Standfirst: A review by researchers at the University of St Andrews found that women were less likely than men to be offered invasive or intensive treatments for the same conditions. The findings span cardiology, surgery, transplant medicine and emergency care, but researchers say the reasons and clinical consequences remain uncertain.
Women may be less likely than men to receive treatments such as surgery, implanted devices or strong pain medication when diagnosed with the same medical conditions, according to a review of 41 studies published between 2018 and 2023.
The research, conducted by academics at the University of St Andrews in Scotland, identified a consistent pattern across several areas of medicine. However, the authors cautioned that the review does not establish whether women are receiving too little treatment, men are receiving too much, or whether some differences reflect clinically justified decisions.
Review identifies differences across several specialties
The studies examined treatment decisions in cardiology, surgery, transplant medicine and emergency care. Across these fields, women were generally more likely to receive conservative management, such as medication, rather than procedures or other intensive interventions.
The pattern appeared in several examples:
- Women with heart failure, heart attacks and tachycardia were more likely to be managed with medication instead of procedures such as coronary artery bypass grafting or percutaneous coronary intervention.
- Men with Parkinson’s disease were more likely to be referred for deep brain stimulation, which uses an implanted device to help manage symptoms.
- Women were less likely to receive a liver transplant or to be referred for surgery in the studies reviewed.
- The differences also included the use of strong painkillers and other intensive forms of treatment.
Miriam Veenhuizen, an honorary lecturer at the University of St Andrews School of Medicine, said the consistency of the findings was notable, even though the overall direction of the results was not unexpected.
Why might women be offered different treatment?
The review does not provide a single explanation. Researchers said further work is needed to determine whether the treatment gap reflects appropriate clinical judgment, differences in patient preferences and medical presentation, or unequal care.
One possible factor is the historic under-representation of women in clinical trials. If medical evidence and treatment guidelines are based disproportionately on male participants, clinicians may have less reliable evidence when assessing how women respond to particular procedures or therapies.
Other influences may include differences in how symptoms are reported or interpreted, referral practices, risk assessments and assumptions about treatment suitability. The researchers did not claim that every difference in care is discriminatory. Instead, they urged clinicians to examine whether decisions are based on the patient’s medical circumstances rather than assumptions linked to sex.
Why clinical trial representation matters
Clinical trials are used to assess the safety and effectiveness of medicines, procedures and devices. When certain groups are under-represented, the resulting evidence may not fully reflect the needs of the wider population.
That issue can affect:
- How symptoms are recognised and diagnosed
- How treatment risks and benefits are calculated
- Which patients are referred to specialists
- How clinical guidelines are written
- Whether patients are offered procedures, medication or monitoring
Better representation alone may not explain every difference in treatment, but it can help improve the evidence available to doctors and patients.
Researchers call for closer examination of treatment decisions
Andrew O’Malley, co-lead of the study, said the findings should encourage clinicians to check whether treatment is being offered on clinical grounds rather than assumption.
That does not mean every patient should receive the same intervention. Medical decisions can legitimately differ because of age, symptoms, other illnesses, treatment risks, patient preferences and the likely benefits of a procedure. Equality in healthcare means that comparable patients should be assessed fairly, with relevant clinical differences taken into account.
The researchers said additional studies should examine what happens to patients after different treatment decisions. This could help establish whether women experience worse outcomes because they are referred less often for intensive care, or whether conservative treatment is appropriate in the circumstances studied.
What the findings mean for patients
The review is not a diagnosis of an individual patient’s care and does not show that women are routinely denied treatment. It does, however, highlight the importance of shared decision-making and transparent clinical reasoning.
Patients discussing treatment may wish to ask:
- What treatment options are available?
- Why is one option being recommended over another?
- What are the benefits and risks of surgery or an invasive procedure?
- Would a specialist referral be appropriate?
- How strong is the evidence for this treatment in patients with similar characteristics?
These questions should support conversations with qualified healthcare professionals, not replace medical advice.
What happens next?
The University of St Andrews review points to a need for more research into sex differences in medical treatment. Future studies could compare referral rates, treatment decisions and patient outcomes while accounting for disease severity, co-existing conditions and patient choice.
For health systems across Europe, the issue is relevant to efforts to improve evidence-based care and reduce avoidable inequalities. The review does not call for identical treatment in every case. Its central message is that decisions should be individualised, evidence-based and free from assumptions that are unrelated to a patient’s clinical needs.
Conclusion: The findings add to concerns about unequal treatment in healthcare, while leaving open the question of whether the differences benefit or disadvantage women. The clearest takeaway is that treatment decisions should be based on robust evidence and each patient’s circumstances—not assumptions about sex.
