Exploring Brain Health Differences in Men and Women
You may have heard that men and women think differently, but the reality is more than just a figure of speech. Men and women’s brains differ in structure, function, and even how they age. These differences are more than quirks—they shape how the brain is protected or left vulnerable over time and can influence each gender’s risk for cognitive diseases like Alzheimer’s. By age 45, women face a 1 in 5 lifetime risk of developing Alzheimer’s, while men face a 1 in 10 risk. Today, nearly 2/3 of Americans living with Alzheimer’s are women.1
Here, we’ll dive into the fascinating differences in brain health between men and women. We’ve interviewed some of the leading experts in brain health and longevity to bring you their insights. With them, we’ll explore the science behind these gender-specific patterns, offering a deeper understanding of how hormonal shifts, genetic factors, and lifestyle choices impact cognitive health. Whether you're looking to enhance your own brain health or simply curious about the ways your mind is influenced by your gender, this exploration will provide valuable takeaways for both men and women alike.
Brain Structure and Function
The brain is an incredibly complex organ, made up of various structures that work together to control everything we think, feel, and do. The brain is primarily composed of two types of tissue: gray matter and white matter. Gray matter contains active neurons that process and interpret information, while white matter acts like a communication highway, connecting different parts of the brain for smooth and efficient functioning. Men tend to have more gray matter, which helps with tasks like problem-solving and decision-making. On the other hand, women typically have more white matter, which helps their brain regions communicate with each other efficiently. These structural differences may explain why men and women approach tasks like memory encoding, emotion processing, and facial recognition in different ways.2
In conversations or social settings, women may be more likely to pick up on subtle emotional cues, such as tone of voice or body language, because their brain’s white matter helps connect areas that process emotions with those that interpret social context. Men, on the other hand, may focus more on the content of what is being said and the logical aspects of the conversation, leveraging their gray matter for detailed processing.
So, there may actually be some truth to the common thinking that women think with their emotions and men think with their logic. These brain structure differences can influence how each gender processes emotions and makes decisions.
Hormones at Play
“One of the fundamental differences between men and women's brains is estrogen. The more estrogen a woman is exposed to in her life, either from her body's own hormones or other sources (birth control pills, menopausal hormone therapy), the less likely she is to develop dementia. In other words, estrogen in all forms is neuroprotective. When estrogen levels begin to decline—as early as one's thirties—a woman's brain can become vulnerable to developing the sticky plaques and tangles that can put her at risk for Alzheimer's later.” -Dr. Annie Fenn, founder of The Brain Health Kitchen and Medical Advisor to NeuroReserve
Men and women have distinct hormones that significantly affect brain health. Both genders rely on hormones from the hypothalamic-pituitary-gonadal (HPG) axis, which regulates reproduction and influence brain function. However, as we age, the decline in sex hormones like estrogen and testosterone increases the risk of cognitive decline.3
For women, menopause leads to a drop in hormones like estrogen and progesterone, reducing their neuroprotective effects and potentially increasing women’s susceptibility to Alzheimer’s disease. Since women spend a significant portion of their lives with reduced levels of these protective hormones, this may explain the higher rates of cognitive decline observed in women as they age.3 You can learn more about how estrogen impacts women with age by visiting our previous article here.
