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Ask Dr. K: Men and women can have different symptoms

DEAR DOCTOR K: It’s obvious that there are some health problems that affect only women, and others that affect only men. But for the health problems that affect both women and men, are there differences in symptoms, or in reactions to treatments?

DEAR READER: That’s an interesting question. Perhaps surprisingly, the answer is yes.

Heart disease is a good example. Angina and heart attacks occur when too little blood flows to the heart through arteries. The classic symptom is chest pain or pressure that travels to the left arm, jaw or neck when you exert yourself.

But men are much more likely than women to have these typical symptoms. Instead, women can have shortness of breath, abdominal pain and fatigue.

In addition, misleading test results for heart disease are more common for women. An angiogram is considered to be the “gold standard” for checking for blockages in the coronary arteries (the main arteries of the heart). But the test may miss important narrowings in women. That’s because women are more likely to have narrowing of small coronary arteries that do not show up well with an angiogram. These narrowings could cause angina or a heart attack.

There are other examples of how men and women respond differently to a disease or its treatment. Women tend to heal faster from injuries, and they recover better from strokes than men. Women also respond differently to medications; they tend to have more or different side effects from the same dose of medication, perhaps due to body size and hormones.

There are also conditions that are more common in one gender than the other:

— Depression and certain autoimmune diseases, such as lupus and rheumatoid arthritis, are more common among women. Interestingly, most autoimmune diseases in animals also are more common in the females of the species.

— Sleep apnea is more common among men.

The danger is that people and their doctors may dismiss the possibility of a condition when it occurs in the gender that gets it less often. And that’s something that all doctors — male and female — should always bear in mind.

I’ve learned that lesson more than once. Once a man in his late 70s called me to say he was concerned about a lump under the skin on his chest. At least 99 times out of 100, such a little lump under the skin is one of two things: a little ball of fat called a lipoma, or a plugged-up gland called a sebaceous cyst. So I knew that’s what it was going to be.

But when I examined his lump, it wasn’t soft and squishy as I had expected. It was rock hard and was sitting in the skin right over his breast. The biopsy showed that the man had breast cancer. I knew that, on rare occasion, men could get breast cancer, but I had never seen it in a male patient of mine — before or since.

Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.


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