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• W4386906601 abstract "With great interest, we read The Lancet Neurology Editorial on sex, gender, and the cost of neurological disorders.1The Lancet NeurologySex, gender, and the cost of neurological disorders.Lancet Neurol. 2023; 22: 367Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar We appreciate the attention given to this important subject, and we agree with the conclusion that better understanding of sex and gender disparities in neuroscience and neurology holds the potential to facilitate earlier and more reliable diagnosis and more effective prevention, treatment, and disease management. However, we believe that additional points need consideration. First, while the terms sex and gender are correctly delineated as corresponding to biological and social constructs, respectively, the demarcation between these two concepts is not always straightforward: gender can be influenced by sex, leading to potential complexities in research methodologies used to investigate their interplay.2Al-Hassany L Verdonk P MaassenVanDenBrink A Studying sex and gender in neurological disease.Lancet Neurol. 2023; 22: 32-33Summary Full Text Full Text PDF PubMed Google Scholar For instance, plasma oxytocin levels are higher in people of female sex, especially among postpartum breastfeeding females, than those of male sex.3Marazziti D Baroni S Mucci F et al.Sex-related differences in plasma oxytocin levels in humans.Clin Pract Epidemiol Ment Health. 2019; 15: 58-63Crossref PubMed Scopus (28) Google Scholar, 4Uvnäs Moberg K Ekström-Bergström A Buckley S et al.Maternal plasma levels of oxytocin during breastfeeding—a systematic review.PLoS One. 2020; 15e0235806Google Scholar Such sex-related hormonal fluctuations might underpin caring behaviours,5Olazábal DE Role of oxytocin in parental behaviour.J Neuroendocrinol. 2018; 30e12594Crossref PubMed Scopus (17) Google Scholar often considered to be associated with gender, thereby blurring the boundaries between intrinsic biological predispositions (ie, sex) and socially constructed characteristics (ie, gender). Second, the Editorial advocates for the inclusion of more diverse populations in research and clinical trials with the aim of optimising novel treatments, in terms of both efficacy and side-effects, for individuals outside of trial settings. However, diverse populations do not unequivocally contribute to optimisation of efficacy, as this is preferably studied in a homogeneous research population to enhance internal validity. Clinical trials done in diverse study populations are often further limited by insufficient statistical power within each subgroup to examine these effects. Nonetheless, it is essential to ensure that the selected research population in a trial accurately reflects the target study population. Finally, it is crucial to emphasise that diversity is broader than consideration of sex and gender. Research endeavours should adopt an intersectional approach by addressing multiple social dimensions that form a person's identity (eg, ethnicity, socioeconomic status, and age) and that also interact with sex and gender. These dimensions overlap and lead to various modes of societal advantage or disadvantage. Addressing each of these identities in every study would be challenging, but we believe that an intersectional approach, in which at least the potential influence of all these factors is taken into account, will advance scientific inquiry, promote health equity, and ultimately enhance clinical care for all individuals. This work was supported by the Dutch Research Council (ZonMw/NWO, Vici Grant 09150181910040). AMvdB has received research grants or consultation fees from Allergan, Amgen/Novartis, Eli Lilly, Satsuma, Teva, and ATI. LA-H declares no competing interests. Sex, gender, and the cost of neurological disordersAlmost one in three people are estimated to develop a neurological disorder during their lifetime , at a cost of more than US$1·7 trillion per year . Many aspects of neurological disease can be affected by sex, which is defined by WHO on the basis of biological and physiological characteristics, and gender, which is defined on the basis of socially constructed characteristics. For example, sex is associated with differences in the risks for and prevalence of several neurological disorders and responses to some treatments; gender can affect diagnosis and prognosis, for instance if cultural norms mean that people are reluctant to seek health care or if health-care professionals have preconceived ideas of who is more likely to have a disease. Full-Text PDF" @default.
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• W4386906601 title "Multifaceted dynamics of sex and gender in neurological research" @default.
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• W4386906601 doi "https://doi.org/10.1016/s1474-4422(22)00447-1" @default.
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