Testosterone, the primary male sex hormone, also declines with age which may in turn cause brain decline. In fact, men with the lowest levels of testosterone have a 43% higher risk of developing any type of dementia, and an 80% higher risk of Alzheimer’s compared to men with higher testosterone levels.4 Testosterone helps regulate the accumulation of β-amyloid, a protein linked to Alzheimer's. Additionally, testosterone has protective effects against cell death induced by β-amyloid and helps reduce oxidative brain damage. Testosterone also supports brain function by influencing synaptic plasticity – the brain’s ability to adapt and change. However, the effects of testosterone on brain health are complex and may involve both testosterone and estrogen working together. While testosterone shows promise in protecting against Alzheimer’s pathology, the full impact on human cognition and dementia risk remains an area of ongoing research.4
Gender and Other Risk Factors
“It is becoming increasingly clear that our biological sex impacts our risk of developing various neurodegenerative conditions later in life. However, the mechanisms behind these sex-related differences are not yet completely understood. One important consideration is that biological sex may modify the influence of other risk factors on overall risk for diseases like Alzheimer’s. For example, a study published in BMC Medicine this year found that men with sarcopenic obesity had a higher risk of dementia compared to women with the same condition. This aligns with other research showing that sex and age can influence the hormones released by fat tissue (adipokines), which may, in turn, affect dementia risk differently across individuals. I believe that understanding these differences is a key to preventing diseases like Alzheimer’s. In 2022, we published key results showing an individualized risk reduction plan that accounts for differences in biological sex is equally effective at reducing Alzheimer’s and cardiovascular disease risk in both men and women.” -Dr. Kellyann Niotis, Director of Parkinson’s and Lewy Body Dementia research at the Institute for Neurodegenerative Diseases (IND) Florida
In our discussions reviewing the Lancet Commission Report, we've highlighted various risk factors that can increase the likelihood of brain decline over time. Some of these are modifiable, like managing blood pressure or maintaining a healthy weight, while others are non-modifiable, such as genetic predisposition. Interestingly, research shows that men and women experience different impacts from these risk factors. For example, men tend to have more modifiable risk factors for dementia, but the way these factors play out for each gender can influence their brain health in distinct ways.5
Take diabetes, for instance. While it doubles the cardiovascular risk in men and more than triples it in women—both of which are risk factors for Alzheimer’s disease—women with diabetes face an even higher risk of developing vascular dementia. Women with diabetes showed a 120% greater risk, compared to a 70% greater risk in men, revealing a significant gender difference in how diabetes affects brain health.6 Women are also twice as likely to experience depression, which is associated with a 70% higher risk of Alzheimer’s in midlife and may impact women’s dementia risk more overall. Men, on the other hand, are more likely to have sleep apnea, a condition that disrupts sleep and is linked to cognitive decline. Although sleep apnea also increases in women after menopause, its greater prevalence in men may mean it plays a larger role in their Alzheimer’s risk.7
Research from Dr. Kellyann's recent study further sheds light on this issue, with conditions like sarcopenia and sarcopenic obesity (loss of muscle mass plus obesity) showing similar gender-specific patterns. Sarcopenia, which is the loss of muscle mass, is linked to smaller gray matter in the hippocampus, a region critical for memory. In sarcopenic obesity, women experienced a slight delay in dementia onset, while men showed a more significant advancement in dementia progression.8
While many risk factors for dementia are common across genders, the effects can vary, underscoring the importance of gender-specific strategies in managing brain health by managing risk factors.
Genetic Influences
"Women with one or two copies of the APOE4 gene generally face a higher risk of developing Alzheimer’s disease compared to men. This risk is compounded by the fact that Alzheimer’s is strongly associated with aging, and women tend to live longer than men.
APOE4 increases the likelihood of developing Alzheimer’s-related neuropathology, and the longer someone lives, the greater the chance of accumulating amyloid plaque burden, impairment, and ultimately dementia. Therefore, it makes sense that women, who live longer, face a higher risk, especially accounting for the potential cognitive vulnerability of hormonal changes they face later in life through the postmenopausal time frame.
Yet, it’s important to note that about 1/3 of individuals with an abundant cognitive reserve—factors like education, mental stimulation, and a healthy lifestyle—may avoid developing the clinical symptoms of Alzheimer's-related pathology.
Being proactive is key. Adopting brain-healthy habits early can help mitigate these genetic risks, offering a potential to slow the progression and reduce the risk associated with APOE4, regardless of gender." -Thomas M Holland, MD, MS., esteemed Rush University Medical Center researcher and medical advisor to NeuroReserve
The APOE4 gene is the strongest genetic risk factor for Alzheimer’s disease. Having one copy of this gene increases your risk by about three times, and having two copies can raise it up to 12 times.9 We’ve talked before about how APOE4 affects brain health, but recent research shows it may be even riskier for women than men.10 Women who carry even one APOE4 gene face a significantly greater risk than men; in fact, female APOE4 carriers have approximately 1.5 times higher odds of developing Alzheimer’s than male carriers.11
This elevated risk for women is linked to more severe brain changes. APOE4 in women is associated with increased tau pathology (the buildup of tau proteins in the brain), lower glucose metabolism (energy use), and a greater amyloid-β burden, all of which are strongly tied to Alzheimer’s progression.11 For women who carry APOE4, there are noticeable changes in brain function and structure—like lower brain energy use (hypometabolism) and thinner brain cortex, which is involved in thinking and memory. This thinning and decreased energy use are strongly linked to Alzheimer’s progression. Men with APOE4, by contrast, show fewer and less intense changes; they may only experience slight reductions in brain energy use or even show areas where the brain cortex thickens slightly.10
Remember, genetics are just one piece of the puzzle when it comes to brain health risk. While genes like APOE4 may increase susceptibility, they don’t determine your destiny. By taking proactive steps you can help offset genetic risks and support a resilient brain. Check out our previous article here for practical tips on how lifestyle and nutrition can empower you, regardless of genetic predispositions.
