Tag Archive for: gender

Behind the Science: Breaking the Mold: Gender, Cannabis, and Substance Use Disorders

Interviewee: Dr. Justin Matheson,  | Authors/Editors: Romina Garcia de leon, Janielle Richards (Blog Co-coordinators)

Published: September 6th, 2024

Can you briefly explain your research?

My research focuses on understanding how sex and gender shape substance use health, which encompasses the continuum from initial drug use experiences to substance use disorders. Specifically, in my current research, I am concentrating on two main areas. The first is examining differences in acute responses to cannabis using a human behavioral pharmacology paradigm. In this paradigm, participants smoke cannabis in the lab, and we observe categorical differences in their responses, such as how high they feel and their cognitive and sometimes driving performance. The second focus is on how gender influences trajectories and experiences in cannabis use disorder treatment, including the type and severity of symptoms experienced by individuals undergoing treatment to reduce or stop cannabis use. The aim is to better understand these trajectories, particularly in cisgender women and gender minorities, and to improve prevention and treatment strategies for substance use disorders, especially cannabis use disorders.

How did you get into this research?

I kind of stumbled into this field when, as a PhD student, my supervisor suggested that we explore differences in our initial cannabis lab study for a conference presentation. As I reviewed the literature, I became increasingly aware of how much harm in science has been caused by andronormativity, the focus on men and male bodies. Substance use has often been framed as a “men’s issue,” and addiction in women is less understood, with limited research on addiction in gender minorities. As a gender-fluid person, I felt it was important to work towards gendered health equity in the addiction field within a restorative social justice framework, addressing gaps in understanding how substance use affects cisgender women and gender minorities.

How do you define sex and gender in your work?

Initially, my approach was to use a classic categorical difference model—males versus females. However, I am now shifting towards exploring the underlying factors driving these categorical differences. For example, I am interested in the relationship between gonadal hormone levels and acute responses to drugs, and how these relationships vary with the menstrual cycle or menopause. There is a significant lack of empirical evidence on how menopause might impact addiction risk. While my research is still grounded in binary categories, I aim to move beyond this binary to examine associated factors that affect all bodies differently based on gender. I think of gender as a way of making meaning of bodies and how societal understandings of gender influence how individuals are treated. Historically, substance use has been more stigmatized for women, contributing to underreporting and less focus in research. Women with cannabis use disorders often face more interpersonal conflicts, while men may experience more neurobiological or pharmacological harm. My research seeks to understand how gender and biology interact and how these interactions influence substance use and addiction.

Are there any findings you could share with us?

In our human laboratory work, we’ve encountered challenges. For example, in my initial PhD research, female participants smoked less cannabis than males and had lower THC levels in their blood than expected. Despite reporting similar subjective and cognitive effects as males, the difference in blood THC levels was significant. However, subsequent attempts to replicate this finding have been inconclusive. We are exploring how contextual factors (e.g., mood, expectations, prior cannabis use history) might moderate the relationship between THC exposure and intoxication states. We are also investigating the impact of menstrual cycle phase, estrogens, and androgens on cannabis use. In our gender-related research, which is primarily qualitative, we’ve identified notable gender narratives. For instance, men often seek treatment after struggling to cut back on cannabis, while women frequently cite external pressures and shame related to their cannabis use. These preliminary findings suggest a need for further exploration of how gender influences treatment-seeking behaviors and barriers to accessing care.

Where do you hope to see this work in 10 years?

In the next decade, I hope to secure more funding for research on specific factors related to substance use. There is a significant gap in understanding how menstrual cycle phases impact cannabis use, with only one published study in this area. I aim to fill this gap and explore neuroendocrinological approaches, including hormone modeling and genetic factors. Additionally, I hope to integrate gender more systematically into laboratory studies, moving beyond qualitative research to develop quantitative measures of gender. For example, understanding how individuals who identify as more feminine may experience cannabis intoxication differently could be crucial. Ultimately, I aim to merge research on gender and cannabis use disorder with studies on individual differences in drug responses, to improve prevention and treatment strategies for cannabis use disorders and other substance use disorders.

Where can you learn more about Dr. Justin Matheson’s work?

Website: https://www.justinrmatheson.com/ 

Twitter/X: https://x.com/justinrmatheson 

A Look Into RE-IMAGYN BC: Improving How We Measure Gender and Relationship Equity

Authors: Yas Botelho (they/them) Youth Research Associate, Faculty of Health Sciences Simon Fraser University and Harman Grewal (she/her), Research Assistant, Faculty of Health Sciences Simon Fraser University | Editors: Romina Garcia de leon, Janielle Richards  (Blog Coordinators) | Expert Reviewer: Lindsey Thurston 

Published: August 16th, 2024

Our intimate relationships are meaningful social determinants of health. Lack of gender equity in relationships can lead to intimate partner violence, exposure to sexually transmitted infections, and unwanted pregnancies. Because of these potential health outcomes, it’s important to: a) measure relationship equity effectively and b) ensure that our measurements encompass diverse relationship structures and populations. However, the scales currently used to measure gender-based power dynamics within intimate relationships were designed solely with cisgender, heterosexual, white, and monogamous married women in mind.

The failure of these measurements to represent the needs of youth became evident in Dr. Kalysha Closson’s work evaluating the effectiveness of the Sexual Relationship and Power Scale (SRPS) with young people in South Africa. The SRPS measures controlling behaviour and decision-making dominance of male partners in intimate relationships. In the study, it was revealed that participants had challenges with comprehension of the SRPS questions resulting in multiple interpretations of questions and overall, a lack of applicability to young people’s lives. These findings demonstrate a need for a more inclusive and contemporary measurement of gender and relationship equity.  

Intimate partner violence occurs in all settings and socio-economic backgrounds, yet research has shown that certain groups of people are at greater risk of intimate partner violence including: young women, young disabled women, Indigenous womennon-binary youth, and lesbian, gay, and bisexual people. Therefore, there is a great need for more accurate measurements of relationship equity to best support programming for those at risk.   

That’s where our study comes in: the Relationship Equity and Intersectional Measurement Among Gender-inclusive YouNg people in British Columbia (RE-IMAGYN BC) is looking to create a more inclusive and comprehensive gender and relationship equity measurement scale through a youth-led and community-based approach that is “informed by the lived and living experiences of queer and trans youth”

In practice, this means putting together a team of youth who belong to the study population of interest (queer, trans, gender diverse, and non-monogamous youth between the ages of 16 and 29 years in BC) to co-lead every aspect of the study as Youth Research Associates (YRAs) or through our Youth Advisory Committee (YAC). 

