4Th Edition

The five years since the publication of the last edition of this textbook have witnessed an exponential expansion of our understanding of human molecular biology and with it, a much more evolved concept of the term “gender-specific medicine”.  In fact, four decades ago our definition was simplistic compared to our current view of how biological sex is established and maintained and how it shapes an individual’s physiology over the course of a lifetime.  This fourth edition samples the work of accomplished scholars of the postgenomic era to illustrate some of our most significant new insights into human physiology.  It is the nature of things, though, that as our knowledge expands, we are inevitably faced with new and often completely unanticipated questions. The world of scholarship is a dynamic, ever-changing scene in which ideas are constantly debated, discarded, and refashioned or emerge as entirely new concepts. 

In spite of every effort to touch upon specific and important development in gender-specific medicine, this fourth edition, like all of the previous iterations, cannot be in any sense an encyclopedic survey. The result is always the consequence of what the editor believes are the most important new themes in medicine and equally important, the ability to secure the collaboration of busy scientists and clinicians to help shape the book. Some of what we have done is simply to update topics that remain important and were first introduced in previous editions. Other chapters address emerging new concepts like that of Argenson and Devi-Chou’s discussion (chapter 38) on the use of artificial intelligence in medicine. Taneja chapter 19) discusses the impact of gender  on the composition and function of the microbiome; two other groups (chapters 13 and 22) discuss the importance of sex in the use of stem cell therapy.  Schmidt (chapter 30) provides us with one of the most exciting glimpses of fields that will have exponentially more important emphasis in the future: he sets out for us the challenges of preparing men and women for space flight and eventually for the colonization and exploitation of other celestial bodies.

It has been my experience that the more we unravel the mysteries of biological life, the clearer it becomes that we are only exploring the edges of a vast sea of reality that is yet to be navigated and integrated into our view of human physiology.  One thing is certain: the interwoven relationship of biological sex and the environment  is much more complicated that we had ever imagined even three decades ago. The next three will doubtless continue to transform our understanding of what makes us ourselves.


Marianne J. Legato, M.D., Ph D (hon c)