Beyond Gender Medicine: An Interview with Dr Susanna Grego

In recent years, the debate surrounding gender medicine has intensified, yet it often lacks precision. According to those working closely in the field, the risk lies in reducing a central theme of clinical practice to a cultural or ideological issue, which can lead to losing sight of its profoundly scientific nature. We discuss this with Susanna Grego, a specialist in cardiology and head of the Sex and Gender Conscious Medicine course at USI Faculty of Biomedical Sciences, alongside Dr Pamela Agazzi, a neurologist. Their programme was born from a clear objective: not to remain a standalone course, but to become an integral part of all medical teaching.

Below is the full interview with Dr Susanna Grego, conducted by the USI Institutional Communication Service and published in the magazine Ticino Management Donna.

Dr Grego, let's start with language. Why is it so central when discussing sex and gender medicine?
"As a university community, it's essential to recognise that the meaning of words enables us to understand concepts. If we do not fully grasp the terms we use, we will struggle to comprehend the subjects we discuss. However, the term "gender medicine," as it has been utilised over the years, has often missed the mark. It tends to reduce the topic to something viewed as feminist or ideological, while in reality, we are addressing issues of biology, physiology, and clinical practice".

So, it's not about feminism, but medicine?
"Absolutely. Feminism is not relevant to this discussion. What matters here is the fundamental difference between males and females and how these differences impact diseases, symptoms, and treatments. This topic should not be viewed as just an additional or secondary subject; instead, it should serve as the foundation and the introductory lesson in any medical degree programme".

In what sense are sex and gender already present in clinical practice, even if we often don't realise it?
"In a very concrete way. When we present a clinical case, even in front of the patient, we always say: 'male patient' or 'female patient'. It is coded information that appears in all hospital registries. The problem is that, during clinical reasoning, this information is often undervalued or used unconsciously."

Can you give us some examples of areas where these differences are crucial?
"Practically all of them. The hormonal system affects men and women differently, and this has consequences for Parkinson's, Alzheimer's, epilepsy, and heart disease, including ischaemic heart disease. Consider pain as well: for years, people spoke of 'typical' and 'atypical' pain. Today, we are trying to move past this distinction, because the risk is that the doctor interprets symptoms subjectively instead of objectifying the clinical picture through appropriate tests."

Is this where gender, understood as a social construct, comes into play?
"Yes, but it must be clarified precisely. Gender concerns the set of expectations, representations, and social roles we attribute to people, and this can translate—even unconsciously—into clinical bias. A frequent example is the diagnosis of anxiety-depressive syndrome, which often appears as the primary label in medical records, especially for women. This initial classification can steer the entire subsequent diagnostic path, leading to symptoms being interpreted primarily through a psychological lens and delaying or overlooking the investigation of possible organic causes. In this sense, gender does not act as a biological factor, but as an interpretative filter that the doctor must be able to recognise and neutralise."

Alongside Dr Pamela Agazzi, you coordinate the Sex and Gender Conscious Medicine module at USI. What does the course syllabus involve?

"The first part is a historical introduction, which serves to provide the conceptual and terminological foundations. This is a necessary step precisely because these foundations are not yet common knowledge in medical training. The course then delves into the biological and clinical differences between males and females, addressing them cross-disciplinarily. With Pamela Agazzi, we work hard to ensure this knowledge does not remain confined to a dedicated teaching module. If every lecturer, within their own specialist field, started from these differences, there would be no need for a specific course in Sex and Gender Medicine. The fact that a separate course still exists today doesn't mean the topic is 'special', but rather that this structural integration has not yet occurred."

In recent years, you have also addressed gender transition, particularly in adolescence. What is your approach?

"A strictly medical and scientific approach. The goal is never to pass judgement, but to understand what happens at a biological level when a developing organism is exposed to hormonal treatments inconsistent with its original biological sex. We therefore asked very concrete clinical questions: what happens, for example, to a biologically female heart subjected to prolonged exposure to testosterone, or to a male endocrine system exposed to oestrogens during developmental years? These are questions regarding patient safety, prevention, and long-term care. Therefore, they fall fully within a doctor's responsibility. These are not ideological or cultural questions, but clinical ones, and they require specific expertise to support individuals in a conscious and informed manner."

Why does biological sex remain an indispensable data point, and what role does the social context play?

"Because biological sex, starting from chromosomal sex, directly influences the onset and evolution of many pathologies. The differences between males and females do not concern only the reproductive sphere but also the entire organism. Chromosomal heritage, for example, plays a fundamental role: many diseases are linked to the X chromosome, and in males, who possess only one, they tend to manifest fully; in females, the presence of a second X chromosome can mitigate their expression. This may also help explain why, on average, women live longer, but it simultaneously entails different risk profiles that a doctor must know to establish appropriate diagnosis, prevention, and therapy. Alongside the biological dimension, however, the social context must always be considered. Gender conditions—understood as social roles, habits, and interaction patterns—influence exposure to risk factors and, in turn, the distribution of diseases. This was clearly seen during the Covid-19 pandemic, when infection trends showed significant differences between different countries and contexts, linked not to biology but to patterns of exposure and daily life."