The YRAs are embedded in RE-IMAGYN’s day-to-day research activities as they check in with one another, as well as the other study members on a bi-weekly basis. Additionally, they support the facilitation of the YAC, collect data, and assist with data analysis and knowledge mobilization activities. They are compensated $50 for every cognitive interview they complete and $25/hour for all other study-related activities. 

In comparison to the YRAs, the YAC plays an overarching advisory role. They participate in discussions about study methods, data analysis, and knowledge mobilization in 2-hour meetings that take place every 4 to 6 weeks. When new youths join the YAC, they are compensated $50 for reviewing various onboarding materials and then $50 for every meeting they attend and complete the associated pre-work for.  

Central to our youth-engaged approach is allowing the youth to show up in this work in the best way that works for them. Some examples of this are: offering tailored research training so that the youth feel empowered to lead the study, and using methods of communication that are more accessible to the youth, such as Discord and text as opposed to email.  

The success of RE-IMAGYN is contingent upon the relationships we have with these youths, as well as our community collaborators. We encourage the youth to bring their whole selves, meaning their identities, experiences, stories, and worldviews, to everything that we do. The goal is to collectively ground our work in relationality to disrupt power imbalances that exist between researchers and community, making room for shared decision-making that makes for more equitable and, in turn, better research.  

To stay up-to-date with our study, please follow us on Instagram @reimagyn.

 

Personality and Sex Differences in Depressive Symptomatology

Authors: Jessica Stewart, PhD Candidate, Health Psychology, University of British Columbia | Editors:  Romina Garcia de leon and Shayda Swann

Published: January 19, 2024

It’s not hard to believe that people with tendencies toward anger or aggression will end up with more health problems than those who have a positive outlook. Many studies have shown that personality traits are associated with physical health and mortality.

Personality traits can be identified as patterns of feelings, thoughts, and behaviours that take shape in one’s childhood and become consistent throughout one’s life.

The Five-Factor Model of personality is a common method of describing personality traits and separates the traits into agreeableness, conscientiousness, extraversion, neuroticism and openness to experience.

Hostility, which is an attribute of neuroticism, is associated with coronary heart disease and mortality, while conscientiousness predicts longevity.

Depressive symptoms, which approximately 350 million people around the world currently experience, have been linked to personality traits. A 2023 study showed that all five dimensions of personality were linked to changes in depressive symptoms but neuroticism has the strongest association with depressive symptoms, with people who are high in neuroticism being more likely to experience depressive symptoms.

Personality traits may also be a cause of the considerable sex difference in depressive disorders that exists between males and females across sociocultural contexts. This difference exists across the lifespan, with females around twice as likely as men to experience depressive disorders from adolescence to late adulthood.

Neuroticism and depression in women

In a 2022 study, neuroticism was correlated with the prevalence of probable major depressive episodes for both men and women. Still, the effect of neuroticism in the incidence and persistence-recurrence of probable major depressive episodes was only found in females. In other words, the study found a neuroticism-related vulnerability in women for the incidence or persistence-recurrence of a major depressive episode.

Past research has suggested one neural mechanism between neuroticism and depression found only in women. It has been described as a correlation between neuroticism and resting-state regional cerebral blood flow in the hippocampus and midbrain, and neuroticism predicted depressive symptoms through greater activity of these regions, which are used in emotional processing and regulation.

Conscientiousness and depression in women

Conscientiousness affects men and women differently as well. In the same 2022 study, the interaction found between gender and conscientiousness for the incidence of depressive symptomatology demonstrated a larger protective effect of conscientiousness for men compared to women. In other words, being high in conscientiousness helps men prevent depressive symptoms more than it does for women.

Considering the impact of personality traits and gender on depressive symptoms, researchers recommend including personality and gender-specific strategies in mental health and depression intervention or prevention programs.

Understanding the Lived Experience of Perimenopause, Menopause and Post-Menopause


Author: Bhairavi Warke, PhD Student, Simon Fraser University Editors: Negin Nia and Arrthy Thayaparan (Blog Coordinators)

Published: April 8th, 2022

What is lived experience of Menopause?

Menopause is when one has gone an entire year without a menstrual period. The average age for menopause is 51 years. It is preceded by Perimenopause, when women start noticing physical and psychological changes, and followed by post-menopause. This transition can be challenging for many due to symptoms like hot flashes, night sweats, mood swings, etc. Not only does it affect women’s physical and psychological well-being, but it may significantly affect their personal and social lives. For example, menopause symptoms can cause limitations in family life, relationships, professional activities, and more. Additionally, every woman’s experience can greatly vary in terms of the severity and duration of symptoms. For some, the symptoms of menopause can last over a decade and thus, significantly lower their Quality of Life (QoL). 

The World Health Organization (WHO) defines Quality of Life as, “an individual’s perception of their position in life in the context of the culture and value systems in which they live, and in relation to their goals, expectations, standards and concerns. QoL is a multi-dimensional concept affected in a complex way by the person’s physical health, psychological state, level of independence, social relationships, personal beliefs and their relationship to their environment.”  

Although it is a natural phase of life, most women struggle to find relevant information that may help them navigate the menopause journey. Women often feel a sense of isolation or lack of support in social settings. Now-a-days, women exchange information in smaller close-knit groups or over online menopause forums to seek help and support beyond their doctors. Despite the sheer number of people who experience menopause, it still seems to bear stigma and is not yet a commonplace topic in public discourses. Menopause is seen as a personal and private health condition than a regular aspect of life and women are expected to “just figure it out” themselves as they go through it. In addition, post-menopausal women are more vulnerable to heart disease, osteoporosis, and breast, ovarian, or uterine cancers. Thus, understanding the impact of the menopause transition on women’s day-to-day lives, i.e. the lived experience, is crucial to address some of the challenges they face.

Why is it important?

We know that menopause is influenced by more than the physiological changes associated with it. The socio-cultural understandings of menopause have a significant impact on women’s experience of it. However, we know little about how this affects women’s ability to adapt to the new phase of life. Menopause and aging women’s needs are often ignored or rarely discussed in mainstream healthcare product and service innovations. This makes it a hidden reality that not only impacts women’s preparedness for this journey, but it also influences how they can participate and contribute to society. Moreover, the socio-economic burdens and costs of healthcare for women in menopause can be very high. Studies have shown that education, appropriate guidance and effective management can have real benefits in improving women’s QoL as they go through this transition.

