Exploring the gender gap in medical research and practice, its historical roots, current data disparities, and pathways toward equitable healthcare.
Explore the ResearchImagine a world where medical treatments and diagnostic criteria were based primarily on female biology, and men regularly received incorrect drug doses, experienced misdiagnosed heart attacks, and felt dismissed by their doctors. This scenario seems absurd, yet it precisely mirrors the reality women have faced throughout medical history. For centuries, the male body has been treated as the default human template in medicine, while female bodies were often considered mysterious, unpredictable, or simply smaller versions of males 5 .
Women wait longer for diagnoses, experience more adverse drug reactions, and have their symptoms dismissed as anxiety or exaggeration 2 4 .
This gender gap in medical research and practice has profound consequences. The historical roots of this disparity run deep—from 19th-century doctors diagnosing women with "hysteria" for having higher libidos than their husbands to the modern failure to recognize that women experience different heart attack symptoms than men 5 . As biological sex and gender influence disease manifestation, progression, and treatment response, bridging this gap becomes not just a matter of justice, but of lifesaving medical precision 8 .
The legacy of gender bias in medicine reveals a troubling history of misunderstanding and mistreating women's bodies. As Dr. Elizabeth Comen, a breast oncologist at NYU Langone Health, describes in her research, modern medicine has grown on "twisted roots" established in the nineteenth and early twentieth centuries 5 . These historical misconceptions continue to influence women's healthcare today.
In the 19th century, Boston physician Horatio Storer famously diagnosed a woman with "nymphomania" simply because she had a higher libido than her older husband. He recommended brutal treatments and potential asylum commitment. Shockingly, he eventually committed his own wife to an asylum for "catamenial mania" (menstruation-induced insanity) 5 .
The consequences of this history remain tangible today. Women's pain is frequently dismissed, with many undergoing painful procedures like IUD placement or endometrial biopsy without proper pain management 5 . The underlying assumption persists: that women are naturally equipped to endure pain because they endure childbirth 5 .
"Medicine doesn't exist in a vacuum" - Dr. Marianne J. Legato, founder of the Foundation for Gender Specific Medicine 5 .
Average female participation in clinical trials
Drugs removed from market (1997-2000) posed greater risks for women
COVID-19 publications examined sex/gender differences
Despite increased awareness, women remain significantly underrepresented in clinical trials across critical disease areas. A comprehensive study published in JAMA Network Open reviewed 20,020 clinical trials with over five million participants, revealing persistent gaps between female representation in research and their proportion in disease populations 4 .
Even when women are included in studies, researchers often fail to analyze data by sex. A 2025 review in the European Journal of Internal Medicine highlighted that "inclusion alone does not ensure sex differences are meaningfully addressed in research" 8 . This failure to disaggregate data means potential sex-based differences in treatment efficacy and safety remain hidden.
The COVID-19 pandemic exposed this analytical neglect. A Northwestern University study analyzing 94,000 COVID-19-related publications found that only 4% examined sex or gender-specific health considerations 6 , despite clear evidence that the disease affected men and women differently. Men were more likely to die from COVID-19, while women were more likely to develop Long Covid 4 .
At the height of the COVID-19 pandemic, while sex differences in immune responses became increasingly apparent, researchers at Northwestern University questioned whether the scientific community was adequately investigating these differences. Their study, published in PLOS ONE and funded by Women's Health Access Matters (WHAM), became the first large-scale bibliometric analysis to evaluate sex and gender-based content in COVID-19 research 6 .
The research team, led by Dr. Nicole Woitowich, employed a systematic approach:
Total Publications Analyzed
Publications with Sex/Gender Analysis
Percentage
"Neglecting to account for sex and gender in research has grievous implications for advancing equitable healthcare" and "reinforces a one-size-fits-all approach to medicine" - Dr. Nicole Woitowich 6 .
Heart disease remains the leading cause of death for women, yet they are consistently underdiagnosed and undertreated. While chest pain is the most common heart attack symptom for both sexes, women are more likely to experience additional symptoms like shortness of breath, nausea, vomiting, or jaw pain 4 .
Despite this knowledge being available since the late 1990s, a 2018 study found that men with chest pain were 2.5 times more likely to be referred to a cardiologist than women 4 . A 2024 study confirmed that women with milder symptoms often have their symptoms misdiagnosed as gastrointestinal or anxiety-related 4 .
Women metabolize drugs differently than men due to variations in body composition, hormones, and enzyme activity 4 . Yet, this fundamental difference is rarely addressed in clinical practice.
Surprisingly, zolpidem (Ambien) remains the only drug with separate dosing recommendations for men and women 4 . Women experience adverse drug reactions nearly twice as frequently as men, partly because dosages are typically based on male metabolism 4 .
The term "Yentl syndrome," coined by Dr. Bernadette Healy, describes the phenomenon where women must prove themselves as sick as men to receive equivalent care 2 . This pattern manifests in extended diagnosis times across multiple conditions. Women with endometriosis, for instance, wait an average of 4.4 years for diagnosis 2 .
| Condition | Gender Disparity | Impact |
|---|---|---|
| Endometriosis | Average 4.4 years to diagnosis | Prolonged pain and disease progression |
| Heart Disease | Women under-referred for specialist care | Higher mortality rates |
| Pain Conditions | Women's pain more often dismissed as psychological | Inadequate pain management |
NIH law mandating inclusion of women in clinical trials represented a crucial first step 4 .
SABV policy further solidified expectations for sex-informed research 4 .
President Biden signed an executive order launching the White House Initiative on Advancing Women's Health Research and Innovation, signaling heightened commitment to "getting women the answers they need about their health" 4 .
The journey toward truly equitable medicine continues, but with increased attention, funding, and commitment to change, a future where every body receives appropriate, evidence-based care is within reach.