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Abstract

As our knowledge of sex- and gender-based medicine (SGBM) continues to grow, attention to precision in the use of related terminology is critical. Unfortunately, the terms sex and gender are often used interchangeably and incorrectly, both within and outside of the typical binary construct. On behalf of the Sex and Gender Women's Health Collaborative (SGWHC), a national organization whose mission is the integration of SGBM into research, health professions education, and clinical practice, our objective was to develop recommendations for the accurate use of SGBM terminology in research and clinical practice across medical specialties and across health professions. In addition, we reviewed the origins and evolution of SGBM terminology and described terms used when referring to individuals outside the typical binary categorization of sex and gender. Standardization and precision in the use of sex and gender terminology will lead to a greater understanding and appropriate translation of sex and gender evidence to patient care along with an accurate assessment of the impact sex and gender have on patient outcomes. In addition, it is critical to acknowledge that SGBM terminology will continue to evolve and become more precise as our knowledge of sex and gender differences in health and disease progresses.

Introduction

Sex and gender affect all aspects of health and disease, including epidemiology, pathophysiology, social determinants of health, access to medical care, and health outcomes. As a result, it is critical that the medical and scientific community routinely consider the effects of sex and gender in basic science, clinical and health services research, health professions education, and clinical practice. As our knowledge of sex and gender differences in health continues to advance, there have been numerous attempts to understand and codify relevant terminology. Specifically, there is considerable variability and some degree of inappropriate use of the terminology pertaining to the relatively new field of sex- and gender-based medicine (SGBM), the “field of medicine which incorporates information about how biological sex and the sociocultural aspects of gender affect health and illness for women and men.”¹ “Sex” and “gender” are often used interchangeably or incorrectly, and the term “women's health” is frequently used to describe what is actually SGBM.^2–4 For example, in the description of animal research, researchers should use “sex,” not “gender,” to describe the differences between male and female animals based on biologic characteristics.

As we advocate for widespread incorporation of sex and gender integration into research, education of health professionals, and clinical practice, it is essential to have standardized, precise terminology. Standardizing the lexicon will ensure the consistent and correct usage of SGBM language, allow reporting of sex and gender differences in health research, and enable practitioners to locate and synthesize evidence-based sex and gender differences within the scientific literature for application to research and practice. The correct use of the terms “sex” and “gender” in research will help audiences to understand both the separate influences of sex and gender on health outcomes as well as the complex interplay between the two constructs.^2–4 In turn, this will lead to more informed prevention, screening, diagnostic, and treatment decisions.

Previous guidelines defining sex and gender have been published but have been designed primarily for researchers.⁵ In contrast, our recommendations are the product of a multidisciplinary group of experts in SGBM, written on behalf of the Sex and Gender Women's Health Collaborative (SGWHC), a national organization whose mission is the integration of SGBM into research, health professions education, and clinical practice.

Our overarching purpose is to recommend the use of standardized terminology related to SGBM so that researchers, educators, and practitioners across health professions have shared consistent language to communicate sex- and gender-based differences leading to the correct use and application of SGBM within the context of clinical care and research. Our specific objectives are to (1) describe the origins and evolution of terminology pertaining to women's health, sex, gender, and SGBM; (2) describe the use of terminology beyond the typical binary categorization; and (3) develop consensus recommendations regarding the use of precise terminology for SGBM in basic science, clinical research, and clinical practice.

The Origin and Evolution of Sex and Gender Terminology

Although we acknowledge that it is important to understand the global context of women's health and SGBM, we have primarily focused on the origins and evolution of the terms “sex” and “gender” in the United States. Since the women's health movement of the 1970s, the definition of women's health, initially conceptualized as health pertaining to reproductive organs and female sex steroids, has evolved. Various organizations and researchers have published definitions of the term “women's health” to capture this contemporary thinking about how best to maintain health and deliver healthcare to women (Supplementary Table S1; Supplementary Data are available online at www.liebertpub.com/gg). In the mid-1990s, Dr. Florence Haseltine coined the term “gender-based biology.”⁶ And in 2000, under Dr. Haseltine's influence, the Society for Women's Health Research (SWHR) was established to promote research on biological differences. SWHR then began to change the terminology to “sex-based biology”⁷ as it became apparent that sex differences are present across most disease states and organ systems, and assumptions made about women's health based on data collected primarily in men were associated with increased risk and harm in women. In 2004, the first edition of Dr. Marianne Legato's two-volume textbook, Principles of Gender-Specific Medicine was published, considered an innovative compilation of health-related differences in men and women.⁸ This textbook, in 2017, is currently in its third edition. In 2006, the International Society of Gender Medicine (IGM), an umbrella organization for international and professional societies dedicated to the study of gender- and sex-specific differences, was established.