Preventive Strategies and Gender-Specific Recommendations
“In blue zones, both men and women engage in habits that contribute to long, healthy lives, but there are some interesting distinctions in how they approach longevity.
Women in blue zone regions often take on roles that emphasize social connection and caregiving, which naturally integrate movement and social bonds into their daily routines. They tend to form tight-knit social circles, such as the moai groups in Okinawa, where women come together to support each other emotionally and financially. These strong social networks have a significant impact on reducing stress and providing a sense of purpose.
Men, on the other hand, often prioritize physical activity and purpose-driven work. In Sardinia, for example, many older men are shepherds, which keeps them active and physically engaged well into their later years. They also maintain meaningful roles within the family and community, whether through leadership or by mentoring younger generations, which reinforces their sense of purpose.
While the principles of diet, movement, social connection, and purpose apply to both genders, the way they are woven into the fabric of everyday life reflects cultural expectations and roles. The key takeaway is that both men and women in blue zones find ways to stay active, eat wisely, build meaningful relationships, and retain a sense of purpose throughout their lives—but they may express these habits in ways that are influenced by their social and cultural contexts.” -Dan Buettner, Founder of the Blue Zones
A person's lifestyle and diet play a significant role in brain health, but the way men and women approach these habits is in a different manner. These differences are shaped by a combination of biological factors, cultural influences, and personal preferences, and they can impact cognitive health in distinct ways. The important thing to remember is that prevention strategies for brain health are helpful regardless of gender. By focusing on specific areas that complement each gender's natural tendencies and preferences both genders can find more impactful ways to boost quality of life and overall brain health.
Getting Enough Sleep: Both men and women should aim for 7–8 hours of sleep per night for optimal health, but women may need to focus more on improving sleep quality. Women are more likely to report poor sleep quality, trouble falling asleep, and feeling unrefreshed upon waking. They also face a higher risk of high blood pressure with only 5 hours of sleep or less, whereas men do not. Especially during the menopause transition, hormonal changes can disrupt sleep, leading to insomnia, frequent waking, and daytime fatigue. Additionally, sleep apnea, though more common in men, is harder to diagnose in women, often leading to undetected sleep-disordered breathing.12 Both men and women need to focus on getting enough sleep for their brain health, but women may have to spend more time focusing in this area.
Managing Stress: Men and women experience and cope with stress differently due to unique patterns of brain activity. Women tend to have increased brain activity in regions related to self-reflection and cognitive processing during stress, which may lead to higher anxiety and a tendency to ruminate. This makes mindfulness techniques, like yoga and meditation, which help quiet overactive thoughts, especially effective for managing stress in women. On the other hand, men often have reduced brain activity in areas involved in strategy and emotional control, potentially leading to externalizing behaviors under stress. Men may benefit from cognitive behavioral therapy, like goal settings and playing sports with friends, which builds coping strategies and can boost brain activity in regions that aid in stress management.13
Staying Active: Exercise is a fantastic way to keep the brain strong—just like it strengthens the body, it also supports brain health. While men and women both benefit from regular physical activity, research shows that women may gain a unique advantage. For instance, weekly moderate exercise has been shown to boost cognitive function by about 5% in men and an impressive 14% in women. So, whether it’s walking, strength training, or aerobics, getting moving is one of the best things to keep your mind sharp.14
Eating a Brain Healthy Diet: When it comes to brain-healthy diets like the Mediterranean and MIND diets, both men and women can benefit from the array of nutrition these diets deliver, but women tend to see slightly more advantages. Research has shown that a closer adherence to the MIND diet is linked to a decreased risk of cognitive impairment and slower rates of cognitive decline in women.15 However, it’s important to consider eating habits when focusing on these diets. Men often prefer red and processed meats and consume them more frequently than women, making it harder to follow these brain-healthy diets. Women, on the other hand, are more likely to choose vegetables, whole grains, tofu, and dark chocolate, which align well with the principles of these diets. Men also tend to eat quickly, dine out more, and eat alone, which could affect adherence to healthier eating habits.16 If men fully embraced the principles of the Mediterranean and MIND diets, they may find themselves enjoying the long-term brain health benefits just as much as women.