Opportunities in Personal Technology

Personalised self-care technologies are becoming more and more ubiquitous. For example, we are surrounded by a large number of fitness trackers and health apps. These technologies focus on tracking personal data like weight, energy levels, physical activities, time usage, sleep and learning strategies, and are intended for self-improvement and behaviour change. Despite their growing success, the existing landscape of interactive self-tracking tools for menopause care is sparse, often limited to period tracking, coaching and information sharing applications. There are a lack of meaningful interventions that could help women through their menopause journey, beyond just tracking symptoms, and seamlessly integrate it within their lifestyles to improve their quality of life.

Where can we start?

To design better self-care tools that are useful for women experiencing menopause, we need to: a) talk to experts in women’s health, and b) understand the lived experience of menopause from women themselves. 

In the initial stage of this research, we, the researchers at the Pain Studies Lab in SFU, are planning to conduct a participatory workshop to explore the lived experiences of menopause from experts in women’s health and from women who are experiencing perimenopause, menopause or post-menopause. The workshop will be conducted online via video conferencing (like Zoom) and participants will discuss how the different stages of menopause affect the day-to-day realities of someone’s life. The workshop will conclude with a short brainstorming activity to explore ideas of what may help women during this transition and benefit their long-term quality of life.

How can we get in contact with you?

If you are an academic researcher or professional expert working in fields related to women’s health or menopause care, WE NEED YOUR HELP! 

Please contact me at bwarke@sfu.ca if you would like to participate in this 2.5-hr online workshop. Participants will be compensated with $20 for their time and contribution.

(Note: We refer to all individuals experiencing symptoms of menopause as ‘women’ in this article. However, we acknowledge all individuals who may or may not identify as ‘women,’ but experience menopause or like symptoms, as a part of this research.)

COVID-19 Differences Between Men and Women

Authors: Maria Tokuyama, PhD, Assistant Professor at UBC Microbiology & Immunology; Joshua Mao, University of California Berkeley, Summer Intern at the Tokuyama Lab, UBC Microbiology & Immunology | Editors: Negin Nia and Arrthy Thayaparan (Blog Coordinators) 

Published: September 10th, 2021

Since March 2020, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has drastically changed our lives and has killed over four million people worldwide. Although people of all ages and sex get COVID-19, a striking observation is that the number of female COVID-19 deaths were half of what was seen in males. Data analysis from New York City Health found that of all death cases 38.2% were female and 61.8% were male. So what are the factors that contribute to this sex difference in COVID-19 outcomes? Several research studies have shown that differences in immune response and metabolism during disease may partly explain the worse outcomes in males than females. Here, we will summarize the key takeaways from those studies. 

The immune system is largely divided into two parts: the innate and adaptive immune system. The innate immune system is the body’s first line of defence against infection. It is able to recognize danger within minutes and rapidly fire inflammatory factors called cytokines and chemokines to recruit immune cells to sites of infection and set off alarms to engage the adaptive immune system. The adaptive immune response takes about five to seven days to fully kick-in, but once activated, it is very specific to the invading pathogen and provides long-term memory responses that can be quickly recalled to fight future infections by the same pathogen. The adaptive arm of the immune system is what is provided by vaccinations. During viral infection, both the innate and adaptive immune responses work together to fight the infection. Ultimately, the magnitude and quality of the immune response dictate disease outcomes. 

Male patients show increased activation of the innate immune response.

In a study published by Yale in August 2020, researchers compared immune responses between female and male hospitalized COVID-19 patients, who were not taking anti-inflammatory drugs. They found that male patients had higher amounts of key inflammatory molecules, interleukin 8 (IL-8) and 18 (IL-18), in their blood compared to female patients, despite having similar amounts of SARS-CoV-2 RNA. In addition, male patients had a higher amount of a type of innate immune cells called non-classical monocytes. These findings are supported by another study that reported worsening health conditions in males due to SARS-CoV-2 infection was related to increased innate immune activation. Although the immune response is intended to fight the infection, over activation of the innate immune response can lead to tissue damage and may be one explanation for why males have worse outcomes than females in COVID-19.  

Female patients have a stronger adaptive immune response.  

The two major players of the adaptive immune responses are B cells and T cells. B cells make virus-specific antibodies that bind to the virus and prevent the virus from infecting cells. T cells recognize cells that are infected and destroy them to prevent further spread of the virus. T cells also help B cells make more antibodies and strengthen the immune response. 

From the same Yale study, researchers found no difference in the amount of antibodies against SARS-CoV-2 between male and female COVID-19 hospitalized patients. However, female patients had a higher amount of fully activated T cells than males. This means that female patients are better able to control the infection through their T cells, and the weaker T cell response in males may be another reason for worse outcomes with COVID-19. 

Kynurenic acid levels correlate with deteriorating disease in males. 

The metabolism regulates the immune system through metabolites, which are small molecules that are produced through chemical reactions in the body. A study published in July 2021 found that a higher amount of a key metabolite called kynurenic acid (KA) produced from kynurenine was related to higher innate immune responses in both female and male COVID-19 patients, but this association was more pronounced in males. Male patients with worse COVID-19 had a higher ratio of kynurenic acid to kynurenine (KA:K), which also seemed to predict higher innate immune responses and lower amounts of activated T cells. A higher Body Mass Index and increased age were associated with worsening disease in male COVID-19 patients. Overall, the metabolic status of individuals seems to contribute to disease outcomes, where certain amounts of KA predicted over activation of the innate immune response and worse disease in males. 

Different levels of sex hormones in COVID-19 patients.

Estradiol and estrone are major and minor female sex hormones, and testosterone is a major male sex hormone. Sex hormones can affect many aspects of the immune system and are important to consider. A preprint article, that has not yet been peer-reviewed, reported that both male and female COVID-19 patients have higher levels of estradiol and estrone compared to healthy individuals. However, only male COVID-19 patients had decreased testosterone levels. Whether lower testosterone levels in male patients results in worse disease is not known, but it will be an important factor to monitor moving forward.     

Concluding remarks:

A wide range of disease outcomes have been observed in COVID-19 including a major difference between males and females. These studies highlight key sex differences in SARS-CoV-2 infection that affect severity of COVID-19 including differences in the coordination between the innate and adaptive immune response, metabolism and potentially, sex hormones. These differences between sexes may be important factors that explain why fewer females have died from COVID-19 than males.  

Bibliography

“Worldometer Coronavirus Death Toll.” Worldometer, 2020, https://www.worldometers.info/coronavirus/coronavirus-death-toll/. (Accessed 1 August 2021).

Takahashi, Takehiro et al. “Sex differences in immune responses that underlie COVID-19 disease outcomes.” Nature. 2020 Dec;588(7837):315-320.

