Gender Differences in Electroacupuncture Response: Hormonal and Neurological Factors

Electroacupuncture (EA) is more than an updated take on traditional acupuncture - it is a technology‑enabled therapy that delivers gentle electrical currents through fine needles to amplify the body’s own healing pathways. While many patients have experienced the relaxing buzz of EA, not everyone responds the same way. 

Clinical practitioners have long noticed that men and women often report different sensations, require different stimulus intensities and even experience different durations of relief. Understanding why these differences occur is crucial for delivering personalised care and for designing devices that support clinicians and patients effectively.

This blog digs into why gender matters in electroacupuncture, exploring hormonal and neurological factors that shape the body’s response. We’ll summarise what recent research shows, compare how other blogs cover the topic, and discuss how we at Pantheon Research integrate these insights into the design of our EA devices and clinical guidance. Each section is kept concise, organised with clear headings and bullet points so you can quickly grasp the take‑aways.

Disclaimer: This blog is for educational purposes and is not a substitute for professional medical advice. Always consult a qualified practitioner before starting any new treatment.

Why Gender Matters in Electroacupuncture

Pain is inherently personal. Biological sex and socially conditioned gender roles influence how pain is perceived, reported and treated. Women are more likely to experience chronic pain disorders and often report greater pain sensitivity than men. Electroacupuncture is used for conditions ranging from back pain and arthritis to mood disorders, and tailoring the therapy to the patient matters for several reasons:

• Different prevalence of disorders. Conditions like fibromyalgia and migraines disproportionately affect women, while men more often seek treatment for musculoskeletal injuries. EA treatment strategies may therefore differ simply because the underlying conditions differ.
• Neurochemical differences. Sex hormones such as estrogen and testosterone modulate neurotransmitter systems involved in EA analgesia (endorphins, serotonin, norepinephrine and dopamine). Understanding these pathways helps us set appropriate stimulation frequencies and durations.
• Device parameters. Men and women often require different stimulation intensities to achieve the same therapeutic effect. A Frontiers review noted that women’s vagal nerve activity increased more than men’s after specific EA interventions, suggesting women may require lower currents for autonomic effects.
• Personalised medicine. Recognising sex‑specific responses aligns with our mission of delivering precision neuromodulation devices that can be adjusted to each patient’s needs. It also supports patient safety by avoiding overstimulation.

Clinical findings suggest that stimulation frequency affects neurotransmitter release differently in males and females. High-end systems like those featured in our best electroacupuncture stimulators, ensure such parameters remain consistent during trials.

Hormonal Factors: Estrogen, Progesterone and Testosterone

Estrogen and pain modulation

Estrogen is not just a reproductive hormone; it profoundly affects pain perception and neurotransmission. A 2019 review on serotonin and estrogen shows that estrogen increases the production of tryptophan hydroxylase (the rate‑limiting enzyme for serotonin synthesis) and decreases expression of serotonin reuptake and degradation enzymes. These changes elevate serotonin levels, which can enhance the analgesic effects of EA. High estrogen also up‑regulates excitatory 5‑HT₂A receptors and down‑regulates inhibitory 5‑HT₁A receptors, potentially making women more responsive to high‑frequency stimulation that releases serotonin and norepinephrine.

Studies in animals and humans reveal estrogen‑mediated differences in EA response:

• Fever suppression in rabbits. Electroacupuncture attenuated endotoxin‑induced fever more strongly in female rabbits than in males. Researchers proposed that estrogen amplified the vagal anti‑inflammatory reflex.
• Analgesic intensity. In rat models, 100 Hz EA produced stronger analgesia in females than in males, again implicating estrogen’s interaction with opioid and monoamine pathways.
• Endorphin dynamics. Estrogen decreases β‑endorphin secretion from certain cell lines and can uncouple μ‑opioid receptors from their potassium channels. This may partly explain why women often require different EA frequencies to achieve comparable endorphin release.

Progesterone and GABA modulation

Progesterone and its metabolites enhance GABAergic inhibition in the central nervous system. Although research specifically examining progesterone’s role in EA is sparse, the general effect is to decrease neuronal excitability. Ovarian hormones, including progesterone, influence neurotransmitters such as GABA, glutamate and the opioid system. During the luteal phase, increased progesterone may dampen sensitivity to EA and require adjustments in current intensity or frequency.

Testosterone and inflammation

Testosterone modulates immune responses and pain perception. Lower testosterone levels have been associated with chronic pain conditions in men. While there is limited direct research on testosterone and EA, some studies suggest that male rats experience a faster onset of analgesia after EA but the effect fades sooner. Testosterone’s immunosuppressive actions may reduce the recruitment of β‑endorphin‑producing immune cells, necessitating different stimulation parameters.

