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Epidemiological data show that women are three times more likely to suffer from MS compared to men and tend to present symptoms earlier. Other evidence indicates that men experience more aggressive forms of MS and women respond better to certain disease-modifying drugs. In this mini review, we summarized recent findings on biological, hormonal and psychological factors underpinning these differences, with reproductive stage being recognized as a key variable to be considered in drug safety and efficacy. Beyond biology, sex and gender influence perception of the disease, quality of life and management. Recognizing sex and gender as important factors in MS supports the move toward precision medicine, leading to care that is not only more effective but also more equitable.<\/jats:p>","DOI":"10.3389\/fnbeh.2026.1777361","type":"journal-article","created":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T05:29:14Z","timestamp":1773120554000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Sex and gender as contributors to brain pathophysiology, clinical course, and therapeutic response in multiple sclerosis"],"prefix":"10.3389","volume":"20","author":[{"given":"Stella","family":"Panou","sequence":"first","affiliation":[{"name":"Barts and the London School of Medicine, Institute of Health Sciences Education, Queen Mary University of London Malta Campus","place":["Victoria, Malta"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia Lucy","family":"Privitera","sequence":"additional","affiliation":[{"name":"Barts and the London School of Medicine, Institute of Health Sciences Education, Queen Mary University of London Malta Campus","place":["Victoria, Malta"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1040","DOI":"10.1080\/15592294.2021.1982510","article-title":"CD4+T-cell DNA methylation changes during pregnancy significantly correlate with disease-associated methylation changes in autoimmune diseases.","volume":"17","author":"Badam","year":"2022","journal-title":"Epigenetics"},{"key":"B2","doi-asserted-by":"publisher","first-page":"106869","DOI":"10.1016\/j.msard.2025.106869","article-title":"Sex differences in multiple sclerosis treatment with disease modifying drugs: A step towards gender neurology.","volume":"105","author":"Baiamonte","year":"2025","journal-title":"Mult. 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