely lead to the discovery of positive outcomes, as well as unintended consequences. The result has potential to strengthen both the practice and science of implementation, improve health outcomes and reduce gender inequities.
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Affiliation(s)
- Cara Tannenbaum
- Insitute of Gender and Health, Canadian Institutes of Health Research, Ottawa, Canada
- Université de Montréal, Montréal, Canada
| | - Lorraine Greaves
- British Columbia Centre of Excellence for Women’s Health, Vancouver, Canada
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154
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Day S, Mason R, Lagosky S, Rochon PA. Integrating and evaluating sex and gender in health research. Health Res Policy Syst 2016; 14:75. [PMID: 27724961 PMCID: PMC5057373 DOI: 10.1186/s12961-016-0147-7] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 09/22/2016] [Indexed: 11/10/2022] Open
Abstract
Both sex (biological factors) and gender (socio-cultural factors) shape health. To produce the best possible health research evidence, it is essential to integrate sex and gender considerations throughout the research process. Despite growing recognition of the importance of these factors, progress towards sex and gender integration as standard practice has been both slow and uneven in health research. In this commentary, we examine the challenges of integrating sex and gender from the research perspective, as well as strategies that can be used by researchers, funders and journal editors to address these challenges. Barriers to the integration of sex and gender in health research include problems with inconsistent terminology, difficulties in applying the concepts of sex and gender, failure to recognise the impact of sex and gender, and challenges with data collection and datasets. We analyse these barriers as strategic points of intervention for improving the integration of sex and gender at all stages of the research process. To assess the relative success of these strategies in any given study, researchers, funders and journal editors would benefit from a tool to evaluate the quality of sex and gender integration in order to establish benchmarks in research excellence. These assessment tools are needed now amidst growing institutional recognition that both sex and gender are necessary elements for advancing the quality and utility of health research evidence.
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Affiliation(s)
- Suzanne Day
- Women’s Xchange, Women’s College Research Institute, Women’s College Hospital, 76 Grenville Street, Toronto, Ontario M5S 1B2 Canada
| | - Robin Mason
- Women’s Xchange, Women’s College Research Institute, Women’s College Hospital, 76 Grenville Street, Toronto, Ontario M5S 1B2 Canada
- Dalla Lana School of Public Health and Department of Psychiatry, University of Toronto, 27 King’s College Circle, Toronto, Ontario M5S 1A1 Canada
| | - Stephanie Lagosky
- Women’s Xchange, Women’s College Research Institute, Women’s College Hospital, 76 Grenville Street, Toronto, Ontario M5S 1B2 Canada
| | - Paula A. Rochon
- Women’s Xchange, Women’s College Research Institute, Women’s College Hospital, 76 Grenville Street, Toronto, Ontario M5S 1B2 Canada
- Department of Medicine, University of Toronto, 27 King’s College Circle, Toronto, M5S 1A1 Ontario Canada
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155
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Becker JB, Prendergast BJ, Liang JW. Female rats are not more variable than male rats: a meta-analysis of neuroscience studies. Biol Sex Differ 2016; 7:34. [PMID: 27468347 PMCID: PMC4962440 DOI: 10.1186/s13293-016-0087-5] [Citation(s) in RCA: 265] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 07/18/2016] [Indexed: 11/27/2022] Open
Abstract
Background Not including female rats or mice in neuroscience research has been justified due to the variable nature of female data caused by hormonal fluctuations associated with the female reproductive cycle. In this study, we investigated whether female rats are more variable than male rats in scientific reports of neuroscience-related traits. Methods PubMed and Web of Science were searched for the period from August 1, 2010, to July 31, 2014, for articles that included both male and female rats and that measured diverse aspects of brain function. Only empirical articles using both male and female gonad-intact adult rats, written in English, and including the number of subjects (or a range) were included. This resulted in 311 articles for analysis. Data were extracted from digital images from article PDFs and from manuscript tables and text. The mean and standard deviation (SD) were determined for each data point and their quotient provided a coefficient of variation (CV) as a measure of trait-specific variability for each sex. Additionally, the results were coded for the type of research being measured (behavior, electrophysiology, histology, neurochemistry, and non-brain measures) and for the strain of rat. Over 6000 data points were extracted for both males and females. Subsets of the data were coded for whether male and female mean values differed significantly and whether animals were grouped or individually housed. Results Across all traits, there were no sex differences in trait variability, as indicated by the CV, and there were no sex differences in any of the four neuroscience categories, even in instances in which mean values for males and females were significantly different. Female rats were not more variable at any stage of the estrous cycle than male rats. There were no sex differences in the effect of housing conditions on CV. On one of four measures of non-brain function, females were more variable than males. Conclusions We conclude that even when female rats are used in neuroscience experiments without regard to the estrous cycle stage, their data are not more variable than those of male rats. This is true for behavioral, electrophysiological, neurochemical, and histological measures. Thus, when designing neuroscience experiments to include both male and female rats, power analyses based on variance in male measures are sufficient to yield accurate numbers for females as well, even when the estrous cycle is not taken into consideration. Electronic supplementary material The online version of this article (doi:10.1186/s13293-016-0087-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jill B Becker
- Department of Psychology, Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI USA ; Department of Psychiatry, Molecular and Behavioral Neuroscience Institute, University of Michigan, 205 Zina Pitcher Place, Ann Arbor, MI 48109 USA
| | | | - Jing W Liang
- Psychology Department, Hunter College, CUNY, New York, NY USA
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156
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Mazure CM, Swendsen J. Sex differences in Alzheimer's disease and other dementias. Lancet Neurol 2016; 15:451-2. [PMID: 26987699 DOI: 10.1016/s1474-4422(16)00067-3] [Citation(s) in RCA: 255] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 02/12/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Carolyn M Mazure
- Yale University School of Medicine, 135 College Street, New Haven, CT 06510, USA.
