If you’ve ever noticed that it seems like the people with autoimmune conditions are mostly women, it isn’t your imagination. It probably is not coincidental that from a group of four sisters, at least two of them have autoimmune issues. There are several for this. Most of them are unknown reasons. Sorry, if you are coming here for a cure, you will be greatly disappointed. I can illuminate a few of the possible reasons why women have more autoimmune conditions than men.
Actually, I am not going to illuminate these reasons. Hank Green1 in this SciShow video will.
Why Women Have More Autoimmune Issues Than Men
I understand that watching a 15-minute video about science might be more work than you are willing to put forth today. That’s fine. I get it. That’s why I watched it and will summarize a few key points for you. Tl;dr2 at the end.
First a brief3 explanation of what auto-immune means. This will not be new information for many of you, especially those of you whose chronic illness is due to an autoimmune condition.
Our body has this thing called an immune system. Crazy, I know. There are lots of different cells involved and some organs (like the ever-forgotten thymus), that work together to try to keep you safe. The main (only?) way that they do this is in a two-step process of identifying things that will hurt you, and then destroying the things that will help you. You might think that means the immune system comes across a virus, bacteria, or parasite, and just know that it is bad. But identification is a lot harder than you might think. The bad things don’t come with a nametag and your cells don’t have eyeballs to see the nametag anyway. Through a series of…things…and stuff…the immune system learns to distinguish friend from foe. Friends include the cells of your body, the food you eat, and the trillions of microorganisms in your gut microbiome. It gets tricky when some of your own cells go rogue and need to be taken down like with cancer. How is the immune system supposed to know when our own cells are not friends? Or what about that microbiome? Some bacteria are good, don’t attack them. But other bacteria are bad, attack those.
Anyway, the immune system has to identify friend, generally categorized as “self”, and foe, generally categorized as “not-self” or “foreign”. Then it has to attack and destroy it. That is also not as straightforward as we might hope. Even if the immune system has not accidentally identified normal, healthy cells as foreign or abnormal, the attack can cause some collateral damage. Kind of like the damage superheroes causes while fighting the bad guys. The immune system is generally better at reducing damage than most superheroes though.
That’s a quick summary of immune system malfunctions.
So why do women get the short stick? Why are we so much more likely to have autoimmune conditions?
These are the hypotheses4 from the video:
- Testosterone (higher in men) tamps down the immune system.
- Estrogen does…something.
- The x-chromosome has a lot of immune system genes on it. Maybe having two x-chromosomes means the immune system is getting double support, and that is causing it to go into overdrive.
- In each cell, there are two versions of genes (one from mom, one from dad). Each cell is supposed to randomly pick which version to turn on. If that randomness leads to a skewed percentage that could lead to the same kind of double support mentioned in the previous hypothesis.
- If that percentage is super-duper skewed, let’s say 90% of cells have dad’s version turned on for that particular gene, then mom’s version is so rare that the immune system may have not come into contact with it enough to recognize it.
- A subset of these skewed distribution hypotheses is that something that causes that random picking to not be random. The thing causing the not-randomness is the same thing that causes the autoimmune issues.
- Maybe the y-chromosome has something on it that makes the immune system better at its job and we, women, are missing it.
- This final hypothesis kind of ignores the nitty-gritty details of this protein, that chromosome, this hormone, etc. The final hypothesis says that maybe it has something to do with pregnancy. Women can tolerate–as in “I see you making a mess over there, but I’m choosing to let you do it–a half-foreign thing inside it for months on end. For a system that frequently decides that this little speck of pollen is a dangerous threat that must be neutralized, that’s pretty impressive.
The less biological reason(s) why more women suffer from autoimmune disorders than men is the same reason why many of the women reading this have been brushed off by their healthcare providers. Issues mainly affecting women tend to not be taken as seriously. This one guy, Paul Ehrlich, didn’t help when he said that he had conclusive evidence that there was no such thing as auto-immune antibodies, therefore the immune system can never go haywire like that. Eventually, enough evidence came up that we have since recognized Ehrlich was mistaken. That means that the researchers spent 100 years NOT researching auto-immunity. Research into auto-immunity has mostly taken place only in the past 50-60 years. That relatively short timespan combined with an “Oh, you’re just being hysterical.”, “it’s all in your head”, and “there’s nothing wrong with you” attitude means that there is a lot we don’t know. The good news (I’m trying to find a silver lining here) is that means that with the recent focus on all things autoimmune, we could find some answers that have been lying just below the surface.
Tl;dr
We don’t know much about autoimmunity because one guy made a mistake and no one caught it for 100 years. Also because of sexism. What we’ve been able to guess is that, since there is such a big difference between how many men vs how many women have autoimmune disorders, something about the difference between men and women (specifically x- and y- chromosomes, and hormones) might be the culprit. Weird stuff happens to your immune system with pregnancy. Because women are having fewer babies these days, maybe the whole “being pregnant for half your life” isn’t happening to prevent autoimmune disorders.
PS Even though you will never see this, I want to say good luck to Hank Green, who recently started chemotherapy for Hodgkin lymphoma.
Footnotes
1 I love the Green brothers. Their Crash Course series are fantastic. The video about cellular respiration helped me finally understand the electron transport chain. At least, understand it at the level that was being taught to me in my Biology for Majors (I thought I was going to go into the medical field) class.
2 For the less internet slang savvy people, Tl;dr means “Too long; didn’t read” and can be used to give people an easy way to find a summary of a longer block of text.
3 I might be completely incapable of explaining anything succinctly. I just get so excited about it and assume everyone else is equally excited. #sorrynotsorry
4 I am not claiming that any of these are for sure THE cause of autoimmunity. Not by a long shot.
Emotional Support Sisters 
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