Do Drugs Act Differently in Men and Women?

This entry was posted in Health and Wellness and tagged Gender on June 2, 2022 by Lyle Murphy.

Last Updated on June 2, 2022 by Carol Gillette

Alternative to Meds Editorial Team
Medically Reviewed by Dr Samuel Lee MD

Men and women frequently have different experiences in relation to medicines and drugs. Sometimes the differences are seen in adverse effects or a drug having a greater effect. These differences can be related to the physiological differences between men and women, as well as other gender-specific differences.

In many cases, more men are enrolled in drug trials than women.¹ There are many reasons behind this gender bias. One frequent major setback caused by this issue is that the results aren’t differentiated between what men and women experience separately. This can put either gender at a disadvantage when trying to understand the scope of adverse effects, especially if they’re experiencing symptoms outside of the norm.

While gender bias is not a new concern, it’s becoming increasingly important that study and trial results separate their findings by the participants’ gender. Having more detailed data and metrics will better serve the community overall. Additionally, it may also illuminate the greater issue of overmedication.

Do Men and Women Metabolize Differently?

People, in general, metabolize differently depending on a variety of factors, including age.² Major physiological changes occur at different stages of our lives, particularly puberty and menopause. When these changes take place in our bodies, our metabolisms slow down or speed up accordingly.

There also appear to be differences between the metabolisms of men and women, and it is suggested that this varies based on the skeletal muscle between each gender.³ In women, more fats are burned post-mealtime and during high-energy activities, but they burn fewer carbohydrates. This suggests that women have a tendency toward a more flexible metabolism, using energy in different ways when more or less is available.

Much of this appears to be affected by the more basic and evolutionary specific needs of the body for reproductive purposes. For women, lactation and gestation require an extreme amount of energy. Because of this, the body is prepared to create higher stores of fats when the reproductive process requires a higher amount of energy. While the research itself isn’t extensive in these areas, much of what is available points to a clear difference in metabolic rates between men and women.

Alcohol affects men and women differently, too. Studies have suggested that women are more susceptible than men to the toxic effects of ethanol.⁴ Women typically experience the results of drinking much quicker than men. This is due to women having lower levels of the enzyme that breaks down the alcohol. Women also often experience greater difficulty gaining treatment and the support of those around them, as fewer people will recognize that an issue exists. While more men experience substance abuse issues, women face a greater stigma and thus have a more difficult time seeking treatment. These factors contribute to a more dangerous experience.

Gender Differences in Drug Responses

Drugs are often not given based on the body fat or weight of the patient. Male and female patients are often prescribed the same dosage regardless of their weight. This causes a higher volume of distribution (Vd) in those weighing less. However, weight variance doesn’t seem to be the only factor.⁵ Some of the categories where drug efficacy is experienced include antiarrhythmic drugs and anesthetics.

Another factor is pharmacokinetics. Pharmacokinetics is the study of how a drug moves through the body, including how it is absorbed, disseminated, metabolized, and excreted. Because there are evident differences in the ways that men and women metabolize chemicals, it’s apparent that their bodies would also process the drugs they receive differently. This can also result in varying adverse effects or stronger adverse effects in those who process the drug differently than the more studied audiences.

In cardiovascular medicine, it is extremely common for men and women to experience different effects. Men and women are physiologically different and often have different chemical compositions in their bodies at different times. This is one factor influencing how men and women respond to drugs differently. Because so many studies are based primarily on middle-aged men, women are prescribed medicine that isn’t gender-specific or evidence-based.

Women also experience a higher incidence of adverse reactions, and the adverse reactions are typically much more severe than those in men.⁶ While this isn’t a strictly drug-related issue, women are also less likely to receive preventative recommendations and receive less aggressive treatments. The same can be said of drug dependency and addiction.

Because women store more fat than men, women are often more greatly affected by fat-soluble drugs. As a result, these medications are distributed by the body differently than in men. However, women tend to respond better to certain medications than men, including antipsychotics and certain antidepressants.

Men and women also have different digestion patterns. Men seem to generate more gastric acid than women, resulting in quicker food digestion. Medication that requires acidic surroundings to be absorbed might be less effective for women than men. Also, because food digestion typically takes longer for women, medicine that needs an empty stomach might be less effective for women.⁷

Why Men and Women Respond Differently to Drugs or Toxins

First and foremost, consider the obvious physiological differences in men and women. During different points, such as menstruation and menopause, women’s bodies are flooded with different kinds of chemicals. As a result, the interaction of drugs and body systems can be quite different. The presence of a higher or lower number of chemical compounds in the body leads to different reactions to drugs.

