A Question of Science Podcast - how does biological sex affect health?

[CaveMum]

Haven’t had a chance to listen to this yet, but the blurb sounds promising:

“Our biological sex affects every cell in our body, so how does it influence our health - from embryo development through to the risk of disease and diagnosis? How and why do some conditions affect females and males differently? And what can we do to ensure medicine is safe and effective for everyone, after decades of male biology bias?

Across autoimmune disorders, cancer, dementia, heart disease and even responses to everyday medications, sex‑based biological differences can shape who becomes ill, how symptoms appear and what treatments work.

Join our expert panel as they explore sex differences in biology, hormones and gene regulation.

Panel:
Prof Edith Heard, CEO of the Francis Crick Institute
Natasha Karp, Biostatistician at Astra Zeneca
Prof Petter Brodin, Garfield Weston chair of Neonatology and Professor of Paediatric Immunology, Imperial College, London
Caroline Criado Perez, Author of Invisible Women”

https://podcasts.apple.com/gb/podcast/a-question-of-science/id1837162757?i=1000797381222

Thanks OP looks really interesting, about to listen to it

It sounds promising, although the Prof is from Imperial College London, a captured institute, so we'll see.

Thanks OP. It has Caroline Criado Perez on the panel, so it should be good.

When you've listened to it, can you tell us if it distinguishes between differences which are removed by cross sex hormones and which are not hormone moderated? If they do I will listen to it, though I don't really like podcasts.

I sit here with a red throbbing thumb because as a person with 2 X chromosomes (called " a woman") I am 8 times more likely to have autoimmune arthritis and no amount of trans treatments will give someone born male that risk.

Thank you OP.
I think the very title How does biological sex affect health? is worthy of a small fist-pump and a quietly-spoke 'reeee-sult!'

It assumes that there is such a thing as biological sex, and that it affects health.
The blurb states 'Our biological sex affects every cell in our body,'

Those are strong statements of sex realism. The kind of thing that people have been put through disciplinary processes for stating🙄

The content may not live up to it, but it looks factual and evidence-based and that's A Good Thing.

You're absolutely right there. Would it even have been made before the SC ruling? It's a great step forward.

Isn't it pleasing to see the shift to accurate reporting in the media. Not there yet, but the BBC are finally making efforts to report accurately.

Sad that the bar is so low but small steps and all that.
Will give it a listen later today.

Very pleased to see the BBC covering this. Quite an acknowledgement from them. Criado Perez's book Invisible Women was brilliant.

And surely it's significant that it's Brian Cox - we know that his wife, Gia Milinovich, is gender-critical, and there has been a suggestion that the mutual antipathy between her and Robin Ince played a part in Ince being dropped from The Infinite Monkey Cage.

Anyway, whatever the background, it seems that Cox is taking a firm stand on the reality and importance of biological sex. Hurrah for him.

Interesting programme, it really stressed the differences between the sexes. I hope the questioner who introduced himself as he/him learned something.

It's crazy, isn't it. I haven't listened to the podcast yet, but what is said in the blurb is so... uncontroversial. Yes, just a year or two ago, there would have been people at the BBC (successfully) censoring this type of content. How did we ever get to a point that talking about biological sex was considered a dog whistle?

Ive mot listened yet, but not everything is about trans people. They've got 45 minutes to cover a huge subject, I'd rather they didn't waste it on a tiny proportion of the population - many of whom aren't taking any hormones and so will be the same in their medical responses as any other member of their sex.

The introduction to the podcast is this:

"At the most basic level, sex is determined by our chromosomes. Two Xs for females, and an X and a Y for males. But as we'll hear, sex is broader than that. It refers to a set of biological attributes, including our hormonal levels, gene expression, and internal and external sex organs - all of which have implications for our health. Science has traditionally ignored the complexity of biological sex, with research and clinical trials largely focused on male biology. But we do know that females and males don't have the same susceptibility to disease, and respond differently to treatment."

Why would you refuse to listen to something that acknowledges that 8 times difference in your susceptibility simply because it may not cover a tiny group of other people who are irrelevant to the main argument and for whom there is barely any decent research?

It is fascinating why women suffering a heart attack often have different symptoms or warning signs to men. I wonder why? For example, stomach pain is often a symptom of a heart attack in a woman, but not in a man.

Be nice to know why MS is three to four as likely to strike women as men.

I have this on my bottom-of-the-playlist. .. I hope to get round to it.

(Was disappointed in a recent The Rest is Science to hear them crowbar "gender" where "sex" was the scientifically correct term ...)

Glad others found it interesting. I did get round to listening to it and thought it was mostly very good. Bit disappointing to hear one of the scientists say that it was not as simple as XX = female and XY = male, but I suppose you could argue that that’s true if you account for DSD, but they should have said that the number affected is vanishingly small.

The he/him question was also pretty clumsy but I thought the answer was sensible - not enough research - and they quickly moved on.

It would be interesting to know if there was anything that didn’t make the edit, but that need someone who was there live.

MS is 4 times as likely to strike women as men because it's an autoimmune disease. The genes that regulate the immune system are on the X chromosome. Men have only one, women get a double dose.

Women have a stronger immune response than men because of this, and a stronger immune system is more likely to go rogue looking for something to attack.

I have rheumatoid arthritis and a woman is 8 times more likely than a man to have that. I hope you don't have MS?

Why would you refuse to listen to something that acknowledges that 8 times difference in your susceptibility simply because it may not cover a tiny group of other people who are irrelevant to the main argument and for whom there is barely any decent research?

