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In A Nutshell
- A review of 41 studies from 2018 to 2023 found women with clinical characteristics similar to men’s were consistently less likely to be offered surgery or other intensive treatment
- Heart care showed the clearest gaps, with women more often managed on medication alone while men received procedures like bypass surgery, angioplasty, or ablation
- Researchers could not fully explain the gaps, since patient choice, unequal access, and clinical judgment are all possible factors alongside bias
- Medical records track only “administrative sex,” not gender, which the study’s authors say makes it hard to research gender-based treatment differences directly
Women with heart attacks, blocked arteries, or spine problems are consistently less likely than men to be offered surgery or other intensive treatment, even among patients with comparable clinical characteristics. That is the finding from a new review of 41 medical studies published between 2018 and 2023, which tracked how doctors actually treat male and female patients rather than how they talk about them.
This pattern showed up again and again, in heart care, surgery, emergency rooms, and even in something as small as the size of a breathing tube. Researchers had to comb through more than a thousand studies to find those 41, a surprisingly small number given how much attention gender gets in other corners of medicine.
Evidence from the review, published in the journal PLOS ONE, points to a healthcare system that often treats men and women differently, although the studies could not fully explain why. Miriam Veenhuizen and Andrew O’Malley, researchers at the University of St Andrews in Scotland, pulled this evidence together to size up the problem before anyone tries to fix it.
Only 41 Studies Measured Sex Differences In Medical Treatment
Veenhuizen and O’Malley set out to answer a simple question: when it comes to actual medical treatment, are men and women treated the same? They searched major medical databases for studies published between 2018 and 2023 and narrowed an initial 1,112 results down to 41 that fit. Most got cut because they focused on how healthcare workers are treated based on gender rather than how patients are treated, a distinction that mattered: during the same five years, 551 papers studied gender differences among healthcare professionals, compared with just 41 studying differences in patient treatment.
Twenty-six of the 41 studies came from the United States, with the rest scattered across Europe, Canada, China, Chile, and Israel. Most looked backward at existing medical records rather than running new experiments, and of those 38, 33 found a real difference in treatment. Among the 29 that adjusted statistically for multiple factors, 25 still found one.
Cardiovascular Care Shows The Clearest Sex Differences In Medical Treatment
Heart care stood out as the specialty with the most research on this topic, and one of the clearest patterns of unequal treatment. Women with heart conditions, including heart attacks and irregular heartbeats, were more likely to be managed with medication alone, while men were more likely to get procedures like artery-opening surgery or a heart-rhythm correction procedure called ablation. One Swedish study found women waited longer to get a diagnostic heart test after symptoms began, and a separate study found women were more likely to be discharged to a nursing facility after a heart attack, a sign of a rougher recovery.
Similar gaps turned up outside the heart, too. Older women were less likely to be offered surgery at all, and women needing a certain spine surgery were told to try non-surgical options first. Men were more likely than women to receive a liver transplant. In emergency rooms, women were less likely to get certain pain medications and less likely to have bystanders use a defibrillator on them during cardiac arrest, and breathing tube size showed a gap too, with women more often given a tube too large for their height.
Not every specialty told the same story. Diabetes care mostly showed no real difference between men and women, and the pattern occasionally reversed: women were more likely than men to be treated for dementia, and teams with strong group dynamics favored women for advanced heart failure treatments, while poorly functioning teams favored men.
A treatment difference doesn’t automatically prove bias, since some gaps might reflect what patients themselves want. In one study on a Parkinson’s disease treatment, women who skipped a certain procedure were more likely than men to have declined it themselves. Still, very few studies pointed to legitimate medical guidelines calling for different treatment by sex, which leaves bias as a real possibility.
Medical Records Rarely Distinguish Sex From Gender
One of the more frustrating discoveries in this review had nothing to do with treatment itself and everything to do with how medical records get kept. Every study relied on what the paper calls “administrative sex,” the sex listed on a patient’s paperwork rather than their gender identity. None of the studies looked at gender as separate from biological sex, and none included intersex patients, so the researchers could only study sex differences based on how hospitals file records. Better recordkeeping capturing both sex and gender could let future research dig further, the authors say.
Most studies also looked at sex on its own, without weighing how it interacts with race or ethnicity. A handful examined both, and the picture got messier where they did. In one study on liver transplants, both Black and white women were less likely than men to receive one, but Black women faced a steeper drop in access, showing how race and sex compound in ways a simple men-versus-women comparison misses.
Across specialties as different as heart care, surgery, and emergency medicine, women were statistically less likely to be offered intensive treatment, and when treated conservatively, less likely to get the guideline-recommended version of it. Whether that reflects patient choice, unequal access, clinical judgment, or bias remains an open question, one the researchers say deserves a much closer look.
Disclaimer: This article is based on peer-reviewed research and is intended for general informational purposes only. It is not medical advice, and readers with personal health concerns should speak with a qualified healthcare provider.
Paper Notes
Limitations
Several limitations are tied to how scoping reviews work in general, including a lack of prospective studies (research that follows patients forward in time rather than looking backward at records), samples that may not represent the broader population, and limited information about the underlying reasons behind observed differences. Most of the included studies relied on retrospective medical record reviews, which can be incomplete, and several did not adjust their statistics for other factors like race or existing health conditions. The literature search covered only two databases, PubMed and Embase, and did not include allied health databases, so some relevant studies may have been missed. Most of the studies also came from the United States, which limits how well the findings apply to other countries. Even so, the authors note that the consistency of results across different medical specialties suggests the overall pattern is unlikely to change much even if a few additional studies had been included.
Funding And Disclosures
Authors reported that they received no specific funding for this work and declared no competing interests.
Publication Details
This article is based on the paper “Measured treatment differences between sexes and genders: A scoping review,” authored by Miriam Veenhuizen and Andrew O’Malley of the University of St Andrews, published in PLOS ONE. DOI: 10.1371/journal.pone.0356176.