Hormones specifically can also greatly influence how a drug is metabolized. Because women’s hormones fluctuate, such as during the menstruation cycle or menopause, they can often experience different reactions than men to certain types of drugs. Estrogen specifically may hinder how the liver distributes medications. If the liver is inhibited in its drug breakdown, higher concentrations of the drug are present in the blood. This can mean that the drug will take longer to process in women than in men.

Unfortunately, not enough research has been conducted to provide a direct answer. This is one of the biggest issues. As fewer women are recruited for drug trials and drug studies, there is less evidence illustrating how women specifically react to drugs. Alternatively, because men are more often participants, drug compositions are often defined based on men’s reactions to the medicine than women.

This gender bias creates a huge gap in both medicine and the treatment of drug dependency. It seems counterintuitive to not include women in the drug trials for medicine as women are more likely to take medications.⁸ Unfortunately, the issue is compounded because women are frequently disregarded when they express medical concerns.

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Dangerous Adverse Drug Reactions

Adverse Drug Reactions (ADRs) are those responses to drugs that are unintended and harmful. These can range from common nausea and sleeplessness to cardiac arrest and death. One significant adverse effect that typically plagues more women than men is called long QT syndrome.

Long QT syndrome is a condition that can be inherited but is often caused by medications. It affects the rhythm of the heart, sometimes making it beat more rapidly. Long QT syndrome can lead to Torsades de Pointes. This condition results in a very fast heartbeat, up to 300 beats per minute, and can cause fainting, dizziness, lightheadedness, heart palpitations, cardiac arrest, and even death.

While possible in men, women are typically diagnosed more often with this condition. Two-thirds of those diagnosed with Torsades de Pointes are women.⁹ Some drugs that may cause this condition include antiarrhythmics, antibacterials, antihistamines, antipsychotics, and gastro kinetics.

What Drugs Work Differently in Men and Women?

The drugs that process and affect men and women differently include, but are not limited to:

Alcohol

As mentioned earlier, women often have less of the enzyme alcohol dehydrogenase, and therefore alcohol takes longer to break down. Women also often experience drunkenness more quickly than men for this reason.

SSRIs Like Zoloft

Women typically have a better time processing this drug for bipolar disorder. It is not fully understood why this might be the case.

Tricyclic Antidepressants

Men typically respond better to these types of antidepressants than women.

Antifungals Like Ketoconazole

This drug requires a more acidic environment. Women typically see a lesser effect because they generally produce less stomach acid.

Antibiotics Like Tetracycline

Medicines that require an empty stomach may have a lesser efficacy in women as typically food takes longer to digest.

Methotrexate, a Cancer Drug

Because of the differences in the way women’s livers and kidneys process toxins (and medicines are somewhat treated like toxins in the body), methotrexate takes longer to clear the body than for men.

Antipsychotics

Women typically see better results with antipsychotics and require a lower dosage in order to control their symptoms.

Aspirin

Often recommended for heart attack risk reduction, this suggestion has been removed for women, as it has a higher potential to cause bleeding in women.

Acetaminophen and Other Non-Steroidal Anti-Inflammatory Medication

Women were found to have had higher blood pressure, or hypertension, than those not taking those drugs. Women taking those drugs frequently, 22 or more days a month, had a significant increase in the risk of hypertension.

Sleep Aides

Women reported a higher difficulty driving the day after taking the sleep aid Ambien. They were recommended to take half a dose due to these adverse effects.

Beta-Blockers

Women typically experience heightened sensitivity to medications used to reduce blood pressure.

Opioids

Women typically see a better response to opioids than men.

Digoxin

Typically used to treat heart failure, digoxin shows an increased mortality rate in women, and thus they require a smaller dosage.

Anticonvulsants

Because some liver enzymes are more active in younger women, some anticonvulsants are less effective.

Psychotropic drugs, in general, are often more effective for women than men. These include opioid painkillers, sleep aids, and antidepressants, all mentioned above. Anti-anxiety medication can see a quicker effectiveness rate in women, but this can also cause a higher level of toxicity with standard doses.¹⁰

Gender Experience for Women in Dependency

While both genders experience adverse effects from drugs and medications, it seems that women more often see a more severe side of this. In the case of drug dependency, this can become incredibly dangerous as the dependency leads to addiction. When certain drugs are more effective, higher doses quickly become more lethal. This appears to be double the case for women.