The evolution from the term “women's health” to SGBM stems from the realization that sex-specific research findings often illustrate the harms that can occur when sex and gender are not considered in research. For example, sex-specific research revealed important sex differences in the use of aspirin for the primary prevention of acute myocardial infarction (AMI). Specifically, data from the “Physician's Health Study” in 1989 showed that aspirin was effective for the primary prevention of AMI but included only male physicians.⁹ In 2005, a similar study was undertaken with 39,000 female health professionals, and the effect of aspirin on AMI was found to be very different from that seen in men in the 1989 study.¹⁰ Aspirin was not found to be beneficial in women younger than 65, and women taking aspirin had more hemorrhagic strokes than those on placebo.¹⁰ The 2005 study, demonstrating the importance of considering patient's sex as a variable when studying effects of prevention strategies and clinical outcomes, showed that extrapolating conclusions from studies conducted in men and applying them to women may lead to suboptimal care and outcomes for women.

Following reactions to the finding of a sex-specific effect of aspirin, a movement was initiated that permeated legislation, research, clinical care, and medical education. Offices of women's health were created at government entities, including the National Institutes of Health (NIH), the U.S. Department of Health and Human Services (DHHS), the Centers for Disease Control (CDC), and the Food and Drug Administration (FDA). Centers of Excellence in Women's Health were established at many universities and health care systems. Throughout the ensuing years, the terminology used to describe the medical issues of women has evolved significantly. For instance, work using animal models began demonstrating that genes and sex hormones function independently from one another,¹¹ illustrating the point that sex differences are not merely a result of hormonal effects, but rather the product of the effects of sex chromosomes in all cells of the body. The completion of the human genome project in 2003 also influenced our understanding of the effects of sex on human biology and disease through the sequencing of all human genes, including those located on sex chromosomes. Understanding the location and function of genes located on sex chromosomes throughout the body's cells, not just in reproductive organs, was critical to understanding that biologic sex not only affects human health and disease via sex steroids and reproductive organs but also affects cells in all organ systems. With the growing knowledge of sex differences in every cell and in all organ systems, the related terminology has expanded to encompass this new and enlarging field of sex and gender differences.

Although it is beyond the scope of this article to include a comprehensive history of sex and gender terminology outside of the United States, work by both European and Canadian organizations has led to progress in the standardized use of sex and gender terminology as well.^12,13 For example, Horizon 20/20, a European organization dedicated to combining research with innovation to facilitate translation of research into industry and policy, funds the European Gender Medicine Project (EUGENMED), an initiative that has combined the expertise of medical researchers, industry representatives, and policy makers in Europe.^12,13 EUGENMED has promoted the study of sex and gender in disease outcomes and has mandated the consideration of sex and gender as separate terms and concepts. Such projects illustrate how the correct use of sex and gender terminology can lead to improved research and clinical care.

Ultimately, under the influence of the IGM and its thought leaders, the terminology of sex-based biology was expanded to include the use of both terms “sex” and “gender” to describe the field of SGBM; this ultimately replaced the term “gender” as the sole descriptor for concepts related to both sex-based biology and gender. Most scholars in the field now believe that both terms must be included to convey the influence that each has in the health differences between women and men accurately. The most recent and culminating definition appears in the Handbook of Clinical Medicine, a 2012 text edited by an international group of leaders in the field: gender-based medicine encompasses sex differences (genetic, biological, and phenotypic) but goes beyond this to include the broader social, cultural, and normative factors that affect health.¹⁴

The currently accepted terminology, SGBM, was first proposed in 2010 as part of the curriculum of the Laura Bush Institute for Women's Health, founded by Dr. Marjorie Jenkins in 2007. The term SGBM captures the application of sex and gender differences in medical research, education, and clinical practice. Sex- and gender-specific health (SGSH), a closely related term, encompasses sex and gender differences in health at a broader level than SGBM and may be applied across health professions; SGSH could also be used to discuss sex and gender differences that may affect population health or public health policy.

