Gender bias in healthcare

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Hello Alpha

7 min readMay 9, 2023

Gender bias exists everywhere — and unfortunately, it’s rather common in healthcare. It refers to the unfair treatment or representation of individuals based on their gender and it can take many forms, including unequal pay, stereotypes, discrimination, and prejudice. It’s important to recognize and address gender bias in order to ensure women get the quality, compassionate healthcare they deserve.

There’s a rich history of gender bias in medicine, beginning in ancient Egypt and Greece with the catch-all “diagnosis” of hysteria. This persisted into the 18th and 19th centuries when the term was widely used to describe any female sexual or emotional behavior that men deemed “irregular” or “unwomanly.” So-called hysterical complaints played a major role in the forced hospitalization of women well into the 1900s and the Diagnostic and Statistical Manual of Mental Disorders (DSM) didn’t remove the diagnosis until 1980.

When we discuss gender bias in medicine, it’s often referring to bias towards women; however, men aren’t immune. For example, mental health conditions, particularly depression and anxiety, are more likely to go undiagnosed in men due to a combination of stereotypes about masculinity and a lack of awareness around how mental health symptoms might show up differently in men. Bias also spans beyond the gender binary and significantly impacts transgender and nonbinary people. In fact:

Almost half of all trans adults have experienced discrimination or other negative treatment from a healthcare professional at least once.
Almost half of all trans adults have been denied coverage for gender affirming healthcare by their insurance company.
2 out of 3 trans adults worry that negative judgment and discrimination from healthcare professionals will affect their health evaluations.
1 out of 3 trans adults say they’ve had to provide education about trans people to their doctor.

Medical education

The education of doctors and healthcare providers obviously impacts the care their patients receive. In the past, women were not allowed to practice medicine until the late 1800s and even still today, medical education does not adequately address gender differences in health conditions. Instead, it often defines a 70-kilogram male as the standard, with all other individuals considered a variant of this, rather than emphasizing a thorough understanding of the unique organ systems and health conditions that affect each biological sex differently.

Healthcare providers used to believe any medical disparities between men and women were confined solely to reproductive organs. As a result, women’s healthcare was sometimes labeled “bikini medicine” as it primarily centered on conditions related to breast and gynecological/obstetric concerns, with all other issues assumed to be identical to those in men’s bodies. Even today the accrediting body for U.S. medical schools doesn’t include teaching about sex and gender differences as a requirement for accreditation. In fact, according to one study, only 9% of medical schools specifically teach women’s health.

One positive trend is the growing emphasis on implicit gender bias training. This refers to the unconscious attitudes or stereotypes that people hold about gender that can influence their thoughts and behaviors towards others, even without them being aware of it. Since it’s often not something people are consciously aware of, it’s challenging to address and it continues to contribute to gender inequalities in the medical field. Thankfully, some medical schools are beginning to tackle this issue head-on through training.

Medical research

In 1977, the U.S. Food and Drug Administration (FDA) suggested that women of childbearing age should be excluded from clinical research studies to protect newborns following the thalidomide scandal. Additionally, researchers cited the hormonal variability of women during their menstrual cycle as a factor that could complicate study results and increase costs by requiring more subjects in clinical trials. This exclusion of women from clinical studies was justified by the belief that what works for men would work for women too, a mistaken assumption that has had devastating consequences.

Eight out of ten drugs removed from the U.S. market between 1997 and 2000 were taken out due to side effects that mainly or exclusively affected women. In the period from 2004 to 2013, U.S. women suffered over 2 million drug-related adverse events compared to 1.3 million for men. Only in 1990, the National Institutes of Health (NIH) began to require the inclusion of women in clinical trials sponsored by them. Unfortunately, transgender people have similarly been excluded from clinical trials and other types of research, to an even greater extent.

In 1997, the FDA published a rule requiring manufacturers to show evidence of how their drug is safe and effective by age, sex, and race. When last measured in depth in 2016, it was clear there had been significant progress, with women accounting for roughly half of the participants in some clinical trials funded by the NIH. Scientists are now required to account for the possible role of sex as a biological variable in both animal and human studies.

Despite this progress, the lack of funding for women’s health remains a huge issue. Seventy percent of the people impacted by chronic pain are women, yet 80% of pain studies are conducted on male mice or human men. One of the few studies to research gender differences in the experience of pain found that women tend to feel it more of the time and more intensely than men. While the exact reasons for this discrepancy isn’t yet understood, biology and hormones are suspected to play a role.

