Gender as a risk factor

For a long time, studies involving women in medicine were considered complicated. And researchers still know comparatively little about women's health. In the neuroscience department at the University of Tübingen, data is already being analyzed in animal models based on gender – and research into women's health is being placed at the forefront.

Gender is a risk factor for many mental illnesses. Women are more susceptible to depression. They suffer more frequently from anxiety disorders. And they are more likely to develop dementia in old age. Men, on the other hand, develop schizophrenia earlier. However, both sexes are usually treated the same. This is also due to a lack of data. Only six percent of published articles contain gender-sensitive analyses. And only 0.5 percent of published studies explicitly concern women. "We know more about erectile dysfunction and its treatment than about women's health," says Professor Birgit Derntl.

Together with colleagues from neuroscience, she aims to improve the prevention, detection, and treatment of mental disorders in women – and subsequently in men and diverse individuals. In the DFG-funded international research training group IRTG 2804, they are collaborating with Uppsala University in Sweden to investigate women's mental health – starting with puberty, continuing through the menstrual cycle, and ending with menopause.

The focus is on cognition, emotion, and communication. These functions are particularly affected by brain diseases. Physical homeostasis also plays a major role, as studies by Prof. Dr. Manfred Hallschmid show. He primarily studies the effects of metabolism and sleep on cognition and emotion in women and men. Data in animal models are now also being analyzed by gender. For example, in the research of Prof. Dr. Steffen Hage, who primarily focuses on communication – such as vocal perception. The better gender differences are understood, the better treatment can be tailored to the individual.

When a girl reaches puberty, her risk of developing depression increases. Stress can be a trigger. Women are also particularly vulnerable during pregnancy, after childbirth, and during menopause. "During this time, enormous hormonal changes take place in the body," says Derntl. But how these affect the brain is still largely unclear. "Let's take the brain of a pregnant woman," says Derntl. "It's a black box." The reason: studies with pregnant women are complex. In addition to in-depth expert knowledge, researchers also need the right technical equipment to avoid endangering the unborn child. Therefore, many universities are able to conduct EEG studies, but not comprehensive neuroscientific studies that focus on the changes in the brains of pregnant women. The result: a lack of data.

But research is needed to best protect women during this sensitive time. What we know so far is that some women are more susceptible to hormonal changes than others. When taking the pill, they suffer from mood swings or periods of depression. However, who these women are remains unclear. In research on contraceptives, they are lost in the mass of study participants, or they have discontinued hormonal contraception and therefore do not appear in this group. Researchers at the Tübingen Medical Faculty want to track them down. In longitudinal research, women are being followed from the time they start taking the pill to the time they stop. And MRI scans of pregnant women are intended to shed light on what changes occur in women's brains from conception to birth.

The neuroscientists at the Faculty of Medicine work closely with other clinics, such as the Department of Gynecology and Internal Medicine in Tübingen, as well as with other departments at the university. "Gender also requires a sociological perspective," says Derntl. By this, he means questions such as: What role do behavioral and social aspects play compared to neuroscientific aspects? Interdisciplinary exchange is one of Tübingen's special features. Another is the strong network with the local German health centers, such as the German Center for Mental Health and the German Center for Neurodegenerative Diseases. Furthermore, the Faculty of Medicine is a standpoint within the German Center for Diabetes Research. And with Professor Andreas Fallgatter, Head of Psychiatry and Psychotherapy, there is a direct connection for clinical trials when it comes to ultimately implementing gender-sensitive treatment methods.

Derntl says: "I see the mandate to collect more data on women's health not only for us, but for the world." The neurosciences at the Tübingen Medical Faculty play a pioneering role in this, which also rubs off on other disciplines – both within and outside the university. Scientists from all over the world met at the symposium "The fe|male brain," which took place at the University of Tübingen in 2023. Dr. Liisa Galea from the University of Toronto spoke about the relevance of basic research for clinical translation and the need to establish gender-sensitive approaches in brain research. Dr. Daphna Joel from Tel Aviv University invited participants to reflect on the binary nature of sexuality, gender, and the brain. And Jill Goldstein from Harvard University spoke about gender differences in comorbidities of brain and heart diseases.