Gender Bias in Healthcare is Very Real and Sometimes Fatal

Gender bias refers to any practice or set of beliefs that favors people of one gender over those of other genders. Traditionally, gender bias favors men and boys, placing them in superior positions professionally, academically, and at home.

Stereotype-fueled gender disparities exist in every area of life. Gender bias shows up in laboratories when men are often automatically perceived as lead researchers or department heads. It happens in education when people assume boys naturally have a greater aptitude for math and science.

It’s also incredibly common in medicine.

Some healthcare professionals might discount symptoms reported by those who aren’t cisgender males, discriminate against transgender patients, and recommend different (sometimes more effective) treatment approaches to male patients.

While discussions on gender bias often focus on the effects on women as well as transgender and nonbinary people, gender bias in healthcare also affects men. 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.

At best, gender bias in healthcare can lead to frustration, not to mention a general mistrust of healthcare professionals. All too often, it has more serious consequences, though, including worsened symptoms and even death.

How it shows up

Gender bias in healthcare weaves a toxic thread throughout history. Take hysteria, for example.

This catch-all “diagnosis” originated in ancient Egyptian and Greek medicine, but it was widely used in the 18th and 19th centuries 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. The Diagnostic and Statistical Manual of Mental Disorders (DSM) didn’t remove the diagnosis until 1980.

A long history of bias also surrounds pain management for women. Even after doctors began using anesthesia during surgery in the mid-1800s, they continued to deny pain relief medications during childbirth for decades. They didn’t consider it necessary because prevailing religious beliefs suggested women should suffer during labor and delivery.

What’s more, 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) and ease the process of labor.

It’s worth noting these doctors were almost exclusively male. Women couldn’t practice medicine legally until the late 1800s. Those who chose to pursue careers in medicine still faced plenty of restrictions, including gender-based harassment.

Modern-day bias

Some doctors and mental health professionals still harbor skepticism around female physical and emotional distress, often assuming that women exaggerate their symptoms or make them up entirely.

For example, 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.

And there’s more:

• As recently as 2021, evidence continues to suggest that doctors still fail to take pain reported by females seriously. Doctors often prescribe therapy instead of the pain medication they often prescribe to males.
• Doctors are also far less likely to recommend timely treatment for heart disease and heart attacks in women.

There’s also the persistent stigma surrounding female reproductive health concerns.

Because of this stigma, plus a general lack of knowledge of the menstrual cycle — a natural process that’s entirely necessary for human life — you’ll find more than a few news stories about doctors dismissing severe pelvic pain as cramps and recommending over-the-counter pain medication.

Later, some patients found doctors who performed more-thorough evaluations that revealed the actual source of the pain: endometriosis, ovarian cysts, and even cancer.

Another major source of bias in healthcare? Body size.

Certainly, weight bias can affect any person, but evidence suggests females experience it more often.

Healthcare professionals sometimes prescribe weight loss to women with larger bodies instead of taking time to explore possible causes of their symptoms. People with obesity also get preventive gynecological and breast cancer screenings at lower rates than people with a “normal” body mass index (BMI).

Personal or cultural bias

People who enter healthcare professions already believing that female health complaints often relate to hormones or underlying mental health concerns will likely carry these biases forward.

Similarly, men who consider women inferior, less intelligent, or unreliable probably likely won’t put as much faith in a woman’s account of her symptoms.

Stereotypes

You’ve probably heard a few jokes about the stereotypical man who puts off medical treatment, even for severe symptoms.

Well, doctors hear the same jokes. Whether they realize it or not, these stereotypes can unconsciously affect the care they provide, making it more likely they’ll take men seriously when they should take everyone’s symptoms seriously.

Limited research trials

It wasn’t until 1990 that the National Institutes of Health (NIH) required researchers to include women in any clinical trials sponsored by the NIH. Previously, clinical trials and research mainly studied white men, applying their findings to the rest of the population.

Transgender people have similarly been left out of clinical trials and other kinds of research to an even greater degree.

Education and training

Those trials and scientific studies mentioned above play a major role in medical education and current standards of care.

Symptoms of many chronic health and mental health conditions show up differently in people of different genders. But healthcare professionals might only learn to link symptoms identified through research on men to specific conditions. Diagnosis and treatment of these conditions in non-male people, then, often fall short.

Knowledge-informed bias

When existing evidence suggests a given health condition affects people of a certain gender at higher rates, this condition may go undiagnosed in people of other genders. Often, this only reinforces the bias.

A doctor might discount symptoms of, say, migraine or hypothyroidism in male patients because those conditions more commonly affect women. As a result, fewer men receive an accurate diagnosis. This doesn’t just prolong their symptoms, it skews the statistics around how common these conditions truly are.

