Doctors used to treat the human body as a one-size-fits-all machine. For decades, the "standard" patient in medical textbooks was basically a 150-pound white male. If you weren't that, well, good luck. But the reality of his and hers health is way more complicated than just different parts. It’s about how a heart attack feels, how ibuprofen clears your system, and why your immune system might be its own worst enemy depending on your chromosomes.
Biology isn't fair.
We’ve spent too long pretending that "equality" in healthcare means treating everyone exactly the same. It doesn't. True equity means acknowledging that a woman’s liver often processes drugs slower than a man's, or that men are statistically more likely to ignore a nagging cough until it’s a stage 4 problem. Honestly, the gap in how we experience illness is massive.
The invisible bias in his and hers health
For a long time, clinical trials straight-up excluded women. Researchers worried that fluctuating hormones would "mess up" the data. It’s wild to think about now, but until the NIH Revitalization Act of 1993, there wasn't even a legal requirement to include women in most federally funded research.
This created a "male-as-default" bias that still haunts us.
Take Ambien, for example. For years, men and women took the same dose. Then, everyone realized women were waking up still groggy and getting into car accidents at way higher rates. Why? Because women metabolize zolpidem (the active ingredient) much slower. The FDA eventually had to cut the recommended dose for women in half. That’s a perfect, albeit scary, example of why his and hers health needs to be specific.
It’s not just about weight. It’s about enzymes. It’s about fat-to-muscle ratios. It’s about cellular-level differences that we are only just beginning to map out.
Your heart isn't his heart
We’ve all seen the movies. A man clutches his left arm, gasps, and falls over. That’s the "Hollywood Heart Attack." And for men, it’s often pretty accurate.
Women? Not so much.
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A woman having a heart attack might just feel really tired. Or she might have indigestion. Maybe some jaw pain. Because these symptoms don't fit the "standard" (read: male) model, women are often sent home from the ER with an antacid while they’re literally having a cardiac event. According to data from the American Heart Association, women are significantly more likely to die in the year following a heart attack than men.
That is a failure of specialized care.
The "Symptom Gap" and the mental health divide
Men have a different struggle. It’s less about being ignored by the system and more about a systemic refusal to show up.
Society tells men to "rub some dirt on it." This leads to a massive delay in diagnosis for things like colon cancer or hypertension. But where this really gets dark is mental health. We know that women are diagnosed with depression at higher rates, but men die by suicide at nearly four times the rate of women.
Why the disconnect?
Men often exhibit "masked" depression. Instead of crying or withdrawal, it looks like irritability, risk-taking, or substance abuse. If a doctor is looking for the "standard" list of depression symptoms, they might miss the guy who is blowing his savings at a casino or picking fights at work. We need to stop looking for the same red flags in everyone.
Autoimmune issues: The 80% problem
If you look at people with lupus, multiple sclerosis, or rheumatoid arthritis, about 80% of them are women. This is a huge pillar of his and hers health that scientists are still trying to crack.
Some researchers, like those at Stanford University, have pointed toward the "Xist" molecule. Since women have two X chromosomes, one has to be "silenced" to avoid a toxic protein overdose. The mechanism that silences that extra X chromosome might actually be what triggers the immune system to go haywire and start attacking the body.
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Men, with their XY combo, don't have this specific trigger. This makes their immune systems generally less "reactive," which is great for avoiding lupus, but maybe not as great for fighting off certain viral infections. We saw this play out in real-time during the early waves of COVID-19—men were consistently hitting higher rates of severe illness and death.
Sleep, stress, and the cortisol trap
Ever notice how a couple can go through the exact same stressful event—like a car wreck or a bad layoff—and react totally differently?
Women generally produce more cortisol (the stress hormone) and stay "wound up" longer. This isn't a personality trait; it's a physiological feedback loop. Prolonged cortisol exposure wreaks havoc on everything from bone density to gut health.
On the flip side, men tend to have a higher "vasopressin" response, which is linked to that classic "fight or flight" aggression.
Sleep is another weird one.
- Women are more prone to insomnia.
- Men are more prone to sleep apnea.
- The "standard" CPAP masks were originally designed for male face shapes, leading to leaks for women users for years.
It’s these little things. The mask fit. The pill dose. The "vague" pain. They all add up to a healthcare experience that is fundamentally different based on sex.
The testosterone myth
People think testosterone is just for muscles and aggression.
Wrong.
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Low T in men is actually a major predictor of type 2 diabetes and metabolic syndrome. When a man’s testosterone drops, his body starts storing visceral fat (the dangerous stuff around the organs) much faster. It’s not just about "low libido" or whatever the late-night commercials are selling. It’s a metabolic crisis.
Meanwhile, women have testosterone too—just less of it. When their levels are off, it can lead to PCOS (Polycystic Ovary Syndrome), which is one of the most underdiagnosed conditions out there. It’s often dismissed as "just irregular periods" until the person starts struggling with infertility or insulin resistance.
Precision medicine is the only way forward
We have to move past "bikini medicine."
That’s a term coined by Dr. Nanette Wenger to describe the practice of only looking at "his and hers" differences when it comes to the parts of the body covered by a swimsuit. Your brain has sex-based differences. Your lungs do. Your skin does.
We’re seeing some progress. Modern drug development is starting to require sex-disaggregated data. This means they have to show how the drug works on men and women separately, not just as a blended average. If a drug works great for 90% of men but only 10% of women, a "blended average" might make it look okay, even though it's useless for half the population.
Actionable steps for your next checkup
You can't wait for the entire medical establishment to catch up. You have to be your own advocate.
If you are a woman:
- Ask about dosages: Specifically ask your doctor if a medication has been studied for sex-based dosage differences. Mention the "Ambien rule" if they look confused.
- Don't let them "anxiety-wash" your symptoms: If you have chest pain or neurological issues and they tell you it’s "just stress," ask for a second opinion or specific diagnostic tests (like a high-sensitivity troponin test for heart issues).
- Track your cycle, even for non-reproductive issues: Migraines, asthma flares, and even ADHD symptoms can fluctuate wildly based on where you are in your hormonal cycle.
If you are a man:
- Get the "boring" bloodwork: Don't just check your cholesterol. Ask for a full metabolic panel, including testosterone and fasting insulin.
- Be honest about the "weird" symptoms: If you’re feeling unusually angry or sleeping 10 hours and still feeling tired, tell your doctor. It’s likely not "just getting older."
- Screening isn't optional: Start colonoscopies at 45 (or earlier if there's family history) and don't skip the prostate exams.
The future of his and hers health isn't about separation; it's about specialization. It's about recognizing that our bodies speak different languages. When we finally start listening to those specific dialects, we stop guessing and start actually healing.
Get a copy of your most recent blood work. Look at the reference ranges. Most of them are still based on a general population average. Start asking your provider how your specific markers compare to people of your own sex and age bracket, rather than just the "normal" range on the paper. This is the first step in moving from generic care to precision health.