Petrey, Aaron C, et al. “Summary of Cytokine release syndrome in COVID-19: Innate immune, vascular, and platelet pathogenic factors differ in severity of disease and sex.” J Leukoc Biol. 2021 Jan;109(1):55-56. 

Cai, Yuping, et al. “Kynurenic acid may underlie sex-specific immune responses to COVID-19.” Sci Signal. 2021 Jul 6;14(690):eabf8483.

Schroeder, Maria, et al. “Sex hormone and metabolic dysregulation are associated with critical illness in male Covid-19 patients.” MedRxiv, 2020, https://www.medrxiv.org/content/10.1101/2020.05.07.20073817. (Accessed September 2021).

 

 

Behind the Science: Politics of Women’s Hormonal Disorders

Authors: Alex Lukey and Arrthy Thayaparan (Blog Coordinators) || Interviewing: Shruti Buddhavarapu, B.A., M.A., University of British Columbia 

Published: August 27th, 2021

There is no single definition of polycystic ovarian syndrome, or PCOS. But what we do know is that this complex disease is one of the most common hormonal disorders in women of reproductive age.

In this month’s article for our Behind the Science Series, author and researcher Shruti Buddhavarapu discusses her master’s work on the medical and gender politics of PCOS in India.

How did you become interested in women’s health research? How did you decide to research PCOS in India?

I started showing PCOS symptoms around the age of 14-15 but it took another 10 years before I officially received a diagnosis. The journey from first noticing my symptoms to finally finding a method of managing the symptoms that aligned with my views was brutal. Women are constantly gaslit in the doctor’s office. We have to toe the line between trying to be “The Good Patient”, and fighting the condescension of a system that naturally distrusts our symptoms and our accounts of those symptoms. I was also hugely disappointed by the number of doctors who asked me to come back to them when I wanted kids—not if. It was as if PCOS only mattered because it threatened my ability to reproduce.

My research on PCOS uses critical discourse theory and analysis which have been important tools for me all through academia. This methodology looks at what the language we use tells us about the social context we’re in. It assesses the ways in which the words we use (consciously and unconsciously) create and maintain social inequalities and systems of power.

Now it seems natural that I’d apply those skills to expose the professional, political and personal networks that underpin an individual experience of a particular medical syndrome. 

How would you explain your research in simple terms?

My PCOS research studied the language and knowledge around illness and health. The paper I published in the Journal of Medical Humanities was a modified version of my Master’s research. I look at the lived experiences of folks with PCOS, especially in India. Which is to say, outside of medical discourse and doctor prescriptions, what does it mean to live with PCOS in the day-to-day? I wrote about how the lack of a known cause for PCOS allows for there to be convenient assumptions on womanhood and femaleness from those who benefit from patriarchy. It used to be common to tell women with PCOS that they invited the syndrome upon themselves due to a “Westernized lifestyle and diet.” I’ve heard this many times from doctors myself. Add to it the horror that women with PCOS may be infertile, which really threatens this nationalist idea of the pure, untarnished, un-Westernized and thus fertile and healthy Indian woman. This scare-mongering and moral policing of folks with PCOS serves no one. It focuses entirely on the wrong thing — the potential of women as mothers as opposed to individuals.

What do you think is the most important impact of your research?

Back in 2015, when I wanted to perform a critical discourse analysis of folks’ experiences with PCOS through their notion of femaleness/femininity, I was surprised to find a huge lack of material. Most academic writing on PCOS was medical with only a handful of sociological articles. So I was creating the literature I wanted to cite. I try to push the boundaries we take for granted in medical literature by bringing attention to the unrelenting but often invisible biases that are present in medicine. 

Why do you think we need to focus on women’s health in research?

I think there’s an urgent (mind you, it’s been long overdue, like centuries overdue) need for science and research to reflect the spectrum of a variety of lived experiences.

Basically, we need to democratize research. We need queer, non-binary, trans experiences to show up in our research, and we need them to be researchers. For too long, science has been the repository of colonial violence, centring a white, cis-male experience. Did you know that the Ferriman-Gallwey index (to measure hirsutism—a condition that results in “excessive, male-pattern” hair growth in women) was built on a caucasian model of “hairiness”? So for a long while, women of colour were judged on a scale that just didn’t factor in their genetic histories. 

Why is your work and women’s health research important and needed in India?

While PCOS is something that affects folks worldwide, India has one of the highest rates of the syndrome. There are ties linking this to the alarming rates of type 2 diabetes in India. (There is a close connection between PCOS and insulin resistance—often a precursor to diabetes.) 

In many ways, I want to say my research is important in India because this is where I live, and I cannot separate my location from my politics. But it also intuitively is where I need to be with my research because such a large population has PCOS in India. 

Did you face any challenges conducting your research or increasing awareness of your findings?

In my case, the biggest impediment to my research was the lack of previous research. But I knew this while going in, so I was prepared for it. 

Since one of my key arguments was that there was so little of it to go around (outside of scientific discussions), it only served my argument’s larger purpose. With my thesis, I wanted to say: “Here’s all the research we have so far. It is pitiful and has a history of being biased towards patriarchal ideas of womanhood. We need to change our language about PCOS to make it accessible to everyone, without bias.”

What are you working on now?

I recently published a creative non-fiction memoir about rootlessness, chronic illness and growing up and dating as a woman in urban India. It’s called “The Weight of a Cherry Blossom”. I’ve also been involved in a couple of pop-culture projects as a PCOS specialist/researcher—Buzzfeed, Mid-Day, Mumbai Mirror, Firstpost and A Sense of Place on Roundhouse Radio Vancouver. 

For Firstpost, for instance, I wrote a series of reimaginings of popular classics, such as Alice in Wonderland and Jane Eyre, where the protagonists have PCOS. It is tongue-in-cheek and irreverent but was a wonderful way to open conversation about PCOS. I would like to write more about the networks of chronic illness, capitalism and notions of productivity in the workplace. 

What makes you excited about the future in women’s health research?

That it’s changing! So radically, so exponentially, so determinedly. When I started research on PCOS in 2015, there was very little material in and outside of academia on the topic. Now, the number of youtube channels, IG accounts dedicated to illness discourse and women (always inclusive of trans folk) and non-binary folks’ health is so affirming. There’s so much more information coming from folks with lived experiences and women’s health researchers to the general public. 

Where would you like people to connect with you?

I’m happy to chat/connect on shrutirao1988@gmail.com or shrutirao.com! 