One major issue is the lack of research necessary for gender-specific answers. Oftentimes, the extreme cases of gender bias show a lack of women involved in drug trials and drug studies. This has damaging effects for a variety of reasons. A major reason is a lack of understanding of how drugs may affect women differently from men.

Another bigger and more frightening concern is the sociocultural implications of the lack of these studies. Women have historically encountered a disregard for their observations and concerns in healthcare as well as proper care for drug dependency and addiction. This created a taboo for women to express their needs in these regards. When women continue to be ignored, we see those struggling with drug concerns fall through the cracks and become disregarded.

Evidence shows that men and women react differently to drugs. These differences range from more serious adverse effects to lower efficacy. What we need is to show greater concern and more research to do both genders justice.

1 (800) 301-3753 for Gender Influence Drug Effect Help

Sources:

1. Holdcroft, A. (2007). Gender bias in research: how does it affect evidence-based medicine? Journal of the Royal Society of Medicine, 100(1). 2–3. https://doi.org/10.1177/014107680710000102

2. Rood, J. (2021, August 12). Metabolism changes with age, just not when you might think. ScienceDaily. Retrieved February 23, 2022, from https://www.sciencedaily.com/releases/2021/08/210812145028.htm

3. Phillips, M. C., Murtagh, D. K., Sinha, S. K., & Moon, B. G. (2014, November 13). Gender differences in skeletal muscle substrate metabolism: Molecular mechanisms and insulin sensitivity. Frontiers. Retrieved February 23, 2022, from https://www.frontiersin.org/articles/10.3389/fendo.2014.00195/full

4. Thomasson, H.R. (2002) Gender differences in alcohol metabolism. Galanter M. et al. Recent Developments in Alcoholism, vol 12. Springer, Boston, MA. https://doi.org/10.1007/0-306-47138-8_9

5. Nicolson, T., Mellor, H., Roberts, R. (2010) Gender differences in drug toxicity. Trends in Pharmacological Sciences, vol 31, Issue 3. https://www.sciencedirect.com/science/article/abs/pii/S0165614709002077

6. Tamargo, J., Rosano, G., Walther, T., Duarte, J., Niessner, A., Kaski, J.C., Ceconi, C., Drexel, H., Kjeldsen, K., Savarese, G., Torp-Pedersen, C., Atar, D., Lewis, B.S., Agewall, S. (2017). Gender differences in the effects of cardiovascular drugs, European Heart Journal – Cardiovascular Pharmacotherapy, Volume 3, Issue 3. 163–182. https://doi.org/10.1093/ehjcvp/pvw042

7. Worth, T. (2015). Drugs that work differently in women and men. Everyday Health. Retrieved February 23, 2022, from https://www.everydayhealth.com/news/drugs-work-differently-woman-than-man/

8. Orlando, V., Mucherino, S., Guarino, I., Guerriero, F., Trama, U., & Menditto, E. (2020). Gender differences in medication use: A drug utilization study based on real world data. International journal of environmental research and public health, 17(11). 3926. https://doi.org/10.3390/ijerph17113926

9. Drici, MD., Clément, N. (2001). Is gender a risk factor for adverse drug reactions? Drug Safety, 24. 575–585 https://doi.org/10.2165/00002018-200124080-00002

10. Jacobson, R. (2014). Psychotropic drugs affect men and women differently. Scientific American. Retrieved February 21, 2022, from https://www.scientificamerican.com/article/psychotropic-drugs-affect-men-and-women-differently/

This content has been reviewed and approved by a licensed physician.

Dr. Samuel Lee

Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. He graduated with an MD at Loma Linda University School of Medicine and did a residency in psychiatry at Cedars-Sinai Medical Center and University of Washington School of Medicine in Seattle. He has also been an inpatient adult psychiatrist at Kaweah Delta Mental Health Hospital and the primary attending geriatric psychiatrist at the Auerbach Inpatient Psychiatric Jewish Home Hospital. In addition, he served as the general adult outpatient psychiatrist at Kaiser Permanente. He is board-certified in psychiatry and neurology and has a B.A. Magna Cum Laude in Religion from Pacific Union College. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself.

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Lyle Murphy

Lyle Murphy is the founder of the Alternative to Meds Center, a licensed residential program that helps people overcome dependence on psychiatric medication and addiction issues using holistic and psychotherapeutic methods.

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