Neurological Differences: Brain and Nervous System Responses

Electroacupuncture doesn’t just act locally at the needle site; it modifies neural activity at multiple levels – peripheral nerves, spinal cord and brain. Emerging neuroimaging techniques shed light on sex differences in these responses:

• Brain activation patterns. A 2025 fMRI study scanned 46 healthy adults while stimulating the LR3 (Taichong) point. Women showed activation in the left inferior cerebellar gyrus, right superior marginal gyrus and left postcentral gyrus, whereas men showed activation in the right superior margin gyrus, left central sulcus and right paracentral lobule. The differences were not just in location but also in connectivity: women exhibited stronger thalamic functional connectivity with regions related to sensory integration and emotion. Subjects also reported different sensations: women noted more soreness, sharp pain, tingling and numbness while men reported greater pressure, heaviness and swelling.
• Autonomic regulation. Heart-rate variability studies show that EA at the HT5 (heart) point enhances vagal tone, with the increase being significantly more pronounced in women. This suggests that women may derive stronger autonomic calming from the same stimulation, which might explain why many female patients feel sleepy or deeply relaxed after EA.
• Analgesic timing. Animal experiments reveal that analgesia from EA begins earlier in males but lasts longer in females. For clinicians, this means male patients might require shorter pulse widths or higher initial intensities for immediate relief, whereas women may benefit from sustained low‑frequency stimulation.
• Pain perception and opioids. A review of opioid analgesia notes that mixed μ‑/κ‑opioid receptor agonists produce greater analgesia in women, whereas κ‑opioid‑selective agonists are more effective in males. Estrogen can decrease β‑endorphin release and uncouple μ‑opioid receptors. Because EA activates endogenous opioid pathways via low‑frequency stimulation, these receptor dynamics are directly relevant to treatment planning. 

To analyze estrogen’s effect on β-endorphin activation, researchers often rely on advanced clinical microcurrent stimulators that allow low-frequency, hormone-specific nerve stimulation without discomfort.

Neurochemical Pathways: Endorphins, Serotonin and Norepinephrine

Electroacupuncture frequency determines which neurochemicals are released. Pioneering work by Han and colleagues, summarised in later reviews, shows that:

• Low-frequency (2–10 Hz) stimulation triggers the release of endorphins and enkephalins. These opioids bind μ‑ and δ‑receptors to provide long‑lasting analgesia. In animal models, the analgesic effect at 100 Hz was stronger in females but low‑frequency EA tended to produce similar analgesia across sexes when appropriate intensities were used.
• High-frequency (50–100 Hz) stimulation promotes the release of serotonin, norepinephrine and dynorphin. Serotonin plays a crucial role in mood and pain modulation. Estrogen increases serotonin synthesis and decreases its degradation, which may make women particularly responsive to high‑frequency EA but also prone to adverse effects like nausea if overstimulated.
• Immune‑mediated mechanisms. A recent mouse study found that EA recruits ICAM‑1⁺/CD11b⁺ immune cells that release β‑endorphins at sites of inflammation. Blocking β‑endorphin with antibodies abolishes the analgesic effect. Since estrogen modulates immune cell function, sex‑specific immune responses may partly explain differences in EA analgesia.

Understanding these pathways helps clinicians choose frequencies that complement each patient’s hormonal and neurochemical profile. Pantheon devices incorporate precision control of frequency and pulse width, allowing practitioners to switch between low‑ and high‑frequency modes or even blend them in sweep patterns for optimal results.

What the Evidence Says: Key Studies on Sex Differences

The scientific literature on sex differences in electroacupuncture is still developing, but several studies provide important clues:

Study & Year	Key Findings	Practical Takeaway
Yang & Litscher (2020) – Review of gender differences in manual, electro and laser acupuncture	Female rabbits showed greater reduction in endotoxin‑induced fever after EA; in rats, 100 Hz EA produced stronger analgesia in females; EA enhanced vagal tone more in women; analgesia onset earlier in males but lasted longer in females; men lost more weight but women had greater waist‑circumference reduction in obesity studies.	Highlights the importance of adjusting frequency and treatment duration based on sex. Consider lower current and longer sessions for women to capitalise on sustained analgesia and autonomic benefits.
Frontiers (2025) fMRI study	Brain scans during LR3 stimulation showed sex‑specific activation patterns; women reported more soreness and tingling; men reported more heaviness and pressure.	Tailor stimulation sites and intensities. Female patients may be more sensitive to deqi sensations and require slower ramping of current.
Review on opioid analgesia (2013)	Mixed μ/κ agonists more effective in women; κ‑agonists more effective in men. Estrogen reduces β‑endorphin release.	Reinforces the need to customise low‑frequency EA protocols that release specific opioid peptides.
Systematic reviews on sex differences in pain	Women show higher pain sensitivity and prevalence of chronic pain, influenced by genetic, hormonal and psychosocial factors.	Recognise that sex differences are multifactorial; personalisation should consider hormones, lifestyle and mental health.