Clarification of sex versus gender

As we further define the term SGBM, the terms “sex” and “gender” must be used in a precise and standardized way. There is general agreement that the definitions of sex and gender according to the Institute of Medicine (IOM) are accurate: sex is a biological construct, whereas gender is a social construct. The term “sex” refers to a person's biological status and is based on a combination of anatomy, genetics, and hormones.² Although previously described as a binary construct, sex characteristics should be considered to exist on a continuum. The term “gender” is a psychological and social construct referring to the attitudes, feelings, and behaviors that a person and his or her culture associates with a person's gender concordant with his or her sex at birth. Consistent with these definitions, experts have proposed that medical educators, researchers, and practitioners use the term “sex” to describe biological differences between males and females and the term “gender” to describe psychological and social differences between men and women.¹⁵ This can be illustrated using a simple example of sex-based cancers: because of sex differences, only women develop cervical cancer and only men develop prostate cancer.¹⁵ In contrast, the variation of pain perception between women and men may be influenced by sex and gender.¹⁶ Pain is perceived differently by women and men because of biological, psychological, and social differences.^17,18 Specifically, it may be more acceptable in certain cultures for women to discuss or express pain than for men, a gender influence. Torgrimson illustrates the difference between sex and gender with the example of transgendered individuals, whose biological sex is discordant with their gender identity.¹⁹

Beyond Binary

There is often immense stigma and negative perception toward people who do not fit into one of two categories of sex (male or female) and gender (man or woman); such stigma must be eliminated to provide optimal healthcare to all patients regardless of biological sex, gender, or sexual orientation. Ensuring that sex- and gender-related terminology is inclusive of all individuals has the potential to reduce stigma and to improve the healthcare of individuals outside of the binary categories of sex and gender. This is critical as recent federal and state data estimate that 1.4 million adults identify as transgender in the United States.²⁰

Sex is often categorized as female or male based on the assumption that external genital and reproductive anatomy matches chromosomal sex of XX and XY, respectively. Conditions exist, however, through which a person is born with external genitalia that is either ambiguous or does not match his or her chromosomal sex. The terms “Intersex” or “disordered sexual development” is a socially constructed category used to represent this biological variability.²¹ It has been estimated that ∼1 in 4500 infants have genital anomalies diagnosed at birth.²² For instance, a child with XY chromosomal complement can be born with a divided scrotum that appears to represent labia. Many conditions that affect genital anatomy have been labeled as specific syndromes such as Turner (XO), XX Male (XX with an SRY gene on the X chromosome), androgen insensitivity, Congenital Adrenal Hyperplasia, or Hypospadias, demonstrating the tremendous amount of variability in the use of the term intersex.²¹

The term “lesbian, gay, bisexual, transgender, and queer” (LGBTQ) encapsulates a broad group. In fact, the acronym is sometimes criticized for being exclusive to certain groups such as Transsexuals, Queer, Questioning, Intersex, Asexual, Ally, and Pansexual (TQQIAAP). The acronym LGBTQ, usually used as an umbrella term and adopted by most sexuality- and gender identity-based community centers, is meant to describe a diverse group of individuals belonging to each one of the subgroups with respect to sex, gender, and sexual orientation.¹⁹ The definition of a person's gender identity, gender expression, and sexual orientation is a conglomeration of a complex set of factors. Definitions of lesbian, gay, bisexual, and transgender can be found in the attached glossary (Table 1).

Table 1.

