St Andrews Review Finds Women Get Less Aggressive Treatment Than Men for the Same Diagnoses

The finding

Women with the same heart condition, kidney disease or Parkinson's diagnosis as men are less likely to get the more aggressive treatment, according to a review published in PLOS One by researchers at the University of St Andrews School of Medicine.

The team, led by Dr Andrew O'Malley and Dr Miriam Veenhuizen, screened 1,112 published studies down to those that directly compared care given to male and female patients, according to the university's own release. Of the 38 studies that analyzed actual patient records, 33 found a significant difference in treatment between the sexes.

Euronews and Streamline Feed reported the review covered 41 studies rather than 38. The university's release and the peer-reviewed paper itself are more precise: 38 studies specifically compared patient records, with the broader set of 41 apparently including additional papers reviewed as part of the wider literature search. Either way, the pattern the researchers describe held across cardiology, surgery, transplant medicine and emergency care.

What the data shows, condition by condition

Women with a heart attack, heart failure or an irregular heartbeat were more likely to be managed with medication. Men with the same diagnoses were more likely to get a coronary bypass, a stent, or another invasive procedure, according to the study findings reported by The Guardian and FemTech World.

Men with Parkinson's disease were more likely to be referred for deep brain stimulation, an implanted device that manages symptoms once drugs stop working. Women with liver failure were less likely to receive a transplant. Women needing dialysis for kidney disease were less likely to get permanent vascular access and spent longer relying on a catheter. Women were also less likely to receive opioids for pain management.

Stroke and diabetes treatment showed no significant difference between men and women. Women were more likely to be treated for dementia, a disease that disproportionately affects women in raw numbers.

On statins, the sources disagree. The Guardian and FemTech World both reported women were less likely to be prescribed statins. HuffPost UK reported the opposite, that women were more likely to be prescribed them. That is a direct contradiction between outlets covering the same study, and it is not resolved in the material available. The university's own release does not mention statins at all.

No guideline says to treat men and women differently

The researchers checked whether any clinical guideline recommends different treatment by sex for these conditions. They found none. That is the detail that matters most here: it means the disparity isn't the product of official medical protocol treating men and women differently on purpose.

O'Malley said the findings are "a prompt to check whether treatment is being offered on clinical grounds rather than assumption." He pointed to one study showing that when teams deciding who gets advanced heart failure therapy functioned poorly, women were less likely to be selected. He also cited research showing doctors more often attribute women's symptoms to anxiety and make more diagnostic errors with female patients, even when test results are positive.

The honest caveat

These are observational studies, not randomized trials, and treatment decisions depend on more than sex. Age, frailty, other illnesses, surgical risk and a patient's own preference all factor into whether someone gets a bypass versus a pill. If women in these datasets were older or sicker on average, that alone could explain some of the gap without any bias involved.

Veenhuizen acknowledged the uncertainty directly: "It's not entirely clear why this is happening, but it is likely because women were under-represented in clinical trials until recent decades, so many guidelines rest on data from men." That's a data problem, not necessarily a bias problem, and the researchers say the pattern "survived statistical adjustment in most studies," meaning they tried to control for confounders like age and comorbidity. Whether that adjustment fully accounts for clinical complexity is exactly the open question the researchers say still needs answering.

Where the money and attention have gone

Veenhuizen also flagged a research-priorities gap: over the same period covered by this review, 551 studies examined sex inequality affecting doctors and other health professionals. Only 41 examined what happens to patients. That's a lopsided allocation of academic attention, regardless of how the underlying treatment-gap question eventually gets resolved.

The findings land amid an active UK policy push. Then-health secretary Wes Streeting said in March that women were being let down by what he called "medical misogyny," and the prior Conservative government had appointed Lesley Regan as England's first women's health ambassador. Those are political framings and characterizations from officials, not findings from this study itself.

What happens next

The St Andrews team says it now plans to test whether the same treatment gap shows up in outputs from generative AI systems, which are trained on the same clinical literature and patient records this review examined. If AI models trained on decades of male-skewed data start recommending less aggressive care for women automatically, the researchers warn that could lock the disparity in at scale rather than fix it. No timeline for that follow-up work has been announced.