| | - Joel Swendsen
- University of Bordeaux, PSL Research University, Bordeaux, France
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157
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Zakiniaeiz Y, Cosgrove KP, Potenza MN, Mazure CM. Balance of the Sexes: Addressing Sex Differences in Preclinical Research. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2016; 89:255-9. [PMID: 27354851 PMCID: PMC4918870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Preclinical research is fundamental for the advancement of biomedical sciences and enhancing healthcare. Considering sex differences in all studies throughout the entire biomedical research pipeline is necessary to adequately inform clinical research and improve health outcomes. However, there is a paucity of information to date on sex differences in preclinical work. As of 2009, most (about 80 percent) rodent studies across 10 fields of biology were still conducted with only male animals. In 2016, the National Institutes of Health implemented a policy aimed to address this concern by requiring the consideration of sex as a biological variable in preclinical research grant applications. This perspective piece aims to (1) provide a brief history of female inclusion in biomedical research, (2) describe the importance of studying sex differences, (3) explain possible reasons for opposition of female inclusion, and (4) present potential additional solutions to reduce sex bias in preclinical research.
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Affiliation(s)
- Yasmin Zakiniaeiz
- Interdepartmental Neuroscience Program, Yale University School of Medicine, New Haven, CT,To whom all correspondence should be addressed: Yasmin Zakiniaeiz, 1 Church Street, Suite 721, New Haven, CT 06510; Tel: 203-737-3448;
| | - Kelly P. Cosgrove
- Interdepartmental Neuroscience Program, Yale University School of Medicine, New Haven, CT,Department of Radiology and Bioimaging, Yale University, New Haven, CT,Department of Psychiatry, Yale University, New Haven, CT,Department of Neuroscience, Yale University School of Medicine, New Haven, CT
| | - Marc N. Potenza
- Department of Psychiatry, Yale University, New Haven, CT,Department of Neuroscience, Yale University School of Medicine, New Haven, CT,Child Study Center, Yale University School of Medicine, New Haven, CT,CASAColumbia, Yale University School of Medicine, New Haven, CT,Connecticut Mental Health Center, New Haven, CT,Women’s Health Research at Yale, New Haven, CT
| | - Carolyn M. Mazure
- Department of Psychiatry, Yale University, New Haven, CT,Women’s Health Research at Yale, New Haven, CT
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158
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Solomon MZ, Gusmano MK, Maschke KJ. The Ethical Imperative And Moral Challenges Of Engaging Patients And The Public With Evidence. Health Aff (Millwood) 2016; 35:583-9. [DOI: 10.1377/hlthaff.2015.1392] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Mildred Z. Solomon
- Mildred Z. Solomon is president of the Hastings Center, in Garrison, New York, and a professor of medical ethics in the Department of Anaesthesia and the Center for Bioethics at Harvard Medical School, in Boston, Massachusetts
| | - Michael K. Gusmano
- Michael K. Gusmano is a research scholar at the Hastings Center and an associate professor of health policy at Rutgers University, in New Brunswick, New Jersey
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159
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Wood SF, Mieres JH, Campbell SM, Wenger NK, Hayes SN. Advancing Women's Heart Health through Policy and Science: Highlights from the First National Policy and Science Summit on Women's Cardiovascular Health. Womens Health Issues 2016; 26:251-5. [PMID: 27052825 DOI: 10.1016/j.whi.2016.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 03/01/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Susan F Wood
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Jennifer H Mieres
- Department of Cardiology, Hofstra North Shore- LIJ School of Medicine, Hempstead, New York
| | - Susan M Campbell
- WomenHeart: The National Coalition for Women with Heart Disease, Washington, District of Columbia
| | - Nanette K Wenger
- Division of Cardiology, Emory University School of Medicine, Emory Heart and Vascular Center, Atlanta, Georgia
| | - Sharonne N Hayes
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
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160
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Mazure CM. Our evolving science: studying the influence of sex in preclinical research. Biol Sex Differ 2016; 7:15. [PMID: 26918114 PMCID: PMC4766639 DOI: 10.1186/s13293-016-0068-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 02/19/2016] [Indexed: 11/15/2022] Open
Abstract
The policy announcement by the National Institutes of Health that sex should be considered as a relevant variable in preclinical research has sparked considerable debate. This debate has largely centered on specific concerns regarding how the policy will be implemented. However, others have reacted to the new policy by calling into question the capacity of preclinical science to generate data that can be useful to human health. This commentary examines the basis for this contention and maintains that it is essential to expand our scientific efforts to include the influence of sex on the biology and behavior that is studied in preclinical investigations.
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Affiliation(s)
- Carolyn M Mazure
- Department of Psychiatry, Women's Health Research at Yale, Yale University School of Medicine, 135 College Street, Suite 220, New Haven, CT 06510 USA
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