Learning to Forget: Making the Case for Sex-Specific Approaches to the Treatment of PTSD


Author: Dr. Luzia Troebinger, Post-Doctoral Fellow, University College London – Clinical Psychopharmacology Unit | Editors: Alex Lukey and Arrthy Thayaparan (Blog Coordinators) 

Published: April 8th, 2021

What’s your worst memory? If I offered you a pill that could erase it, would you take it? Or let’s rephrase the question: How bad would your worst memory have to be to take that pill? What if you couldn’t leave your house without reliving this memory? You might think this scenario is exaggerated, but for people suffering from post-traumatic stress disorder (PTSD), this might be a daily reality. For many people with PTSD, the impact on quality of life is so severe that they would not hesitate to take that pill. 

Research suggests that women are twice as likely to develop PTSD, even though rates of trauma exposure are higher in men.[1-3]  The reason for this disparity is complicated and dependent on environmental and biological factors.[4]  With regard to biological factors, the role of sex hormones in the context of stress and fear memory has become a primary target for research in this area.[5-7]

Studying fear memories in the laboratory can help improve our understanding of the mechanisms involved in PTSD. In the lab, a ‘fear memory’ is first established through a learnt association between a neutral and an adverse stimulus (e.g. a tone paired with an electric shock). This is similar to what happens in PTSD: a previously neutral stimulus becomes associated with the traumatic event. Extinction learning refers to the process of suppressing or reversing that learnt association. This is typically accomplished through repeated exposure to the neutral but not the adverse stimulus. Finally, extinction recall refers to how well this ‘extinction memory’ is remembered when confronted with the neutral stimulus later in time. 

Fear extinction plays an important role in exposure therapy, a type of behavioural treatment commonly prescribed in PTSD.[8-10] Briefly, this type of therapy involves repeated exposure to trauma-related memories in a safe context. Just as in the laboratory models, the idea is that repeated exposure will result in the ‘extinction’ of learnt associations between environmental stimuli and the traumatic event. Although this type of treatment is effective for many people, it has limitations. 

Try to think about your worst memory again.  Now imagine doing this over and over again. Not exactly pleasant, is it?

There is a host of factors that influence if exposure therapy will benefit an individual. One aspect that might be highly relevant for women is the level of sex hormones at the time of treatment.

Evidence from rodent studies suggests that low estrogen levels in females are associated with poor extinction recall. These findings also seem to translate to studies in human subjects, with extinction recall being worse during low-estrogen stages of the menstrual cycle.[5,11] Moreover, the suppression of the body’s natural estrogen through the administration of hormone-based contraceptives has also been found to impair extinction recall.[12] This is an issue because impaired extinction recall could render exposure therapy ineffective or even counter-productive. If patients go through the difficult process of recalling traumatic memories without an understanding that doing so is safe and effective, they may lose motivation to continue treatment.

What are the possible implications of this in a clinical context? Timing could be a crucial factor in prescribing exposure therapy in naturally cycling women. Also, women with chronically low estrogen levels may benefit from pairing exposure therapy with pharmacological interventions. For instance, a recent study in rodents has shown that a certain type of blood pressure drug could reverse the adverse effects of low estrogen on extinction recall, possibly by making up for low-estrogen-related deficits in the regulation of the physiological stress response.[13]

Another approach to dealing with intrusive, distressing trauma memories is to reduce their impact near the time they are formed. This could be achieved by using pharmacological treatments to prevent traumatic memories from being further strengthened. As with exposure therapy, the case can be made that such treatments should take sex into account.

Previous research suggests that high progesterone levels at the time of trauma exposure could contribute to a strengthening of the traumatic memory, resulting in the type of intrusive, ‘flashback’ memories associated with PTSD.[14] Another study found that women who had been exposed to sexual assault had differing levels of PTSD depending on if they received hormone-based emergency contraceptives and what hormone the contraceptive contained. [15] One of two types of emergency contraceptives was administered, with one containing both synthetic estrogen and progestin (Ogestrel), while the other drug contained a synthetic progestin-only (Plan B). Interestingly, the women who took Ogestrel reported fewer intrusive memories than those who took Plan B. This might point to a combined effect of estrogen and progesterone on the formation of trauma memories. In any case, these studies highlight the importance of considering sex in the development of pharmacological treatments intended for use in the immediate aftermath of a trauma.

Given this research, why are we not prescribing treatments – behavioural or pharmacological – in a sex-specific way?  

Treatments need to be well-studied before they can be used in clinical practice. Particularly in the case of pharmacological interventions, this process can be lengthy, costly and complex. The reality of research is that resources are limited, and drug studies are expensive. Testing for the influence of the menstrual cycle phase would increase the sample size required and would also put further demand on resources by necessitating the acquisition, storage, and analysis of biological samples for rigorous testing of hormone levels.  At this time, there is a need for more evidence regarding hormonal influences on PTSD treatments. With the emergence of funding opportunities dedicated to the field of women’s health, there is hope that this will change. What is clear from the evidence is that there are hormonal influences on the development of PTSD. By including sex differences, we are presented with an opportunity to drastically improve the treatment of mental health disorders.

About the author

Dr. Luzia Troebinger currently works as a postdoctoral research fellow in Professor Sunjeev Kamboj’s group at University College London’s Clinical Psychopharmacology Unit. Her research focuses on both behavioural and pharmacological approaches to the treatment of PTSD and is funded by the Sir Bobby Charlton Foundation.

Twitter: @UCL_SBCF

Bibliography

1. Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry 1994;51(1):8-19. doi: 10.1001/archpsyc.1994.03950010008002 [published Online First: 1994/01/01]

2. Breslau N. Gender differences in trauma and posttraumatic stress disorder. J Gend Specif Med 2002;5(1):34-40. [published Online First: 2002/02/28]

3. Kessler RC, Sonnega A, Bromet E, et al. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry 1995;52(12):1048-60. doi: 10.1001/archpsyc.1995.03950240066012 [published Online First: 1995/12/01]

4. Christiansen DM, Berke ET. Gender- and Sex-Based Contributors to Sex Differences in PTSD. Curr Psychiatry Rep 2020;22(4):19. doi: 10.1007/s11920-020-1140-y [published Online First: 2020/03/04]

5. Milad MR, Zeidan MA, Contero A, et al. The influence of gonadal hormones on conditioned fear extinction in healthy humans. Neuroscience 2010;168(3):652-8. doi: 10.1016/j.neuroscience.2010.04.030 [published Online First: 2010/04/24]

