Greetings

I am really happy that “Research Center for Sex- and Gender-Specific Medicine” has been established at the Seoul National University Bundang Hospital in South Korea.

Now the world is passing over the pandemic era of COVID 19. Over 50% of the world population are vaccinated while there is some variation depending on each country. However, I wonder whether the effect of COVID vaccination is equally effective for a man with 185 cm height /110 kg weight and a woman with 145 cm / 40 kg. Maybe it will be different in terms of pharmacokinetics and pharmacodynamics which are affected by sex. In addition, the side effects seem to be different depending on sex/gender. While physicians tend to agree that children are not miniature adults, few recognize that women are not simply smaller men. For many, women and men were considered the same except for reproductive organs. In the 1980s and 1990s, the realization that medicine as a whole—including the diagnosis and treatment of diseases—is male-centered led to a focus on women’s health such as endocrine and reproductive systems. With new studies of sex/gender differences in diabetes and cardiovascular diseases, sex became recognized as an important biological variable. Although many researchers and clinicians believe that sex differences are already well understood, experts point out that even where females and males are included in a study in equal numbers, data are frequently not analyzed according to sex. As a result, medical studies tend to present an “average” for each disease - an average that may not accurately describe either females or males. This issue is very important because studies that fail to disaggregate and analyze data by sex miss specific disease mechanisms and treatments for women, men and non-binary people. For example, estrogen receptors (ERs) have widespread effects in numerous cells throughout the body, not just in reproductive organs. This means that differences between females and males in estrogen levels impact cells well beyond the reproductive system. In light of these findings, researchers have been actively investigating conditions where the disease incidence is higher in one sex, or where clinical manifestation is different between women and men even in cases where the disease incidence is similar.

While I have been a gastroenterologist over 33 years, I first encountered the concept of “Gendered Innovation” or “Sex/Gender-Specific Medicine” in 2014 when I joined the GI Workshop cosponsored by Stanford University, National Science Foundation, Korea Foundation of Women’s Science & Technology Associations (KOFWST). The workshop was held at Stanford University and colorectal cancer (CRC) was one of the topics in this workshop. In particular, the sex/gender-specific aspect of colon cancer was very impressive and attractive as a research topic. The incidences of gastrointestinal (GI) cancers such as esophageal, gastric, colorectal and hepatocellular carcinoma are higher in males compared to females, suggesting the protective role of estrogen in the GI cancers. Sex difference of GI cancers has two aspects between sexual dimorphism (biological differences in hormones and genes) and gender differences (non-biological differences in societal attitudes and behaviour). It is opposite in the case of functional gastrointestinal disorders (FGID). FGIDs, such as functional dyspepsia and irritable bowel syndrome, are more common in women than in men and are related to sociocultural factors such as stress, which tend to differ by gender. Various mechanisms of FGID have been proposed, such as disturbed gastroduodenal motility and visceral hypersensitivity. Women with FGID more commonly have visceral hypersensitivity and are more strongly influenced by the brain-gut axis. Physiological mediators such as ghrelin and transient receptor potential vanilloid-1 (TRPV1) play a significant role in the pathophysiological mechanism of functional dyspepsia in men, but factors related to the brain-gut axis, such as depression and anxiety, play a larger role in women. Women and men frequently are presented with different symptoms of FGID and respond differently to treatment. These differences can be caused by the effects of sex hormones or genetic predispositions on disease mechanisms (i.e., pathophysiology) and by sociocultural factors related to gender. In 2022 a book entitled as “Sex/Gender-Specific Medicine in the Gastrointestinal Diseases” (Editor, Prof. Nayoung Kim) has been published by Springer Co. which highlights the sex/gender differences in the diseases of entire GI organ. Especially regarding the gut and oral microbiota, which affect various parts of a person’s body from brain to gut, neurologists, psychiatrists, dentists as well as gastroenterologists collaborated to uncover the sex/gender difference of depression, anxiety, cognitive disorders and Parkinson’s disease. This book clearly showed that studies must integrate both sex and gender analysis into the research design and analyze how sex and gender interact with each other. In the next 34 clinicians from different areas published Korean book entitled “Sex/Gender-Specific Medicine in Clinical Areas” (Editor, Prof. Nayoung Kim) by SnC Publishing Co. INC on Dec. 2022. GISTeR and National Academy of Medicine of Korea supervised the publication of this book . Finally, “Research Center for Sex- and Gender-Specific Medicine” is open in the Seoul National University Bundang Hospital on Apr. 2023 to perform effective research regarding the “Sex/Gender-Specific Medicine”. This is the first institute for the research of Sex/Gender-Specific Medicine in South Korea. We hope our activities in this research center respond to the interests of researchers and clinicians worldwide and also stimulate further curiosities.