Because I like the written word so that I can go out and research the bits I don't understand or want more information on.

And I have researched the impact of genes on sex differences in health and I'm aware of what's probably going to be covered in a base level podcast already.

If you're going to discuss male and female differences, then actually it really matters whether the diseases are caused or moderate by hormones that can be altered, or whether they are permanent for the sex of the person.

Google AI is your friend here. I didn't know this either.

Why These Differences Happen

1. Coronary Microvascular Dysfunction: Men tend to build up plaque in the large, main coronary arteries ("the tree trunk"), which cleanly cuts off blood flow and causes classic, dramatic chest pain. Women often develop blockages, spasms, or tears not only in major arteries but also in the tiny blood vessels (the microvasculature or "root system"). This smaller-scale damage leads to more diffuse, subtle pain signals.

1. Hormonal Influences: Before menopause, natural estrogen provides a protective effect on women's blood vessels. After menopause, estrogen drops, and risks—along with arterial stiffness and microvascular changes—rise sharply. Women are also more prone to specific conditions like Spontaneous Coronary Artery Dissection (SCAD) and stress cardiomyopathy, which present differently than standard plaque-rupture heart attacks.

1. Nerve and Pain Perception: Variations in how nerve pathways process pain and how the brain interprets signals from smaller vessels mean women may experience deep fatigue, back aching, or nausea instead of sharp thoracic pain.

I'm intrigued why the questioner added he/him after saying his name. None of the other questioners(women) mentioned their pronouns.
Why did he think it appropriate or necessary in such a forum?
Surely if you want an honest answer to a question you shouldn't show any bias you might have. It just puts the responder on their guard.

Performative main character syndrome no doubt. Pretty standard for a bloke who is so confident in his self-righteousness as an “ally”.

My Mum died from a coronary dissection...though it did 'present' in typical heart attack style.

The 'nerve and pain perception' aspect is most intersting. How and why do female brains process pain differently? Some of those symptoms listed ( fatigue/back ache/nausea) are very reminiscent of those that occur during pregnancy.

I'm sorry about your Mum. I have a friend in her 40s who had a heart attack and the doctors would not believe her and asked her whether she took cocaine! When her blood results came back they were absolutely grovelling in their apologies.

Another Google I'm afraid -

I think the fluctuating hormones are quite a bit factor, personally. Things are much harder to ignore if they are up one day and down the next, I reckon.

1. Hormonal influences

• Testosterone (Anti-nociceptive): Higher levels of testosterone in men act as a natural pain dampener, raising pain thresholds. Studies show that adolescent boys with higher testosterone report less pain over time.
• Estrogen and Progesterone: Fluctuations in female sex hormones directly interact with pain pathways, neurotransmitters, and inflammation. High estrogen can sometimes trigger pain-relieving opioid receptors, but changing levels during the menstrual cycle, pregnancy, or perimenopause can also heighten pain sensitivity.

1. Neurological and Immune Differences

• Lower Pain Thresholds and Tolerance: In laboratory and clinical settings, women consistently exhibit lower pain thresholds and higher pain intensity ratings when exposed to the same physical triggers (like cold, heat, or pressure).
• Central Sensitization: Women tend to experience greater central sensitization, meaning the brain and spinal cord become more reactive to pain signals, making minor or chronic stimuli feel more intense.
• Immune Signaling (Microglia): Research in animal and human models suggests that chronic pain in females is more heavily driven by immune system signaling—specifically through microglial cells and inflammatory pathways—whereas male pain regulation often relies on different neural circuits.
• Endorphin Response: Female brains have been shown to produce fewer natural pain-inhibiting endorphins immediately following a painful stimulus compared to male brains.

1. Psychosocial and Cultural Factors

• Coping Mechanisms: Social and cultural conditioning influence how pain is expressed. Women are often socialized to be more attuned to bodily changes and to seek social support or use descriptive language when discussing discomfort. Men are traditionally socialized toward stoicism, distraction, or avoidance.
• Higher Rates of Chronic Conditions: Conditions like fibromyalgia, migraines, irritable bowel syndrome, and rheumatoid arthritis are significantly more common in women, which contributes to higher baseline reports of chronic pain.

No, I have other crosses to bear.

Genetic diseases around chromosomes can be devastating. I have a friend and it wasn't until her daughters had children that it emerged someone, somewhere was carrying the haemophilia gene. So both her grandsons - cousins to each other - are haemophiliac. Spending a lot of their early lives in and out of hospital. (If this tugs at anyones heart strings who can give blood and doesn't - you know what to do ....)

That's really interesting about the genes regulating the immune system being on the X chromosome. My husband has a very rare autoimmune disease (less than 1 in a million people have it). He is seeing a lot of chronic illness stuff popping up on his FB feed (probably hovered over something for a millisecond and now that's all he gets!) and was only saying this morning that all of the posts are by females, or aimed at females. It has been triggering him quite a lot (part of his illness means he gets triggered by stuff that would never used to have bothered him). However, what you've said now makes total sense as to why he's seeing that with women being far more affected by autoimmune diseases than men.

Sorry to hear that your husband has an autoimmune condition too . I've found the autoimmune group of the Mayo Clinic site quite helpful and not too obviously only women. They are a mine of information about the newer, better and more expensive biologic immunosuppressant drugs (that the NHS try not to prescribe) too.

Will take a look, thanks. He had 5 days of IVIG in May, then had two Rituximab Infusions in July and is due to have them 6 monthly for the next 18-24 months.

Life has changed immensely for both of us so it's taking a lot of getting used to.

Anyway, thanks again and sorry for the derail.