Glossary of Terms

Term	Definition
Sex⁴³	A person's biological status determined by their DNA (sex chromosomes as well as autosomes); categories are male, female, and intersex.
Gender⁴³	A person's self-representation as male or female, or how that person is responded to by social institutions based on the individual's gender presentation. Gender is rooted in biology and shaped by environment and experience.
	Though gender is a psychosocial construct, it can affect/alter gene expression through epigenetics.
Male^25,43	A category of sex, typically associated with XY chromosome complement.
Female^25,43	A category of sex, typically associated with XX chromosome complement.
Man^25,43	One of two binary categories of gender; typically associated with masculine behaviors and constructs.
Woman^25,43	One of two binary categories of gender, typically associated with feminine behaviors and constructs.
Intersex²⁵	Biologic sex as defined by gonadal, chromosomal, or anatomic characteristics that does not fit into binary categories of male or female.
Transgender/transsexual^5,23	When one's gender identity is not consistent with his or biologic sex at birth (i.e., a person assigned as a biologic female at birth identifies as a man).
Gender identity²³	A person's sense of themselves as being a man, woman, or other gender.
Cisgender²³	When one's gender identity as a man or woman is consistent with his or her biologic sex at birth.
Genderqueer²³	“A person with a nonbinary gender identity.”
Gender expression/gender role^25,a	Characteristics of a person that are viewed as masculine or feminine as defined by cultural norms.
Gender variant/gender non-conforming²⁵	Refers to people that diverge from cultural gender norms in their personality, behaviors, or appearance.
LGBTQ/LGBTQI²⁵	Term referring broadly to the people who identify as lesbian, gay, bisexual, transgender, queer and/or intersex.
SGBM^a	“The field of medicine which incorporates information about how biological sex and the sociocultural aspects of gender affect health and illness for women and men.”¹
Gender-based analysis⁵	Analysis of data in such a way that gender perspective is applied to data interpretation and into the development of policies and programs.
Sex-disaggregated data⁵	In research, data on females and males are reported separately.

Term was introduced to the Sex and Gender Women's Health Collaborative by the Laura W. Bush Institute for Women's Health. All other terms are marked with specific reference number.

LGBTQ, lesbian, gay, bisexual, transgender, and queer or questioning; LGBTQI, lesbian, gay, bisexual, transgender, queer or questioning, and intersex; SGBM, sex- and gender-based medicine.

Using accurate and precise terminology when providing healthcare for individuals falling outside the binary sex and gender constructs is a critical first step to providing compassionate, competent, and patient-centered care. Over the past 15 years, organizations such as the IOM, the NIH, and the U.S. DHHS have convened to make recommendations regarding health initiatives for sexual minority individuals as they are considered a vulnerable group, at higher risk of physical and mental disorders. Accurate terminology is required to properly identify and construct a comprehensive treatment plan for sexual minority individuals.^23–25 In December 2015, the U.S. DHHS released their annual report, “Advancing LGBT Health & Well-being,” which highlights the need for improved data collection and research focused on LGBT individuals.²⁶ The use of accurate, standardized terminology is critical for such initiatives. As this evolution in terminology continues and our knowledge base grows, there may be other upcoming changes in terminology.

Reporting Sex and Gender in Research

Following a long period of underrepresentation of women in clinical trials, considering sex as a biological variable (SABV) when designing and analyzing medical research studies is now gaining more traction and is an NIH requirement. While women constitute the majority of subjects in some clinical research areas, studies using animal or cell models have continued to involve male animals or cells predominantly and often fail to report subject sex. This lack of attention to the sex of animals has been problematic in conditions that may be influenced by sex and could have impacted the rigor and generalizability of scientific findings.

Since 1987, the FDA has required that both male and female animals be included in safety and toxicity preclinical studies for products that will be utilized by both men and women. In recent years, the NIH has taken a strong stand to encourage the inclusion of sex and gender in medical research. As of January 2016, the NIH requires grant applicants to consider SABV in research study designs and analyses involving vertebrate animals and/or human subjects.²⁷ Unfortunately, it is not clear that adherence to such requirements is being followed and/or addressed adequately at this time. Lack of adherence to such policies has the potential to lead to continuing gaps in research evidence and persisting poor health outcomes for women, including increased rates of adverse side effects of medications and medical devices in women. Like other basic research design consideration such as power analyses or randomization, inclusion of sex and gender as variables is critical to sound experimental design.

To move toward precision medicine, or even to adequately search the scientific literature, precise terminology is critical. The evolution of science requires accuracy and precision, the very basis of scientific method and evidence-based medicine. Based on sex- and gender-specific data, terms imply different risk assessment, measurement tools, extrapolation to population, and therapeutic strategies. For example, it was only after 14 studies showed that therapeutic zolpidem levels persisted in women 8 h after taking the standard 10 mg dose that manufacturers changed the recommended dose for women to ½ the dose for men,^28,29 indicating a sex difference in metabolism of that drug. In contrast, when researchers addressed the Ebola epidemic in Guinea, Africa, they observed that 75% of the Ebola deaths were in women.³⁰ Researchers postulated that this was due to gender and societal roles leading to increased Ebola exposure, since women in Guinea are more likely to be caregivers, midwives, laundry workers, and morticians.