6. Maeng LY, Milad MR. Sex differences in anxiety disorders: Interactions between fear, stress, and gonadal hormones. Horm Behav 2015;76:106-17. doi: 10.1016/j.yhbeh.2015.04.002 [published Online First: 2015/04/19]

7. Goel N, Workman JL, Lee TT, et al. Sex differences in the HPA axis. Compr Physiol 2014;4(3):1121-55. doi: 10.1002/cphy.c130054 [published Online First: 2014/06/20]

8. Foa EB, McLean CP. The Efficacy of Exposure Therapy for Anxiety-Related Disorders and Its Underlying Mechanisms: The Case of OCD and PTSD. Annu Rev Clin Psychol 2016;12:1-28. doi: 10.1146/annurev-clinpsy-021815-093533 [published Online First: 2015/11/14]

9. Kothgassner OD, Goreis A, Kafka JX, et al. Virtual reality exposure therapy for posttraumatic stress disorder (PTSD): a meta-analysis. Eur J Psychotraumatol 2019;10(1):1654782. doi: 10.1080/20008198.2019.1654782 [published Online First: 2019/09/07]

10. Steenkamp MM, Litz BT, Hoge CW, et al. Psychotherapy for Military-Related PTSD: A Review of Randomized Clinical Trials. JAMA 2015;314(5):489-500. doi: 10.1001/jama.2015.8370 [published Online First: 2015/08/05]

11. Wegerer M, Kerschbaum H, Blechert J, et al. Low levels of estradiol are associated with elevated conditioned responding during fear extinction and with intrusive memories in daily life. Neurobiol Learn Mem 2014;116:145-54. doi: 10.1016/j.nlm.2014.10.001 [published Online First: 2014/12/03]

12. Graham BM, Milad MR. Blockade of estrogen by hormonal contraceptives impairs fear extinction in female rats and women. Biol Psychiatry 2013;73(4):371-8. doi: 10.1016/j.biopsych.2012.09.018 [published Online First: 2012/11/20]

13. Parrish JN, Bertholomey ML, Pang HW, et al. Estradiol modulation of the renin-angiotensin system and the regulation of fear extinction. Transl Psychiatry 2019;9(1):36. doi: 10.1038/s41398-019-0374-0 [published Online First: 2019/01/31]

14. Ney LJ, Gogos A, Ken Hsu CM, et al. An alternative theory for hormone effects on sex differences in PTSD: The role of heightened sex hormones during trauma. Psychoneuroendocrinology 2019;109:104416. doi: 10.1016/j.psyneuen.2019.104416 [published Online First: 2019/09/01]

15. Ferree NK, Wheeler M, Cahill L. The influence of emergency contraception on post-traumatic stress symptoms following sexual assault. J Forensic Nurs 2012;8(3):122-30. doi: 10.1111/j.1939-3938.2012.01134.x [published Online First: 2012/08/29]

Sex-and-Gender-Based Considerations in Exercise-Based Randomized Controlled Trials in Individuals with Stroke: A Road of Opportunities Ahead


Author: Elise Wiley, Ph.D. Student, McMaster University | Editors: Alex Lukey and Arrthy Thayaparan (Blog Coordinators) 

Published: March 19th, 2021

There is a growing body of research focused on the biological differences between males and females in pharmaceuticals, risk factors, pathology, severity, and prognosis of different diseases [1]. In contrast to this large body of evidence related to sex-based differences, we know far less about how gender impacts the risk of disease. For example, how does the risk for stroke or heart attack differ in a heterosexual man versus a transgender non-binary individual? While more research is accounting for sex differences, this is not the case for gender identity. The lack of sex and gender considerations are causing a significant gap in knowledge for many health conditions.

Stroke is a leading cause of disability and death worldwide [2]. Over the past 20 years, there has been a growing body of literature showing that exercise-based interventions are beneficial in improving physiological and psychosocial health markers in individuals with stroke [3]. However, the extent to which sex-and gender-based considerations were implemented into exercise trials in individuals with stroke has not been previously reviewed. 

In this blog post, I will share results from a study that I conducted, which aimed to examine the extent to which stroke researchers include sex-and gender-based considerations in their exercise trials. In this study, we surveyed publications of exercise trials in stroke and applied the Sex and Gender Equity in Research (SAGER) tool as a framework to determine whether sex and gender considerations were implemented in each section of a study (i.e., introduction, study design/methods, results and discussion) [4]. We were also interested in examining whether the incorporation of sex- and gender-based considerations had increased since the publication of the SAGER guidelines in 2016. 

I will preface the summary of the results by stating that we have a long way to go in addressing sex-and gender-based considerations in exercise-based trials in individuals with stroke. Over the past ten years, sex-and gender-based considerations have gained recognition for their importance in health research. This is thanks to the pioneer Canadian researchers in the field of sex and gender research who advocated for more inclusive research practices. Unsurprisingly, before 2016, the vast majority of stroke and exercise studies did not include any sex or gender considerations in any section of the research article. After 2016, we found a slight increase in the proportion of studies incorporating sex-based considerations since the publication of the SAGER guidelines. However, we also noted that researchers continued to use terminology related to “sex” and “gender” interchangeably. 

Of note, there were no exercise-based studies in stroke that included gender-based considerations. While this is unsurprising, I do wonder why we, as researchers in the field of exercise and stroke, have neglected gender in our studies? Is it that there isn’t enough awareness of the available gender-based resources to guide its inclusion or assessment? Or is the reason more deep-seated? It is important to acknowledge that it is indeed challenging to incorporate gender-based considerations into research studies when self-reported gender measures are unavailable, and there is no firm consensus on how various constructs of gender are to be measured [5]. 

We hope that our research findings will serve as a call to action for researchers in the field of exercise and stroke to acknowledge the opportunities that lie ahead in being able to address the knowledge gaps related to sex-and gender-based considerations in exercise trials in individuals with stroke. We must continue to reinforce the idea that although sex and gender are interrelated, they are not interchangeable. I urge researchers to consult the resources that I’ve provided to ensure that their participants are being addressed properly. It may also be that there is a greater onus on journal editors to ensure that, at minimum, authors submitting to their journal are incorporating proper sex and gender terminology. 

Stroke researchers are well-equipped to move forward in the area of sex and gender research. We have access to resources such as the SAGER  guidelines, the CIHR e-learning modules Integrating Sex and Gender in Health Research, and the Gender-based Analysis Plus course [4,6,7].

As an advocate for sex and gender implementation in health research, the findings from this work suggest that we have a long way to go, but the positive trend is encouraging. I am optimistic for the years to come and continue to be inspired by my fellow researchers who advocate for enhanced sex and gender implementation in health research.  

