Female patients of rheumatic arthritis outnumber males, while stroke is more common among men than women. Men have a higher risk of myocardial infarction, and women are more vulnerable to alcohol.

It is common knowledge that the incidence or pattern of the same disease can vary between men and women. But little has been said about "why" such a difference occurs. Gender difference is the most basic and "natural" variable and has been easily overlooked in clinical fields and medical studies. All standards were set at “170-cm and 65-kg males” and "50 percent of humans were always at risk of error.”

As most of the existing medical studies have been done by male researchers on men, “too deadly damages intended by none” followed. Eight out of 10 drugs recovered by the U.S. Food and Drug Administration adversely affected women. Zolpidem, a sleeping pill, had its prescription for women halved no earlier than 2013.

Sex/Gender-Specific Medicine (SGM) began with the awareness of the problem. It is aimed at “providing medical service more suitable and safer for everyone” by considering the influence the biological sex and its sociocultural background gender have on health.

In the era of precision and customized healthcare, there are also growing calls for developing an understanding of the basic variable of gender.

In 2021, an amendment to the Basic Act for Science and Technology, which called for considering sexual characteristics in scientific and technological research, also passed the National Assembly, laying the legal foundation for sex- and gender-specific medical research.

Against this backdrop, the Research Center for Sex- and Gender-specific Medicine, the first such research institute, opened at Seoul National University Bundang Hospital (SNUBH). Professor Kim Na-young of the Gastrointestinal Disease Department took the inaugural directorship. Director Kim has led Korea’s sex- and gender-specific medicine by publishing related books, such as “Sex/Gender-Specific Medicine in Gastrointestinal Diseases” and “Sex/Gender-Specific Medicine in Clinical Areas.” Professor Kim said at the center’s opening ceremony, “We will develop sex- and gender-specific research in basic areas and improve the quality of patient treatment.”

The center plans to benchmark frontrunning examples at Stanford University School of Medicine and Mayo Clinic, publicizing the importance of SGM and leading related studies. It also will collaborate with the Korea Center for Gender Innovation for Science and Technology Research (GISTeR) and the National Academy of Medicine of Korea, which affected SGM and the center’s establishment.

Korea Medical Review met with Professor Kim to learn about SGM’s importance and tasks.

Question: You have worked vigorously in SGM and produced substantive research results. What made you have an interest in SGM?

Answer: I became aware of SGM after receiving an invitation from Gendered Innovation in 2014. I conducted a study on functional gastrointestinal diseases as part of the gender-innovation project initiated by the Korea Federation of Women’s Science and Technology Associations in 2013 and found that reflex esophagitis was more common among men, but the heartburn was more severe in women. Gender differences existed not only in incidence but in aspects as well.

In 2016, commissioned by the Korea Research Foundation, I began studying gender differences in colorectal cancer. I had many opportunities to release related papers, wanting to continue these studies. This feeling grew as I encountered the results of gender difference research in other fields, including circulatory organs, nerves, and skin.

Q: We also are curious why you decided to establish a research institute that only deals with SGM.

A: Following a graduate course in 2017, I opened SGM as an elective course for the sophomore students of the Department of Medicine (main course) of Seoul National University College of Medicine in 2018. Professor Shin Chan-soo, dean of the medical school, gave lots of help. It was the first attempt in Kora. I thought it an excellent opportunity to increase the understanding of sex and gender in medical science. However, people said they were disappointed because related studies were too poor. We set about to educate medical students but kept telling them that “there are such and such differences between men and women.” We failed to give answers to questions asking “why.”

I reflected on myself then. There was a lack of academic approach to gender difference before considering how to educate gender difference medicine. Medicine loses its vitality unless backed up by research. Questions about the disease should be solved, and depth should be added endlessly. You should not just list the facts but look behind them. To continuously produce research results, you should gather researchers together. For this, we needed to have a related organization.

Q: SNUBH has become the first medical institution to open an SGM research center.

A: In 2021, GISTeR was separated from the Korea Federation of Women’s Science and Technology Associations to become an independent organ. The Basic Act for Science and Technology was enacted. Such external trends coincided with SNUBH’s atmosphere that stresses “innovation.” I recommended the establishment of this center to former SNUBH Director Paik Nam-jong. I received an answer from him that I had better begin with a provisional organization.

Q: SGM is often (mis)understood as a category of “women’s medicine.”

A: Whenever I discuss gender difference medicine, I receive many questions asking whether I have begun a feminist movement. Recently, as gender issues have become more acute in society, aggressive reactions are also considerable. Some say it is reverse discrimination against men. However, the targets of SGM are all people. SGM also ensures male breast cancer patients receive more appropriate and safer treatments and stress the importance of preventing male osteoporosis as much as women’s.

Q: Recently, the importance of LGBT care has also been emphasized. Does SGM include “sexual minorities?”

A: In the beginning, there was also a view that connected SGM only to the topic of sexual minorities (LGBTQ). Inversely, I learned about LGBTQ issues from these responses. Gender difference medicine should be helpful for holistic treatment. There is a considerable lack of studies on gender dysphoria due to a mismatch between specified and experienced gender. SGM needs to study this issue, too.

However, there is this problem while sex, a biological concept, can be categorized and quantified, it is impossible to do the same for gender. Since gender is a socio-cultural context, it is also inappropriate to apply previous Western research methods and models as they are. To expand the research horizon of SGM, we need to consider more on how to study gender in the future.

Q: Any concluding message?

A: From what I said, you might think you can find gender differences in all diseases, but that's not the case. We thought there would be a difference, but in most cases, it is not. A case in point is pediatrics. There is nothing to call a "gender difference" before the second sex symbols appear. Then it's a bit disappointing (laugh). But the important thing is to recognize that what has been regarded as natural so far is no longer natural. All of us medical professionals need to think again about the blind spot of medicine, which has looked so natural that we could not help but miss them.