Ask Doctor K: Same disease causes different symptoms in men than in women

DEAR DOCTOR K: A doctor who specializes in women’s health told my wife that some diseases cause different symptoms in men compared to women. Is that really true?

DEAR READER: 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. When that happens in men, they usually have chest pain or pressure that travels to the left arm, jaw or neck when they exert themselves (or get angry).

In contrast, women are less likely than men to have these symptoms. Also, they are much more likely to 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 (the main arteries of the heart). But the test may miss important narrowings in women. That’s because women with angina are more likely to have narrowing of small coronary arteries that do not show up well with an angiogram. Men more often have narrowings of the large coronary arteries that are seen by the test.

There are other examples of how men and women respond differently to a disease or its treatment. Women usually 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 sex than the other:

• Depression and certain autoimmune diseases, such as lupus, multiple sclerosis and rheumatoid arthritis, are more common among women. Interestingly, most autoimmune diseases in animals also are more common in the females of the species.
• Sleep apnea is more common among men.

I’m afraid that sometimes doctors forget these gender differences. I had a female friend who went to her doctor because of more than a month of unusual breathlessness and fatigue. He didn’t think to test her for heart disease. She had a heart attack a few weeks later.

I’ve learned that lesson more than once myself. I vividly remember a man in his late 70s who called me to say he was concerned about a lump under the skin on his chest. At least 99 times out of 100, such a little lump under the skin is one of two things: a ball of fat called a lipoma, or a plugged-up gland called a sebaceous cyst. So I was sure that’s what it was going to be.

But when I examined his lump, it wasn’t soft and squishy as I had expected. It was rock hard and was sitting in the skin right over his breast. I almost dismissed it and sent him on his way. However, instead I got a biopsy: The man had breast cancer. It’s rare, but it happens. And I almost missed it. You don’t forget those lessons.

(This column is an update of one that ran originally in April 2013.)

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