Table 4 Recommendations for sex/gender and health research

Two paradigmatic shifts needed to fundamentally improve the quality of sex/gender and health research:

1. Sex/gender should not only be recognized, but also understood as intersecting with other axes of inequality such as race, ability, socioeconomic status, geographic location, sexual orientation, and age.

2. Gender should be conceptualized as a structural/social determinant of dealth, and should accompany any investigation of “sex” differences—in other words, research should not assume or proceed with the idea that “sex” can be separated from gender.

Six questions to help operationalize these paradigmatic shifts:

1. Does the study automatically give primacy to sex/gender? Does it move beyond asking whether sex/gender considerations are taken into account to explaining what relevant factors are taken into account to understand a particular illness, disease or health experience?

2. How does the study (biomedical, clinical, health systems, or population health focused) identify relevant factors that shape and determine health (e.g., ethnicity/race, sex/gender, age, socio-economic status, geographic location, sexual orientation)? What are the inclusion/exclusion criteriain relation to this question?

3. How does the research design (data collection and analysis) capture the relationships and interactions (e.g., using a multi-level analysis linking individual experiences to broader social structures) among pertinent health determinants and factors, including, but not limited to, sex/gender? Is the sample size adequate for capturing diversity between and within groups often treated in homogeneous manner (e.g., women, men)?

4. Does the study conceptualize and/or model gender as a social/structural determinant of health?

a. If yes, how?

b. If no, has a strong rationale been provided for how/why a gender conceptualization is not needed—even if the researcher was not able to directly test the gender mechanism?

5. Does the study assert male/female differences in health related to biological mechanisms?

a. If yes, how are those biological mechanisms specifically explained and/or tested? Also, has it been explicitly described how gender and other intersecting factors are intertwined with these biological mechanisms?

b. If no, does the study specifically state/demonstrate that intersecting social processes can cause the same biological mechanisms leading to male/female differences in health?

6. Where relevant, does the study contextualize research findings undertaken with human subjects within broader social structures and processes of power?