The Concerning Impacts Of Male-Centric Medical Research And Healthcare Systems

Vector art visualizing the male and female aspects of healthcare and medicine.

A 2020 report found that only one percent of healthcare research and innovation was invested in female-specific conditions (aside from oncology). And yet, women spend 25 percent more time in debilitating health compared to men. As a result, women experience adverse effects from medications at twice the rate of men, are more likely to be misdiagnosed during life-threatening events like heart attacks, and face longer delays before receiving accurate diagnoses and quality treatment. 

Even when women make up half the global population and have outnumbered men in the United States since 1946, there are still too many disparities and oversights that reveal how the medical community constantly underinvests in women’s health, designs drugs and devices around male bodies, and writes up diagnostic guidelines that ignore how diseases present in women.

Although women technically live longer than men, some studies have found that much of that longevity is tied to factors like lower rates of occupational hazards and combat-related deaths rather than better health. In reality, women spend more of their lives sick, misdiagnosed, or undertreated, and they face higher rates of chronic pain, autoimmune disorders, and disability. This means that a longer lifespan is not in itself indicative of better health or a happier life. Women live longer not because of the public health system but despite it. 

This trend is, like many modern-day injustices, a continuation of historical gender inequities. For most of medical history, the human body that medicine has cared about most is not actually “human” in a universal sense, but very specifically male.

This bias can be traced back to the earliest foundations of Western medicine, when physicians like Hippocrates and Galen wrote anatomical descriptions based on male bodies. Women were studied only when reproduction was at stake, as if their sole purpose was to function as baby incubators rather than human beings with a full range of legitimate health needs.

By the Renaissance, most anatomy textbooks and medical illustrations still relied on male cadavers, which meant that the standard model for medical education was men studying other men. As medical schools became all the rage in the nineteenth century, women were barred from enrolling, ensuring that only men could study and practice medicine. Without women’s representation or input, female health concerns were neither prioritized nor even acknowledged in the growing field of medicine. Consequently, when women sought help from hospitals, their symptoms were often attributed to hysteria or “nervous disorders” and seen as an emotional response rather than a physiological one.

These oversights ensured that male physiology became the default template for everything from diagnosis and treatment to research and representation. Even as more women entered the field, such longstanding biases continued to fester. In the late 1950s and early 1960s, when the foundation for Second-wave Feminism was already in the works, women, especially those of “childbearing potential,” were treated as a liability to the research enterprise. Much of this was due to the thalidomide tragedy, when a drug prescribed for pregnancy-related nausea caused severe congenital disabilities. As a result, regulators and researchers reacted by excluding women from drug and treatment trials. 

Another unjust justification, pharmaceutical companies and academic labs claimed that menstrual cycles and fluctuating hormones would confound findings and that including women made studies more expensive and complicated to interpret. Much as they avoided conducting studies on female mice because of the greater costs of purchasing and housing both sexes, they decided to study men and assume the results would generalize. 

An aerial photo of the U.S. National Institutes of Health’s Mark O. Hatfield Clinical Research Center in Bethesda, Maryland.

It was not until 1993 that the U.S. National Institutes of Health required women to be included in federally funded clinical research and insisted that sex be considered as a biological variable in study design. Even then, follow-up audits in the 2000s found that although many trials had technically enrolled women, they did not recruit enough to draw meaningful conclusions, and many papers still failed to report results separately for male and female participants. In other words, women were present in the sample but still invisible in the data. This left women at higher risk for misdiagnosis, ineffective care, and harmful, often life-threatening side effects.

Take cardiovascular disease as an example. Even though it’s the leading cause of death for women globally, it was considered, for decades, a “man’s disease,” in part because early large-scale studies like the Framingham Heart Study were conducted in populations that skewed male. For instance, classic teaching about heart attacks emphasizes crushing chest pain radiating down the left arm. These are indeed common symptoms, but in many women, it presents differently. Women are more likely to experience shortness of breath, nausea, unusual fatigue, back or jaw pain, or a vague sense of “something is wrong” rather than the textbook dramatic chest clutch. When diagnostic algorithms, triage protocols, and physician training are built around male-pattern symptoms, women’s symptoms will almost always appear “atypical.” As a result, women with heart attack symptoms are more likely than men of the same age to be misdiagnosed or discharged from the emergency department without receiving the urgent treatment they need.

In neurodevelopmental conditions like attention deficit hyperactivity disorder (ADHD), the disparity is even more glaring. For much of the twentieth century, ADHD was defined around the behavior of hyperactive young boys. Early research cohorts were overwhelmingly male, partly because teachers referred boisterous boys for evaluation more often than quieter students. That influenced the dominant diagnostic narrative: ADHD was a problem of fidgeting, blurting, and bouncing off walls. Many girls and women with ADHD don’t fit that stereotype, struggling instead with inattention, internal restlessness, perfectionism, or difficulty starting and completing tasks. Because the original data set and diagnostic criteria emphasized external hyperactivity, clinicians have been more likely to overlook these presentations in girls, who are more often described as “spacey,” “disorganized,” or “emotional” instead of neurodivergent. As such, many women are diagnosed only in college or adulthood, after years of feeling like a failure rather than a person who an unjust system has ignored.

Importantly, the gender data gap is part of a broader “male as default” mindset in engineering. For decades, crash test dummies used in regulatory testing were modeled on the body of an average male: about 5 feet 9 inches tall and 170 pounds, with male patterns of muscle and fat distribution. When so-called female dummies were eventually added, they were often just scaled-down versions of the male model rather than anatomically accurate representations of female bodies. In addition, they were typically used in passenger seats rather than the driver’s seat. The design of seats, head restraints, and safety belts was optimized using male bodies, which puts anyone who deviates from that norm at risk. Research has shown that women are more likely than men to be injured or killed in comparable car crashes, even when accounting for factors like seatbelt use and collision severity. 

Similarly, for years, many drugs were approved based on studies in mostly male volunteers, under the assumption that a standard dose would be appropriate for all adults. In reality, women often differ in body fat percentage, enzyme activity, and hormone levels, all of which can affect how drugs are absorbed, distributed, and metabolized. It was only recently that it became clear that a drug dose tested in men will not necessarily be safe or effective for women.

Each of these discrepancies reveals an unsettling truth: women continue to receive inadequate care because the medical system is geared towards men in many cases. If any of this is to be changed, the solution needs to be as systemic as the problem itself. At the research level, that means journals and regulators must require sex-disaggregated data and reject studies that fail to recruit a sufficient number of women in clinical trials. 

Researchers should also pay attention to how race and other social realities intersect with gender discrimination. That means teaching heart attack presentations to women with the same level of detail as for men, including case studies featuring women of different ages and backgrounds in medical institutions. If researchers correct only for sex while ignoring other dimensions, they will fail to create a fairer system for all and once again perpetuate the same issues that were present in the first place. On the clinical side, medical education can be redesigned to foreground variability. 

The bottom line is this: When women are excluded from trials and misrepresented in safety tests, everyone pays a price. Children lose mothers, siblings lose sisters, communities lose leaders, and the health care system loses credibility. As Melissa Herbst-Kralovetz, Director of the Women’s Health Research Program, explains, “We know that if we increase the health of women, we are increasing the health of our communities because women give birth to all of humanity.” By designing research, standards, and technologies that take women’s bodies and experiences seriously, we can begin to level the playing field. The question is not whether we can afford to collect better data on women. The real question is how much longer we are willing to accept a status quo that is often male-centric.