Sex-Linked Biology and Gender-Related Research Is Essential to Advancing Hearing Health

Abstract

There is robust evidence that sex (biological) and gender (behavioral/social) differences influence hearing loss risk and outcomes. These differences are noted for animals and humans—in the occurrence of hearing loss, hearing loss progression, and response to interventions. Nevertheless, many studies have not reported or disaggregated data by sex or gender. This article describes the influence of sex-linked biology (specifically sex-linked hormones) and gender on hearing and hearing interventions, including the role of sex-linked biology and gender in modifying the association between risk factors and hearing loss, and the effects of hearing loss on quality of life and functioning. Most prevalence studies indicate that hearing loss begins earlier and is more common and severe among men than women. Intrinsic sex-linked biological differences in the auditory system may account, in part, for the predominance of hearing loss in males. Sex- and gender-related differences in the effects of noise exposure or cardiovascular disease on the auditory system may help explain some of these differences in the prevalence of hearing loss. Further still, differences in hearing aid use and uptake, and the effects of hearing loss on health may also vary by sex and gender. Recognizing that sex-linked biology and gender are key determinants of hearing health, the present review concludes by emphasizing the importance of a well-developed research platform that proactively measures and assesses sex- and gender-related differences in hearing, including in understudied populations. Such research focus is necessary to advance the field of hearing science and benefit all members of society.

Metformin Protects Against Noise-Induced Hearing Loss in Male Mice

“…Although the ovariectomized female mice again demonstrated a similar response to the noise stimulus as the male mice, neither female cohort benefitted from metformin. A lack of otoprotective effects of metformin in female mice may be secondary to insufficient metformin dosing or different metabolism in the female mice (8). Overall, there is a known paucity of clinical trial data regarding the study of disease and effects of medications on women (28).…”

“…However, to date, the rigorous evaluation of metformin's otoprotective effects against hearing loss in animals of both sexes has not been completed. Furthermore, recent studies demonstrate the importance of hormonal status and biological sex in the susceptibility to NIHL and in the efficacy of potential therapeutics for hearing loss (7,8). In particular, endogenous estrogens are known to have a protective effect on hearing (9).…”

Sex-Specific Interactions Between Hearing and Memory in Older Adults With Mild Cognitive Impairment: Findings From the COMPASS-ND Study

“…While the evidence in this study is cross-sectional, we observed specific auditory-cognitive connections in females, this time in a sample of individuals with MCI. Postmenopausal reduction in estrogen, the sex hormone suggested to play a protective role in the inner ear, has downstream negative effects on females’ hearing and likely contributes to the development of their HL (Stenberg et al 2001; Hederstierna et al 2010; Reavis et al 2022). Given the association of menopause with cognitive decline and the development of dementia in females (Mosconi et al 2017), reduction in estrogen may act as a common cause for auditory-cognitive associations in females.…”

“…Gender-related factors (e,g., work noise exposure) are known to influence HL (Helzner et al 2005; Palmer et al 2016). Thus, while the current study addressed sex-related differences in auditory-cognitive associations, it is likely that gender also played a role in the observed associations, as sex and gender are strongly intertwined (Reavis et al 2022).…”

“…While this relationship may vary based on the type and duration of HRT (e.g., Armstrong et al 2020b), these findings suggest a protective role for sex hormones, most probably estrogen/estradiol, in the development of HL in females. Overall, sex likely plays a role in the development of HL in some etiologies (Reavis et al 2022).…”