Sex-related differences in temperature regulation during heat stress from childhood to older age

Epidemiological studies have observed that female sex is associated with a greater risk of adverse health outcomes during heat extremes. It remains unclear if sex-related differences in autonomic temperature regulation contribute to these observations. This narrative review article provides an overview of studies that compared autonomic temperature regulation during heat stress between males and females across the lifespan. Our literature search focused on studies that investigated components of heat loss thermoeffector loops and/or that accounted for confounding differences in body morphology and metabolic heat production between males and females. Guided by this framework, we present studies that compared autonomic temperature regulation between males and females during childhood to adolescence, adulthood, middle-age, and older age. The review highlights that few studies have specifically studied sex-related differences in autonomic temperature regulation during heat stress. Most studies have focused on thermoeffector output and core temperature. In contrast, little is known regarding thermoafferent signalling, central integration of thermoafferent feedback, thermoefferent signalling and thermoeffector organ structure and function. Additional research is needed to understand how biological sex modulates autonomic temperature regulation during heat stress and how any sex-related difference may contribute to the greater health risks observed in females during heat extremes.