Impact on Practice

Unfortunately, the terms “sex” and “gender” are often used interchangeably in research despite clarification of these terms in the medical literature.^{15,19,31–33} It is important for investigators to understand the difference between these terms, to be specific in their language, and to consider sex and gender as separate variables when appropriate so that findings can be interpreted and translated accurately into clinical practice. For example, when caring for transgender patients, it is necessary to consider the effects of both their biologic sex and their gender identity. However, the realization that biology influences psychological and social constructs, which in turn influence biology is becoming an increasingly important focus in epigenetics, as epigenetic modifications are an important pathway for psychological and environmental effects to influence biology. Considering whether sex, gender, or both influence a disease or treatment has significant health implications. For example, if disease risk is linked to the social construct of gender rather than sex, it is possible that this risk may be modifiable through policy changes, social changes, and individual health behaviors. In contrast, risk associated with biologic sex might require medical interventions or genomic manipulations. Table 2 demonstrates some examples of the correct use of sex and gender as variables in medical research. To find sex and gender differences in disease, researchers should methodically incorporate sex and gender variables into the design of clinical research studies, including power analyses using these variables.³⁴ However, if a study is not designed and powered to evaluate sex and/or gender differences at the outset, post hoc analyses should be considered. While post hoc analyses have important limitations, post hoc analyses when utilized strategically to drive hypothesis development for future research can be beneficial.

Table 2.

Examples of the Use of Sex and Gender in Research

Concept	Research study example	Correct terms
Sex	In a study of smokers with chronic obstructive pulmonary disease at a given level of tobacco exposure, females were more likely than males to develop airflow obstruction controlling for environmental factors.	Sex, male/female
Gender	In a study of social determinants of health leading to delays to hospital arrival among patients with stroke, social isolation was more common in women but was associated with longer delays to hospital arrival only in men.	Gender, women/men
Gender bias	In a study of patients with suspected acute coronary syndrome and the ordering practices of cardiologists, male cardiologists were more likely to order stress tests for men than for women.	Gender, gender bias, women/men

It is also the responsibility of journal editors and reviewers to ensure that sex and gender are appropriately used and reported in medical research. Over a decade ago, the Office of Research in Women's Health (ORWH), in collaboration with the SWHR, urged scientific journal editors to develop specific instructions for editors, peer reviewers, and authors regarding the analysis of data from clinical trials to ensure potential sex differences are discovered. However, an informal survey of 11 science journals in 2010 showed that only 2 of the 11 journals required reporting of sex differences, while others did not set any sex-specific requirements for authors.³⁵ Since that time, journal policies have evolved to address the inclusion of sex differences in the design, analysis, and reporting of clinical trials.

Emerging literature in leading medical journals has also drawn attention to the lack of reporting of sex and its potential consequences on the clinical applications of scientific findings. In a 2010 editorial, Arnold highlighted consequences of the lack of inclusion of both sexes in preclinical and clinical research and the importance of reporting on sex differences.³⁶ Wald and Wu suggested that reporting would significantly change if journals adopted a common set of guidelines on the sex of animals for all submitted articles.³⁷ An editorial in Nature highlighted the dangers of the lack of adequate participation of women and men in research and suggested that funding agencies, the FDA, and medical schools all take action to educate the medical community on the importance of sex differences and that journals require the reporting of the sex of animals in their published research.³⁸ Such strategies can help foster interest and further research in sex differences by mitigating the challenges that authors face in the publication of sex differences research, such as the lack of understanding of the significant role that sex plays in health. Resources for incorporating sex and gender into research can be found in a recently published review³⁹ and summarized in Table 3.

Table 3.

Additional Resources for the Incorporation of Sex- and Gender-Based Medicine into Research

