Does a patient’s sex affect the treatment they receive? In a 2026 review of scientific literature published by researchers at the University of St Andrews (UK), data from various medical fields was analyzed, revealing significant differences in treatment practices between women and men.
For the same disease or clinical condition, patients of different sexes do not always receive identical diagnostic procedures, medication treatments, or surgical interventions. A significant portion of the differences identified in the studies showed that women received certain medical interventions less frequently or later than men, though in individual clinical areas the picture was the reverse, or no statistically significant difference appeared at all.
The researchers analyzed 41 academic papers published between 2018 and 2023. The studies covered cardiovascular diseases, neurology, endocrinology, nephrology, transplantation, surgery, emergency medicine, anesthesiology, psychiatry, and primary care. Out of 38 retrospective studies, 33 revealed statistically significant differences in treatment between women and men.
However, the authors emphasize that these observed differences do not automatically imply medical bias or discrimination; in most of the studies, the underlying causes of the differences were not clearly defined and may relate to, among other things, patient preference or disparities in healthcare access.
Based on this extensive review, treatment practices by clinical specialty are as follows:
Cardiovascular Diseases: In the management of cardiovascular diseases (such as myocardial infarction, heart failure, and supraventricular tachycardia), women were more frequently prescribed conservative medical treatment compared to men, rather than invasive procedures such as coronary artery bypass grafting, stenting, or ablation. Furthermore, all reviewed studies conducted on patients with atherosclerosis showed that women were less frequently prescribed statins (lipid-lowering therapy).
Diagnostics were also delayed: More time elapsed from the initial symptoms of an infarction to the recording of an electrocardiogram (ECG) in women. This may be due to an atypical clinical presentation in women (nausea, shortness of breath, back pain), which physicians often mistakenly attribute to psychosomatic disorders or anxiety. Following an infarction, women were more frequently discharged to specialized nursing facilities, which the authors suggest may indicate worse clinical outcomes. Additionally, a smaller proportion of women were discharged from the hospital on optimal medical management following aortic reconstruction.
During cardiac arrest in public places, bystanders used automated external defibrillators (AEDs) less frequently on women compared to men. However, decisions to terminate resuscitation were less frequent in women, and they more often reached the hospital with maintained vital signs.
Neurology: Men with Parkinson’s disease were more frequently selected for deep brain stimulation (DBS) procedures, though among patients already evaluated, the frequency of performing the procedure did not differ significantly between sexes. In cases of dementia, however, women received treatment more frequently.
Endocrinology: Regarding treatment for adult patients with diabetes, no statistical difference was observed between women and men. However, a study conducted in children showed that boys with obesity were screened for diabetes more frequently than girls.
Nephrology and Transplantation: Liver transplantation was performed more frequently in men. Women on the transplant waiting list were hospitalized more frequently, and women in intensive care units underwent transplantation more frequently compared to men. For women on dialysis, temporary central venous catheters were used for longer periods, and they were transitioned to permanent vascular access less frequently.
Surgery: For hernia repairs, women more frequently underwent open surgical procedures, while minimally invasive methods (endoscopic/laparoscopic) were used less often. Older female patients were offered surgery less frequently. Additionally, in cases of symptomatic spinal stenosis, women were more frequently advised to initially try non-operative (conservative) treatment compared to men.
Emergency Medicine: Prior to hospital arrival, emergency medical personnel performed targeted temperature management less frequently for women during cardiac arrest and administered opioid analgesics less often.
Anesthesiology: During intubation, women were more frequently fitted with endotracheal tubes larger than recommended for their height.
Psychiatry: Men were diagnosed with bipolar disorder less frequently, while medications for depression were more frequently prescribed to men. In cases of treatment-resistant schizophrenia, women were less frequently prescribed clozapine.
Primary Care: Older women received vaccinations less frequently compared to men, though benzodiazepine-class medications were prescribed to them more frequently.
What might be the possible reasons for treatment differences between the sexes?
The review does not establish a single overarching reason to explain the differences observed across all clinical fields, but the authors point to several potential factors:
Fundamental knowledge deficit in academic literature: First, the problem is evident in the studies themselves. Between 2018 and 2023, 551 articles investigated gender disparities directly among medical staff, while only 41 papers addressed differences in patient treatment. Such a scarcity of clinical data regarding patient treatment creates a major knowledge gap in its own right.
Implicit bias: The authors also consider sex-related implicit bias in medical practice. According to the studies they reviewed, women’s symptoms are sometimes attributed to excessive anxiety, which can influence condition assessment and diagnostic decision-making. They also note that certain diseases—including cardiovascular diseases—have historically been more strongly associated with men, while women have been less represented in clinical trials.
Multidisciplinary team (MDT) dynamics: When selecting advanced heart failure therapies (AHFT), one study showed that in well-functioning teams, therapies were prescribed equally to women and men (or more to women), whereas in poorly functioning teams, they were prescribed more to men. This demonstrates that the working dynamics of a medical team can influence treatment decisions.
Patient choice: The authors also note that in some cases, observed treatment differences related to the patient’s own decision. For instance, in Parkinson’s disease, patient preference was more frequently cited as the reason for not undergoing deep brain stimulation (DBS) in women.
It should be noted that because the review relied on electronic medical records, the data reflects biological sex rather than gender identity.
In discussing sex-based treatment differences, the researchers also touched upon the COVID-19 pandemic. They noted that the pandemic made the role of intersectionality in healthcare particularly visible—specifically how sex intersects with race, ethnicity, and socioeconomic status. The authors point out that low-income women and minority women faced additional risks and limited access to healthcare during the pandemic.
The authors emphasize that the available evidence is qualitatively limited: most studies are retrospective and often fail to fully account for confounding factors that could influence outcomes, including comorbidities and other clinical characteristics. Furthermore, a large proportion of the studies were conducted in the USA, meaning the findings may not fully reflect healthcare systems in other countries. Another significant flaw is the lack of data on gender; the studies included in the review relied solely on administrative sex recorded in medical records.
Future research should focus more on improving research methodology, addressing equality and intersectional analysis, and studying healthcare systems in other countries. This is crucial to determine whether the identified disparities reflect clinically justified differences or stem from systemic inequalities.