Similarly, women might have a higher chance of receiving a depression or anxiety diagnosis — but that doesn’t necessarily make men less likely to have these conditions. Depression, in particular, can involve different symptoms for men, so men with depression may not get the correct diagnosis right away.

On the flip side, healthcare professionals who believe women have a higher risk of depression and anxiety might hastily diagnose these conditions instead of evaluating their symptoms more thoroughly.

Yet pain, fatigue, trouble sleeping, and difficulty with memory and concentration can also happen with physical health conditions. These symptoms can also affect mood and energy to the point where they mimic depression.

Other factors

Many Women of Color face additional racial bias when seeking medical treatment.

Healthcare professionals might, for example:

Even more barriers exist for Women of Color from lower income households, who often lack access to healthcare and prenatal care.

Regardless of intention, healthcare in the United States often perpetuates racism. People of Color, especially Women of Color, often receive lower quality care. As a result of systemic racism, these disparities remain even when doctors honestly attempt to provide equal care to all patients.

The impact

It can feel deeply distressing when a doctor dismisses your concerns, patronizes you, or believes they know more about your body and health needs than you do.

But gender bias in healthcare can have far more devastating consequences beyond frustration and emotional distress.

People who experience this bias on a regular basis might lose their trust in healthcare professionals and avoid routine health checkups. They might make fewer appointments, which can mean they won’t get testing or treatment for chronic diseases and other health conditions.

An even more concerning outcome? They could easily begin to doubt themselves. Consequently, they might ignore major symptoms and signs of serious health concerns until it’s too late to get effective treatment.

Even those who continue to seek care may not get the help they need. Doctors who don’t recognize common symptoms of heart attack in women, for example, probably won’t prescribe the right treatment. Since heart attacks are a medical emergency, this lack of treatment can lead to preventable death.

Misdiagnosis of any medical condition can cause long-term pain and distress in large part because easily treated symptoms often get worse. The end result? Treatment becomes more difficult when it does happen.

A small tumor that goes unrecognized can grow, becoming more painful (and harder to remove) over time. Untreated cancer can spread. Without help and support, people living with untreated health or mental health conditions may begin having thoughts of suicide, believing they have no other options.

Addressing it

Overcoming bias in healthcare is no small task. It requires large-scale change, both in medical research methods and in the systems that reinforce gender bias and racism.

That said, both healthcare professionals and patients can take steps to challenge gender bias.

For doctors, this begins with medical training, which should address the reality of gender bias and teach doctors strategies to avoid making medical decisions based on stereotypes and prejudiced beliefs.

A greater awareness of bias can help doctors learn to listen to your unique symptoms and revisit any diagnosis that doesn’t feel right or treatment that doesn’t work for you.

As for what you can do? It never hurts to keep a detailed log of your symptoms, with information about their severity, when you experience them, and for how long. Bring this record to each appointment so you can show your doctor how your symptoms have progressed over time.

When your doctor continues to dismiss your concerns, it might help to ask a few key questions:

• “What are the accepted testing or treatment guidelines for these symptoms?”
• “What else could these symptoms suggest?”
• “I’ve had these symptoms for [length of time], and they’ve only gotten worse. Can you explain why I don’t need treatment?”
• “I’ve tried the treatment approach you suggested, but it hasn’t helped. What’s next on the list?”
• “I’d like to be tested for [name of condition]. If you don’t think I need that test, please note that you declined my request in my chart.”
• “Would you recommend this approach if a [certain gender] reported the same symptoms?”

If these questions still fail to yield any results, it may be time to ask for a referral to a specialist or find a new care team, if you have that option.

Remember, you know your body best. Some doctors may not take your symptoms seriously, but that doesn’t mean those symptoms aren’t serious.

If something about your health concerns you, be persistent and direct until they’re willing to listen. While gender bias is still very present in the medical community, there are plenty of conscientious, informed healthcare professionals working to overcome it.

The bottom line

Biased healthcare can leave people coping with symptoms that disrupt daily life, peace of mind, and overall well-being — symptoms that might have rapidly improved with prompt and appropriate care.

Want to learn more about gender bias in healthcare? Just ask the non-male people in your life. You can also check out these resources for more insight:

• “Unwell Women” by Elinor Cleghorn
• “Doing Harm” by Maya Dusenbery
• ‘Everybody was telling me there was nothing wrong’ by Maya Dusenbery

Crystal Raypole writes for ishonest and Psych Central. Her fields of interest include Japanese translation, cooking, natural sciences, sex positivity, and mental health, along with books, books, and more books. In particular, she’s committed to helping decrease stigma around mental health issues. She lives in Washington with her son and a lovably recalcitrant cat.

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