Beyond a catalogue of differences: A theoretical frame and good practice guidelines for researching sex/gender in human health

Extensive medical, public health, and social science research have focused on cataloguing male–female differences in human health. Unfortunately, much of this research unscientifically and unquestionably attributes these differences to biological causes – as exemplified in the Institute of Medicine’s conclusion that “every cell has a sex.” In this manuscript we theorize the entanglement of sex and gender in human health research and articulate good practice guidelines for assessing the role of biological processes – along with social and biosocial processes – in the production of non-reproductive health differences between and among men and women. There are two basic tenets underlying this project. The first is that sex itself is not a biological mechanism and the second is that “sex” and “gender” are entangled, and analyses should proceed by assuming that measures of sex are not pristine, but include effects of gender. Building from these tenets – and using cardiovascular disease as a consistent example – we articulate a process that scientists and researchers can use to seriously and systematically assess the role of biology and social environment in the production of health among men and women. We hope that this intervention will be one further step toward understanding the complexity and nuance of health outcomes, and that this increased knowledge can be used to improve human health.