References 

1.     Melloni Chiara, Berger Jeffrey S., Wang Tracy Y., et al. Representation of Women in Randomized Clinical Trials of Cardiovascular Disease Prevention. Circulation: Cardiovascular Quality and Outcomes. 2010;3(2):135-142. doi:10.1161/CIRCOUTCOMES.110.868307
2.     Campbell BCV, De Silva DA, Macleod MR, et al. Ischaemic stroke. Nature Reviews Disease Primers. 2019;5(1):1-22. doi:10.1038/s41572-019-0118-8
3.     Saunders DH, Sanderson M, Hayes S, et al. Physical fitness training for stroke patients. Cochrane Database of Systematic Reviews. 2020;(3). doi:10.1002/14651858.CD003316.pub7
4.     Heidari S, Babor TF, De Castro P, Tort S, Curno M. Sex and Gender Equity in Research: rationale for the SAGER guidelines and recommended use. Research Integrity and Peer Review. 2016;1(1):2. doi:10.1186/s41073-016-0007-6
5.     Lacasse A, Pagé MG, Choinière M, et al. Conducting gender-based analysis of existing databases when self-reported gender data are unavailable: the GENDER Index in a working population. Can J Public Health. 2020;111(2):155-168. doi:10.17269/s41997-019-00277-2
6. Government of Canada CI of HR. IGH Learning – CIHR. Published September 2, 2015. Accessed February 25, 2021. https://cihr-irsc.gc.ca/e/49347.html
7. Government of Canada CI of HR. Gender-Based Analysis Plus (GBA+) at CIHR – CIHR. Published May 15, 2018. Accessed June 5, 2020. https://cihr-irsc.gc.ca/e/50968.html

Sex Differences Are No Afterthought

Authors:  Jolande Fooken, Xiuyun Wu, & Doris Chow | Editors: Alex Lukey and Arrthy Thayaparan (Blog Coordinators) 

Published: November 12th, 2020

In recent years more scientists have advocated an increased focus on the role of sex and gender differences in neuroscience research. Specifically, it is important to study sex-related mechanisms in the brain and how they affect sensory processing and motor behaviour. 

Considering that historically most research included only male participants, research standards are trending in the right direction. Today, researchers are strongly encouraged to take sex and gender into consideration for their research. However, is it enough to simply collect the same number of male and female participants or should we think about sex as a scientifically relevant and meaningful variable?

Missed Opportunities in Present Research

A recent study by Mathew and colleagues investigated the effect of sex as a biological variable on hand-eye coordination and processing by the brain, led us to reconsider how sensory and motor neuroscience currently take sex differences into account.[1] It’s true that researchers pay greater attention to sex and gender balance in their research than in the past. However, we still know very little about how visuomotor function might vary between people of different sex and gender. 

Driven by that very question, Mathew and colleagues decided to analyze how the ability to manually track a moving target varies between self-reported male and females.[1] Whereas the general research question could fill a large gap in our current literature, the authors missed their chance to make a significant contribution and advance our knowledge about the importance of sex as a biological variable.

The study, entitled “Sex Differences in Visuomotor Tracking”, was published in July 2020 in Scientific Reports and could potentially reach a high impact in the field. Yet, this study has several gaps, which we will later discuss,  that are not sufficiently addressed in the paper. Therefore, the conclusions drawn should raise red flags as they may mislead some readers and future research. In the following, we will comment on three major points that scientists—interested in sex differences in behavioural neuroscience—should take into account

1. Sex differences are no afterthought

We are living in a time where there are vast amounts of data being used for scientific research. Often scientists publish a subset of the full dataset that was collected, reporting only those measures that address the current research question. At the same time, there may be additional information about the participants, such as age, handedness, or biological sex not included in the analysis. Therefore, it is very tempting to later re-analyze the data to look for differences across various variables. Such differences are exactly what Mathew and colleagues reported.

The authors analyzed data from a manual-tracking baseline task that usually preceded the main experiment in their lab. Manual tracking is a common task in sensorimotor research, in which participants move a joystick to align a visual cursor with a moving target. Typically, experiments aim to investigate how participants adapt their visuomotor control to changes in the visual scene. In the study by Mathew et al., the baseline task required participants to track the moving target as closely and accurately as possible. The authors observed differences between female and male participants: females tracked the unpredictably moving target with a larger time lag than their male counterparts.

These findings should spark interest in any curious scientist. However, there is also a problem: the authors did not have an a priori hypothesis (reasoning based on inference before the study, rather than evidence) about the role of biological sex with respect to visuomotor tracking. Instead, they performed their analyses after the fact. Accordingly, several factors that may influence the role of sex and gender on the results were not controlled for. 

One factor that may have skewed the results of this study is video-gaming, an activity more common among males.[2, 3] Video game experience most likely influences participants’ ability to accurately use a joystick to track a moving target. Additionally, general personality traits could explain the observed individual differences in manual tracking behaviour. For example, risk-averse individuals may track the target with a higher time lag to be able to adjust their hand movements more precisely to sudden changes of target motion. All of this is of course speculative. The study was not designed to study sex differences and therefore cannot answer if visuomotor tracking truly differs between males and females.

 

2. The battle of the sexes: what is a male advantage?

Some readers may cringe when they read that Mathew and colleagues wrote that they found, “a clear male advantage in hand tracking accuracy”. The study shows differences, yes, but an advantage? Tracking a target as fast as possible does not necessarily translate to advantages in everyday life in which timing is often relevant. 

Imagine getting into a car with someone who is trying to follow the car in front as closely as possible—keeping a larger distance may in fact be the safer option. Driving and many other naturalistic scenarios may require us to choose a tracking behaviour that differs from a pure distance minimization. To study optimal visuomotor behaviour we need to first define normative models that allow us to evaluate a decision or judgement.[4] What is the goal of the actor? What does it mean to be successful in a task? What is the error we should aim to minimize?

In motor control, there may be some tasks in which action accuracy is easy to judge. For example, how well a person can throw a ball can be measured in the distance the ball has travelled. However, when we change the definition of success, we also change our measure of accuracy. For daily activities, it may be relatively easy to judge success, but in basic sensorimotor research, it is less clear. 

Thus, optimal performance during manual tracking can be defined in different ways: it may be optimal to track a moving target as closely as possible or to track it as smoothly as possible and thereby reduce overall movement cost. Defining optimal task performance is key to understanding individual strategies when solving any given task. Only then can we draw conclusions about so-called advantages.