The bias and assumptions around the female reproductive system are being proven to be based on exactly that. New research challenges the assumptions that male mice are more consistent as test subjects for clinical trials. For decades, scientists used male mice in studies because female mice were believed to behave more erratically due to their hormonal cycles. Yet a new study shows it is male mice that behave more erratically, and female mice don’t exhibit changes in behavior during their reproductive cycle.

Pain

Pain management for women has a troubling history of bias. Despite the use of anesthesia during surgery in the mid-1800s, women were denied pain relief medication during childbirth for decades. This was because of prevailing religious beliefs that women should suffer during labor and delivery.

Unfortunately, even today there is evidence to suggest doctors still don’t take women’s pain seriously. Female patients are often prescribed therapy instead of the pain medication that is more commonly prescribed to male patients. A 2013 study by the Pain Research and Intervention Center of Excellence at the University of Florida found that women are also more sensitive to pain than men and are more likely to express it, but the result is that women’s pain is more often seen as an exaggeration than a reality.

Delayed care

One of the most significant implications of gender bias in healthcare is delayed care. Research has shown that women are more likely than men to experience delays in receiving medical care. Healthcare providers may not take women’s symptoms seriously, may not fully understand their symptoms, or may assume that their symptoms are not severe, all of which can lead to delayed diagnoses and treatment.

There are numerous examples of this:

In a 2015 study involving 18,618 people just diagnosed with cancer, researchers found evidence to suggest females often waited longer to receive a diagnosis after their symptoms first appeared.
According to 2020 research, women with moderate hemophilia receive a diagnosis 6.5 months later than men, on average. Women with severe hemophilia face delays of 39 months. For women with Von Willebrand’s disease (VWD), the delay between symptom onset and diagnosis is 16 years.
A survey from the American Autoimmune Related Diseases Association (AARDA) found 62% of people with an autoimmune disease had been labeled “chronic complainers” by doctors, or told they were too concerned with their health. This figure applies to all the people surveyed but 75% of people with autoimmune conditions are women which means this dismissive attitude disproportionately affects women. In cases of lupus, for example, women make up 90% of patients. Although men receive a lupus diagnosis at a later age than women, on average, it takes them less time to receive a diagnosis once they present with symptoms.

Women’s health conditions

Given the implicit gender bias, lack of training, and underfunded research, there is often a general lack of understanding and lack of appropriate care for women’s health conditions.

Menopause is a natural stage of life for women, but it can also be a difficult one. Women going through menopause may experience a variety of symptoms, including hot flashes, mood changes, and difficulty sleeping, however, these symptoms are often dismissed or attributed to something else, leading to delayed care and treatment.

Similarly, menstruation is a normal biological process for women, but it can also be a source of significant discomfort and pain. Many women experience painful cramps, heavy bleeding, and other symptoms during their menstrual cycle, but these symptoms are often dismissed or not taken seriously by healthcare providers.

Reproductive health is another area where gender bias can have a significant impact on women’s care. Issues such as infertility, pregnancy, and childbirth are unique to women, but they are often not given the attention they deserve in healthcare settings. Historically many physicians simply wrote off maternal death as a natural consequence of childbirth, rather than exploring safer ways to deliver babies (like washing their hands between patients). Even today, women may be dismissed or not taken seriously when they express concerns about their reproductive health, leading to delayed diagnoses and treatment. Recent changes in the political and legislative landscape represents a lack of judicial discipline, overreach, and disregard for scientific expertise which jeopardizes our personal right to make decisions about our health and the health of our families.

How Hello Alpha helps

Women deserve healthcare that puts more decisions in their hands, that doesn’t paternalize or dismiss their concerns, and honors that they are patients and people. That’s the story of why Hello Alpha was created: to rebuild a system that addresses women’s unique health needs.

One of the best ways to advocate for unbiased care is to have a relationship with a trusted primary care provider. Women deserve quality, compassionate care that supports their needs. Hello Alpha closes the gaps in healthcare for women. Our inclusive platform covers treatment for over 100 medical conditions from a dedicated provider trained in women’s health.

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Gender bias in healthcare

Written by Hello Alpha Team