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Doctor K: Symptoms may differ between sexes

Thu., April 4, 2013

DEAR DOCTOR K: It’s obvious that there are some health problems that affect only women, and others that affect only men. But for the health problems that affect both women and men, are there differences in symptoms, or in reactions to treatments?

DEAR READER: That’s an interesting question. Perhaps surprisingly, the answer is yes.

Heart disease is a good example. Angina and heart attacks occur when too little blood flows to the heart through arteries. The classic symptom is chest pain or pressure that travels to the left arm, jaw or neck when you exert yourself.

But men are much more likely than women to have these typical symptoms. Instead, women can have shortness of breath, abdominal pain and fatigue.

In addition, misleading test results for heart disease are more common for women. An angiogram is considered to be the “gold standard” for checking for blockages in the coronary arteries. But the test may miss important narrowings in women. That’s because women are more likely to have narrowing of small coronary arteries that do not show up well with an angiogram. These narrowings could cause angina or a heart attack.

There are other examples of how men and women respond differently to a disease or its treatment. Women tend to heal faster from injuries, and they recover better from strokes than men. Women also respond differently to medications; they tend to have more or different side effects from the same dose of medication, perhaps due to body size and hormones.

There are also conditions that are more common in one gender than the other:

• Depression and certain autoimmune diseases, such as lupus and rheumatoid arthritis, are more common among women.

• Sleep apnea is more common among men.

Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.

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