Women have historically faced barriers to receiving adequate medical treatment, from the long legacy of doctors dismissing women’s symptoms as “all in their heads” or as simply “hysteria,” to the reality that most research has been done on men’s bodies. Congress only mandated that women be included in studies funded by the National Institutes of Health (NIH) in 1993, and even after that, science has been slow to implement changes.
That was over 30 years ago, and the fact that the sexes are still treated differently in the medical setting still holds true—and a new review digs into exactly how. The paper, published in PLOS One, found that across disciplines, women were both less likely to be offered invasive treatments and to be prescribed medication in accordance with guidelines.
For experts who’ve long been sounding the alarm about sex and gender bias in medicine—and how female biology differs from male biology—it’s a welcome development. “It hits all of the key points that we’ve been thinking about for decades now,” says Marcia L. Stefanick, Ph.D., founding director of the Stanford Women’s Health and Sex Differences in Medicine Center. “It’s been this long, hard struggle to ever get anyone to actually pay attention.”
Ahead, what the researchers found, and what it means for those seeking treatment.
Meet the Experts: Andrew O’Malley, Ph.D., study co-author and head of the Division of Education at the University of St Andrews School of Medicine; Marcia L. Stefanick, Ph.D., founding director of the Stanford Women’s Health and Sex Differences in Medicine Center; Syreen Goulmamine, M.P.H., associate director of research translation and programs at the Society for Women’s Health Research.
What did the study find?
The researchers analyzed data from 41 papers published between 2018 and 2023, 26 of which were conducted in the U.S. After they crunched the numbers, they found disparities across specialties, many of which uncovered similar findings: less invasive procedures, less medication.
Here are some of the specifics:
- Women with certain cardiovascular conditions were more likely to be managed with medication rather than invasive options such as coronary artery bypass grafting, percutaneous coronary intervention, or ablation therapy
- Women were less likely to be given opioids for pain management by emergency teams
- Women with Parkinson’s were less likely to be considered for deep brain stimulation devices
- Women were less likely to receive medication for cholesterol management and blood pressure control
- Women in need of liver transplants were less likely to receive them and more likely to be hospitalized
The researchers were surprised to find that “the direction of the difference was the same across cardiology, neurology, surgery and emergency medicine,” says Andrew O’Malley, Ph.D., study co-author and head of the Division of Education at the University of St Andrews School of Medicine. “We were also surprised at how few studies there were in this field—we expected more.”
The data was particularly limited when it came to intersex and trans people. (Data on the latter is limited in part because of these studies’ reliance on medical records, which do not separate sex and gender.) Additionally, only four of the studies examined how sex bias intersected with race bias; due to the limited data, the researchers weren’t able to draw conclusions.
“The review shows that women are often treated differently, but it does not always tell us the impact it is having on women’s health outcomes. The review is a useful snapshot and a strong case for better research,” says Syreen Goulmamine, M.P.H., associate director of research translation and programs at the Society for Women’s Health Research.
Why do women and men receive such different treatment?
There are likely several factors at play, not limited to cultural biases, differences in patient preferences, and a lack of data and awareness about how sex affects different biological systems. It’s actually not necessarily a bad thing to treat the sexes differently, in accordance with their different biologies; the trouble comes when those differences aren’t based on well-researched guidelines. “Ultimately, success is not identical treatment rates, but ensuring every patient receives evidence-based care,” Goulmamine says.
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She adds, “Much of the evidence base was built around men. Guidelines, risk scores, diagnostic thresholds, and even equipment may not always reflect women’s physiology.” What’s more, women don’t always have the same symptoms for the same conditions that men do—just look at all the differences in heart attack signs—and oftentimes, the symptoms they do experience are “more likely to be attributed to stress or anxiety, further delaying diagnosis and treatment.” Goulmamine says.
Then there are social factors, too. “Caregiving, cost, transportation, insurance, and how treatment options are presented all shape the type and quality of care someone receives,” she says.
It’s also important to remember that, in many cases, it’s not clear that women are receiving worse treatment, just that they’re being managed more conservatively. “We have to keep wondering: like, are we over-treating men or are we under-treating women?” Stefanick says. “That’s a question that is worth asking, and just realizing that no matter what, we shouldn’t be treating them the same because they’re not the same.”
What changes would experts like to see?
Stefanick and Goulmamine would both like to see sex-specific evidence guide medical treatment. “This includes using sex-specific diagnostic thresholds, validated risk tools, and appropriately sized equipment wherever evidence supports it,” Goulmamine says.
“The amount of information that we have on sex differences is definitely increasing at a very high rate, and it’s a matter of getting that information into the medical school curriculum,” Stefanick adds.
And researchers are also aiming to draw attention to how incorporating LLMs into medical care might further sex bias—a potential step backward in the fight for evidence-based, sex-specific medicine.
“We undertook the review to ground forthcoming research: We needed documented, real-world examples of how women and men are managed differently so that we could recreate them as clinical vignettes and test whether large language models replicate the same biases, and since no existing scoping review described those differences, we conducted our own,” O’Malley says of the future research he hopes to conduct based on the conclusions of the review. “This is becoming very important as AI-powered tools are increasingly used in clinical medicine.”
So how can you make sure you’re getting the best care?
Unfortunately, sex disparities in healthcare are largely perpetuated at the structural level. But there are a few things you can do to improve the odds you’ll receive quality treatment.
“Be specific about your symptoms and how they affect you. Ask direct questions to your providers like, ‘What else could this be?’ or ‘Am I receiving the standard treatment?’” Goulmamine says. “After a diagnosis, ask about recommended therapies and follow-up care. It can also be helpful to bring someone with you to appointments and take notes.”
And if you feel like you were dismissed or the treatment you were offered isn’t helping you feel better, don’t hesitate to follow up with your doctor or seek out a second opinion, she continues. “You are your own best health advocate.”
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