The sex of our bodies can have a profound influence on our health and well-being. For example, female and male bodies are susceptible to different diseases, such as ovarian and prostate cancer. Even when the same disease occurs in both males and females, it may be much more common in one sex or the other, as in the case of breast cancer and hypothyroidism. Health conditions that affect both females and males, such as heart disease, sometimes have different symptoms. Males and females may also react differently to treatments for the same ailment.
Certain health conditions may also shift secondary sex characteristics along the sex continuum. Consider the case of polycystic ovarian syndrome, which affects 5-10% of women in the reproductive years. The multiplication of cysts on the ovaries not only interferes with hormone levels, menstruation and fertility, it can also result in male-pattern balding and profuse body hair growth – characteristics that are more commonly associated with and accepted in male bodies.
At the same time, sex affects health when bodies are not clearly or exclusively male or female. Indeed, individuals with ambiguous genitalia or atypical sex chromosomes face particular health challenges.
Consider the story of Julio. At birth, doctors diagnosed Julio with cryptorichidism – one of his testicles had not settled into his scrotum. (Like ovaries, testes form within the abdomen during development, but then they descend into the scrotum, usually before birth but no later than one year of age). Doctors recommended that the undescended testicle be treated with drugs or surgery because if it was left untreated it posed an increased risk of cancer and herniated tissue.
Since Julio was not in pain and had no other “symptoms” of illness, his parents were not concerned. During puberty, however, Julio began to experience periodic tenderness in his lower abdomen. Upon examination, his doctor felt that the undescended testicle was the cause and again recommended treatment. This time Julio and his parents agreed to surgery. When the testicle was removed and tested for cancer, the pathologist realized that the organ was actually an ovary. Julio had a condition called ovotestis – a combination of ovarian and testicular tissues. This new diagnosis made sense of the fact that Julio had been experiencing development of his breast tissue, which his parents and doctor had attributed to weight gain during adolescence. Julio’s atypical biology meant that he was much more likely to be infertile and would probably need hormone therapy.
Sex matters in health, no matter where we find ourselves on the continuum of chromosomes, genitalia or secondary sex characteristics.