About the gender bias in healthcare

The more I read about the history of female health, the stronger my purpose of helping women becomes. Traditionally, the signs and symptoms of female health imbalance have been too often deemed irrelevant, an exaggeration, ‘normal’, or dealt with by putting us on the pill or SSRIs. Learn more about how gender bias affects our health.

From medical research to textbook diagnostic procedures and treatment options, gender bias is still prevalent in primary care settings, quite often limiting our access to effective, timely and specialised care. To understand and identify this, it is important to highlight the historical roots of this bias:

Gender blindness in research

In medical research, it has traditionally been preferred to use healthy young males as subjects of experiment, and later extrapolate the results to the general population; moreover, up until the 1990s, female subjects of child bearing age were excluded from clinical trials in the US, where big pharma conducted the trials…

There have been some advances since then, however the fair and representative inclusion of biological females in research it is still controversial – as our menstrual cycles, hormonal changes in different life stages and the pregnancy potential are seen as risks for reliability and accuracy of results. It is not cost-effective to have a sample large and equal enough to spot the core differences between sexes.

What is even more worrying, is that replicating existing studies made in males in female-only samples is too costly and time-consuming. Therefore, any treatments designed using those early studies do not take into consideration that women metabolise drugs differently, our genetics predispose us to different conditions, and our bodies normally have different compositions and metabolic needs.

Gender bias in clinical practice

In addition to pure statistical bias, there are a number of patriarchal gender stereotypes that still affect the quality of the service we receive in primary care. While men are expected to communicate using direct commands and requests, women have historically used emotion-based language to express their health concerns. When reality meets the gender expectation, it may not only trigger a paternalistic response from the primary care physician, but also result in gaslighting of the female patient – a dismissal of our pain and suffering as not worth the worry.

But what would happen if gender expectations are not met? Female patients speaking up and presenting facts, asking questions, requesting referrals and discussing treatment options at primary level, may be labelled as ‘difficult’ or ‘hypochondriac’ – I have been there, and most of my clients too. Physicians become defensive, and argument that ‘they know better‘. Stay in your lane and do as you’re told, woman.

 

In sum, if you are a woman and have experienced ongoing health issues, you have probably encountered gender bias at some point in your treatment. Some common symptoms experienced by us in our 30s and onwards are being systematically attributed to either a sex hormone imbalance, a thyroid condition or a psychosocial cause, as a blanket standard of diagnostic investigations.

And they send us for blood tests, but when the results come back and our hormones show to be within NHS ranges, the investigations stop. Headaches, exhaustion, anxiety, painful or irregular periods, forgetfulness or gastrointestinal disturbances go on to be considered ‘unexplained illness’ or a consequence of depression and stress, and dealt with using the contraceptive pill, or in most cases antidepressants. But most of us are not depressed; we experience symptoms that limit our quality of life, a strong enough reason to show low or unstable moods.

The truth is that while men’s symptoms tend to be automatically considered biological dysfunction, there is a question mark above our heads from the moment we cross the GP office’s doors. That women are at increased risk of psychosomatic illness is a fact; however, by perpetuating the idea that gender should be used as a determinant for the diagnosis of depression and mood disorders, we are enabling the hysteria stereotype to keep being part of the gender bias in medical care – while also putting men at risk of undertreatment. And why does that matter?

In practical terms, this overt gender bias can translate into excruciating delays in identifying autoimmune disorders (7-10 years for endometriosis), unnecesarry drug prescription (70.9 million prescriptions for antidepressants were given out in 2018 in the UK, compared with 36 million in 2008), and a knock-on negative effect on long-term health derived from different temptative treatments, where side effects and interactions may trigger other symptoms.

As a society, new generations are breaking new ground for female empowerment and equality, but there is still much work to do to improve female health around the world. If we want to be represented and fairly treated by the healthcare system, we need to defend our right to be part of research, understand to a T how our bodies work, and learn to communicate effectively with the medical community.

 

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