Case Studies
CASE STUDY 1
Cardiovascular disease
Women’s symptoms of cardiovascular disease are more likely to be misdiagnosed as psychological, due to gendered narratives of pain, or labelled as atypical, due to androcentrism. They thus receive reduced primary and secondary prevention, delayed management and intervention, and subsequently experience worse outcomes than men after a heart attack (Wilkinson et al., 2018)
Despite troponin levels (a blood test to detect damage to the heart) being lower in women, patients are reviewed against non-sex-specific thresholds (Chapman et al., 2018).
When sex-specific thresholds are used, diagnosis increases for both women (42%) and men (6%) (Lee et al. 2019).
People who are transgender or gender diverse also experience disparities in cardiovascular risk factors and outcomes, further complicated by a lack of research on reference ranges (Streed Jr et al., 2021).
CASE STUDY 2
Autism
While traditionally (and to this day), it has been wrongly assumed that autism predominantly impacts men and boys, and much more rarely women and girls, recent epidemiological studies have revised the prevalence in males compared to females to 3:1 (Looms et al, 2017).
Women and girls, partly due to gendered societal expectations, are more likely to ‘mask’ or ‘camouflage’ autistic traits, which subsequently may lead to anxiety and other adverse mental health outcomes. This means that autism is frequently misdiagnosed in women and girls as anxiety (Wood-Downie et al, 2021).
Lack of identification of autism diagnosis in women and girls is hindered by assessment tools having been developed using males. Studies therefore highlight the importance of using sex- and/or gender-specific targeted assessment tools in research and diagnostic processes to improve outcomes for all (Mandy & Lai, 2017).
CASE STUDY 3
Osteoporosis
Osteoporosis risk is associated with hormone levels and interactions. For example, low oestrogen and low testosterone in cis women and men respectively increases risk for osteoporosis.
Though it is known that hormone therapy may affect osteoporosis risk, there is limited research to understand the nuance of this. For trans men who have had their ovaries removed, oestrogen levels are too low to protect bone density. In trans men, while testosterone should protect againstbone density loss, poor aromatisation (converting testosterone to oestradiol) may mean even after starting testosterone, bone density decreases. (Verroken et al, 2022, Stevenson et al, 2019, Khosla et al, 2019, Davidge-Pitts et al, 2019, Rothman et al, 2019).
Individuals who undergo a gonadectomy (as is common among intersex infants) and do not take hormone replacement therapy are at greater risk of osteoporosis, however further research is needed to understand interactions between hormone therapy and intersex people’s health across the lifecourse.