Description/URL
NIH ORWH Home Page for Sex and Gender in Research: http://orwh.od.nih.gov/sexinscience/index.asp
NIH ORWH iGIANT fact sheet: http://orwh.od.nih.gov/about/pdf/ORWH-iGiant-Factsheet-Studying-Sex.pdf
Expert interviews: http://orwh.od.nih.gov/sexinscience/researchtrainingresources/methodstechniquesbiovar.asp
Specialized Centers of Research on Sex Differences: http://orwh.od.nih.gov/sexinscience/researchtrainingresources/scor.asp
NIH Sex/Gender FAQ: http://orwh.od.nih.gov/sexinscience/researchtrainingresources/q_a.asp
IOM Report: Does Sex Matter?: www.nap.edu/read/10028/chapter/1#xiii
IOM Sex-Specific Reporting of Scientific Research: www.ncbi.nlm.nih.gov/books/NBK84192/
NIH Sex Bias in Cardiovascular Research: www.nhlbi.nih.gov/research/reports/sex-bias-cardiovascular-research
News Articles on Sex in Science: http://orwh.od.nih.gov/sexinscience/overview/inthenews.asp
Administrative Supplements: http://orwh.od.nih.gov/research/fundedresearch-admin-supp.asp
Strategic Plan for Women's Health Research: http://orwh.od.nih.gov/research/priorities.asp
Canadian Institute of Gender and Health: www.cihr-irsc-igh-isfh.ca/

IOM, Institute of Medicine; NIH, National Institutes of Health; ORWH, Office of Research in Women's Health.

Terminology Recommendations

Based on the rapidly progressing knowledge of sex and gender differences in patient health and disease, we recommend the following:

(1) SGBM-related terminology should be standardized in clinical research, and journal editors and reviewers should require use of such standard terminology and definitions. Authors across medical specialties should adhere to the use of standard terminology. These recommendations apply to the use of terms, including sex, gender, and SGBM, among others. Researchers must also be aware that sex and gender should not be considered binary constructs. Authors should report sex, gender, or both demographics of the study participants, as well as whether this information is based on self-report or genetic testing.

(2) SGBM-related terminology should also be standardized in the training and education of all health professionals. Health professions trainees should be taught the most current evidence-based definitions of SGBM terms and should be trained to consider patients' sex and gender routinely in clinical care. This will require a modification of how demographic information is collected and recorded.

(3) SGBM-related terminology should be standardized in clinical practice across professions. Healthcare professionals in all aspects of healthcare, including prehospital providers, registration personnel, nurses, physicians, and social workers, should receive training on the correct use of sex and gender terminology. This approach has the potential to lead to improved care for individuals across the sex and gender spectrum. Standardization of terminology must also be considered in the design of electronic medical record platforms, and patients should be asked to self-identify their gender.

(4) As our understanding of the impacts of sex and gender on health continues to evolve, the related terminology must be regularly re-evaluated and updated to match our advancing knowledge, ensuring standardization across healthcare disciplines.

Conclusions and Future Directions

Accurate use of SGBM terminology is essential given the impact of sex and gender on health and disease and disease epidemiology, progression, severity, and symptoms, as well as appropriate diagnostic procedures, response to treatment, and prognosis. The impact of sex and gender is also important to consider in biomedical research, policies, programs, services, and products involving health and healthcare. Furthermore, accurately identifying sex and gender and understanding their interaction with each other as well as factors such as race, ethnicity, socioeconomic status, and environment is the first step toward precision medicine, the incorporation of an individual's specific genetic make-up and environmental influences into his or her healthcare.⁴⁰ In addition to the impact SGBM will have on health and medical care, standardizing SGBM terminology will increase the ability to disseminate SGBM research findings effectively and accurately and will allow other healthcare providers to become familiar with and apply such findings to their clinical practice. As we continue to make progress toward providing personalized healthcare that takes patient sex and gender into account, standardizing the language surrounding SGBM will need to be continuously evaluated as the understanding of its impact evolves.

Although this consensus statement is based on the experience and expertise of clinicians, educators, and biomedical researchers, many of the concepts related to the accurate use of SGBM-related terminology can and should be applied to other health professions, including dentistry, nursing, occupational and physical therapy, pharmacy, public health, and social work. Standardizing terminology across health professions is essential for team-based communication and clinical care and is consistent with the Interprofessional Education Collaborative's recommendations for using interprofessional education to improve health outcomes.^41,42

Embracing these recommendations to improve standardization of terms related to SGBM throughout basic science and clinical research, health professions education, and clinical practice will lead to an enhanced ability to translate sex and gender differences into improved health outcomes for all. Future efforts should focus on refinement of the terminology to include other health professionals, ensuring standardization and precision in all aspects of healthcare research, education, and practice.

Footnotes

Acknowledgment

We acknowledge the Sex and Gender Women's Health Collaborative for supporting this project.

Author Disclosure Statement

M.F.M. is a consultant to Marinus Pharmaceuticals, Radnor, PA.

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