Maintaining brain health in men and women requires a tailored approach, as each gender has unique focus areas that can impact cognitive well-being. It's definitely not a one-size-fits-all strategy. By understanding the differences in how lifestyle, diet, and other factors affect brain health in each case, everyone can make changes in their daily routine that best suit brain's needs and support its long-term health.
Regardless of gender, life can get busy, and it’s common for both men and women to struggle with staying consistent and covering all the necessary aspects of a brain-healthy diet. That’s where additional support can be helpful. Our brain health supplement, RELEVATE is designed to meet those needs, with 17 nutrients derived from the Mediterranean and MIND diets that target brain health. This daily supplement helps you stay nutritionally supported and helps you maintain focus on your cognitive well-being. The vast majority of RELEVATE users report cognitive improvements such as less brain fog and better memory. Many users also report improved sleep, better energy, improved mood and fewer hot flashes, making it a valuable addition to any routine.17 Learn more and order RELEVATE by visiting here, or explore our limited-time Holiday offer by visiting here.
References
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4. Yeap, B. B. & Flicker, L. Testosterone, cognitive decline and dementia in ageing men. Rev Endocr Metab Disord 23, 1243 (2022).
5. Anstey, K. J. et al. Association of sex differences in dementia risk factors with sex differences in memory decline in a population-based cohort spanning 20–76 years. Sci Rep 11, 7710 (2021).
6. Chatterjee, S. et al. Type 2diabetes as a risk factor for dementia in women compared with men: A pooled analysis of 2.3 million people comprising more than 100,000 cases of dementia. Diabetes Care 39, 300–307 (2016).
7. Mielke, M. M. Sex and Gender Differences in Alzheimer’s Disease Dementia. Psychiatr Times 35, 14 (2018).
8. Zhang, J. et al. Sarcopenic obesity is part of obesity paradox in dementia development: evidence from a population-based cohort study. BMC Med 22, 1–17 (2024).
9. Alzheimer’s: Is it in your genes? - Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/alzheimers-genes/art-20046552.
10. Sampedro, F. et al. APOE-by-sex interactions on brain structure and metabolism in healthy elderly controls. Oncotarget 6, 26663 (2015).
11. Yan, S. et al. Sex modifies APOE ε4 dose effect on brain tau deposition in cognitively impaired individuals. Brain 144, 3201–3211 (2021).
12. Sleep’s an Important Part of the Health Equation—Now More. https://orwh.od.nih.gov/about/director/messages/sleeps-important-part-of-health-equation-now-more-than-ever.
13. Seo, D., Ahluwalia, A., Potenza, M. N. & Sinha, R. Gender Differences in Neural Correlates of Stress-Induced Anxiety. J Neurosci Res 95, 115 (2017).
14. Lenzen, S., Gannon, B. & Rose, C. A dynamic microeconomic analysis of the impact of physical activity on cognition among older people. Econ Hum Biol 39, 100933 (2020).
15. Sawyer, R. P., Blair, J., Shatz, R., Manly, J. J. & Judd, S. E. Association of Adherence to a MIND-Style Diet With the Risk of Cognitive Impairment and Decline in the REGARDS Cohort. Neurology 103, e209817 (2024).
16. Feraco, A. et al. Assessing gender differences in food preferences and physical activity: a population-based survey. Front Nutr 11, 1348456 (2024).
17. RELEVATE User Experience Study, RELEVATE Direct-to-Consumer users, administered through AYTM (2022).