Although some studies are small or animal‑based, the cumulative evidence indicates that sex hormones, neural connectivity and immune responses all contribute to the observed differences. Importantly, sex differences do not mean one group will always benefit more than the other; rather, they point to different mechanisms and optimal parameters.

Practical Implications: Personalising Electroacupuncture Treatments

At Pantheon Research, our mission is to blend traditional wisdom with modern science to deliver precision neuromodulation devices. Understanding how men and women respond differently to EA informs both our device design and clinical recommendations:

1. Adjust frequency based on goals and hormonal status. For patients seeking mood regulation or management of conditions like fibromyalgia, higher‑frequency stimulation may tap into serotonin and norepinephrine pathways. Women, particularly during high‑estrogen phases, may respond strongly to high frequencies; clinicians should start with lower intensities and monitor for overstimulation. For pain requiring opioid release, low‑frequency modes (2–10 Hz) are effective across sexes, but some animal studies suggest higher frequencies may yield better analgesia in females.
2. Tailor intensity and pulse width. Women often need lower currents to achieve similar physiological effects due to higher vagal sensitivity. Our 12c.Pro device offers adjustable pulse widths and current ranges, so practitioners can deliver gentle stimulation for sensitive patients. Men may require higher initial intensities for rapid analgesia.
3. Consider cycle phases and hormonal status. Estrogen and progesterone levels fluctuate throughout the menstrual cycle. Higher estrogen around ovulation can increase serotonin tone and sensitivity to high‑frequency EA, whereas progesterone in the luteal phase may require higher currents. Clinicians should inquire about cycle timing when scheduling treatments.
4. Account for comorbidities and medications. Women often take hormonal contraceptives or hormone‑replacement therapy, which modulate neurotransmitter systems. Men may be on testosterone therapy or have conditions affecting androgen levels. These factors influence EA response and should guide frequency/intensity choices.
5. Use patient‑reported sensations to guide adjustments. In the 2025 fMRI study, women described more tingling and sharp sensations. Encouraging patients to communicate sensations helps practitioners dial in the deqi level without causing discomfort.
6. Educate patients about expected responses and side effects. Many normal side effects of EA – mild soreness, skin irritation or temporary fatigue – resolve within 24–48 hours. Our blog on managing electroacupuncture side effects explains what’s normal and when to seek help. Educating patients builds trust and ensures safety.
7. Blend with other therapies. Because EA interacts with opioid and monoamine systems, combining it with exercise, cognitive‑behavioural therapy or pharmacological treatments may produce synergistic effects. Women’s higher prevalence of anxiety and mood disorders may make them particularly receptive to EA paired with breathwork or meditation.

At Pantheon Research we go further, integrating insights from neurochemistry, endocrinology and device engineering. Our mission is not merely to describe differences but to translate them into actionable advice for practitioners and patients. We also back our guidance with rigorous citations and internal resources. For instance:

• If you’re new to EA, our How Electroacupuncture Works article breaks down the process, from needle insertion to adjusting frequency, in a friendly step‑by‑step format.
• To understand how EA compares with other needle therapies, read Electroacupuncture vs Dry Needling, which explains the differences in philosophy, mechanism and applications.
• Concerned about discomfort? Our piece on Managing Electroacupuncture Side Effects outlines normal reactions versus red flags and underscores the safety of our devices

Conclusion & Future Directions

Understanding gender differences in electroacupuncture response isn’t just an academic exercise - it’s a practical roadmap for delivering safer, more effective, and more individualized care. Hormones like estrogen influence pain perception, neurotransmitter release, and nervous-system reactivity, which means male and female patients may not always respond identically to the same stimulation settings.

For clinicians, this reinforces a simple truth: precision matters. The more accurately you can control frequency, pulse width, and current intensity, the easier it becomes to tailor treatment to each patient’s physiological profile.

At Pantheon Research, this principle drives every device we build. Our engineering focus has always been the same - consistent signal output, stable waveforms, and clinically reliable electroacupuncture stimulation.

If you’re looking to integrate sex-specific parameter adjustments into your practice, our professional-grade stimulators offer the flexibility and accuracy required for nuanced clinical work:

• The 8c.Pro Electrostimulator is ideal for clinicians who need multi-frequency control and ultra-stable biphasic output - crucial when shifting settings for hormone-related pain sensitivity differences.
• The 4c.Pro Electrostimulator provides streamlined, dependable stimulation perfect for standard protocols where consistent nerve activation is key.

As research continues to uncover how biological sex influences electroacupuncture outcomes, Pantheon Research remains committed to supporting practitioners with evidence-based guidance, safe technology, and devices built for real-world clinical demands.

Because when your equipment is precise, your treatments can be personalized and your patients can feel the difference.