3. Males are different from females, now what?

For a moment let’s assume that, despite all the weaknesses in the study by Mathew et al., that we have pointed out, that there is a difference between male and female participants during visuomotor tracking. What does that mean? 

First, we should aim to investigate where such a difference originates. Mathew and colleagues conclude that males may rely on “faster decisional processes dynamically linking visual information of the target with forthcoming hand actions”.[1] However, some of these proposed processes, such as visual processing and early visual brain regions have relatively fixed time scales.

So the question that arises is at what stage of the decision process do differences occur? Does the transformation from visual information into motor commands take longer in female participants? Why? Does this difference change with experience or training? Or are there other factors, such as knowledge about motor uncertainty, that influence visuomotor tracking? Again, we simply don’t know yet and we need more carefully designed research to find these answers.

Another important question that we should ask ourselves is what the implications of the observed differences are. For example, visuomotor control has become very important in the medical field, where robotic devices enable complicated brain surgeries. Are such devices tailored to an average operator? Should we design different devices for female neurosurgeons as compared to males? Is there an actual physiological difference between males and females or are we just measuring differences along a spectrum of individual performance variability? At this time we do not have concrete answers to these questions. So, until we have better answers to the questions of how these differences arise, it may be harmful to make sweeping statements of sex-based advantages. 

We have the opportunity to study sex differences in sensory and motor neuroscience in a meaningful and thorough way. Let’s not report sex differences as an afterthought, but instead study biological sex as an interesting and important factor at the centre of our research agenda.   

REFERENCES

1. Mathew, J., Masson, G. S., & Danion, F. R. (2020). Sex differences in visuomotor tracking. Scientific reports, 10(1), 1-12. https://doi.org/10.1038/s41598-020-68069-0

2. Terlecki, M.S., Newcombe, N.S. (2005). How Important Is the Digital Divide? The Relation of Computer and Videogame Usage to Gender Differences in Mental Rotation Ability. Sex Roles, 53, 433–441. https://doi.org/10.1007/s11199-005-6765-0

3. Quaiser-Pohl, C., Geiser, C., & Lehmann, W. (2006). The relationship between computer-game preference, gender, and mental-rotation ability. Personality and Individual Differences, 40(3), 609-619. https://doi.org/10.1016/j.paid.2005.07.015

4. Körding, K. (2007). Decision theory: what” should” the nervous system do?. Science, 318(5850), 606-610. https://doi.org/10.1126/science.1142998

Images courtesy Joel Staveley, Jehoots and Photologic on Unsplash

Sex/Gender Research: Resources for the Early Integrator to the Advanced Champion

Author: Jennifer Williams, PhD Candidate, McMaster University | Twitter: @jennyswilliams

The importance of integrating sex/gender in health research has been evident in the calls for action by researchers, funding organizations, and peer-reviewed journals alike. Especially in the midst of the global COVID-19 pandemic, this remains at the forefront of study design, illuminated recently by the first of the Women’s Health Research Cluster blogs. Over the past few years as a graduate trainee, I have been involved in research projects either integrating sex-based differences or examining female-specific conditions to fill gaps evident in cardiovascular research. Mentored by leaders in the field, much of my passion for sex/gender research has also been directed to supporting education of undergraduate and graduate trainees through mentorship, teaching, and volunteering with the CIHR Institute of Gender and Health Trainee Network

However, in reflecting on my research journey, it occurred to me that many trainees may be presently searching for resources and a network of colleagues considering these important questions. As the upcoming semester approaches, my hope is that this blog will serve as a useful guide to explore sex/gender in your future research studies, whether you’re an early integrator (like me) or an advanced champion (like many of my mentors). By no means is this an exhaustive list, so I encourage you to continue the conversation by sharing your favourite resource on Twitter with the #sexandgender.

Getting Started

What is Sex? What is Gender? When I started to ask myself these questions, I found the following definitions and infographic on the CIHR website helpful in finding the answers. Furthermore, this video (3min) provided me with an explanation about why learning about sex/gender is important. 

The CIHR Institute of Gender and Health curates an excellent list of resources for researchers to consider when integrating sex/gender into research. Check out their guide here, which is updated frequently with new resources and published studies. 

Training Modules

The following training courses/modules served as a foundation for developing my understanding of sex/gender in health research. 

Resources for Grant Applications

In addition to the training modules provided by CIHR, this video (5min) is a helpful resource for understanding what grant reviewers are looking for in assessing your integration of sex/gender into your research study design. This video, alongside a resource for reviewers, entitled “Key considerations for the appropriate integration of sex and gender in research”, can provide insight into what makes a strong research design, and hopefully a successful grant application.

The following article by Day et al. (2017) is a useful guide for understanding how to create your study proposal, based on some essential metrics outlined in their paper: “Essential metrics for assessing sex & gender integration in health research proposals involving human participants”. See Table 1 to do an early evaluation of your proposal (or your trainee’s proposal) and recognize gaps to fill prior to grant submission.

What are Researchers Saying? Research Articles & Guideline Documents 

The following article about the Sex and Gender Equity in Research (SAGER) guidelines are recommended for all researchers to review and include in their research study designs. Find out more here (Table 1 includes a comprehensive checklist of considerations).

Strategies have also been well detailed by the following articles:

Finally, this website from Gendered Innovations, curated by a worldwide group of researchers, has a Health & Medicine Checklist for considering sex/gender at each stage of the research process and case studies on sex/gender in health to use as examples for researchers and educators. 

Journal Clubs: One of the most impactful ways I’ve found for integrating sex/gender into discussions within my lab is in suggesting journal articles during journal club gatherings. Here’s an extensive list of articles curated by the NIH and a list of articles from the CIHR here.

Championing Sex/Gender Research: Organizations to Get Involved With 

Become a Sex and Gender Champion on collaborative research initiatives with CIHR. Similarly, consider joining the Institute of Gender and Health Trainee Network as a trainee mentee or Faculty mentor, and spearhead local initiatives at your institution with the support of this network. You can subscribe to the trainee network’s newsletter here.

CIHR Institute of Gender and Health also provides resources and events to engage with. Find out about Sex & Gender Events here, and consider becoming involved in the Organization of the Study of Sex Differences (OSSD) through their annual conference and journal. 

Finally, look for mentors and collaborators who are experienced in exploring sex and gender in research. If exploring women’s health, the Women’s Health Research Cluster directory is useful for connecting with individuals from across Canada, but primarily in BC, and similar for this directory in Ontario.

Have a resource to share not on this list? Continue the conversation by sharing your favourite resource on Twitter with the #sexandgender.