———
I lost it the other day, which is unlike me. I am, by nature, a person who nods along and says “that’s frustrating” in a measured voice. Not this time.
I was telling a friend about a bone density scan I’d had, prompted by her own recent osteoporosis diagnosis. Unsurprising for a woman north of sixty, she said, and she was right: roughly half of women over fifty will break a bone because of it.1 A woman’s lifetime risk of a hip fracture is higher than her combined risk of breast, uterine and ovarian cancer2, which is the kind of fact that ought to be printed on a poster in every doctor’s waiting room but instead sits in obscure medical journals, waiting for someone’s furious friend to find it.
Casually, mid-conversation, she mentioned she’d decided not to pursue treatment.
I assumed I’d misheard. I probed. She didn’t like the idea of another pill, in case it upset her stomach. She was also busy with appointments for her father she was caring for, so felt like this was a problem for another day. I mentioned the infusion option, the one that trades a daily tablet for an appointment every so often. She didn’t budge. When I pushed, it came out: her doctor hadn’t really given her a plan. No comparison of options, no explanation of what happens to bone if osteoporosis goes untreated, nothing. Just a diagnosis, dropped on the table, and an expectation that she’d go home and work out the rest herself, ideally by enrolling in a part-time medical degree.
That was the moment I lost it. A woman is handed a diagnosis with lifelong consequences and sent off with nothing, and this barely registers as notable, because it happens constantly, to more or less everyone with a female body.
What happened next made me want to scream into a pillow. Her husband went with her to the next appointment, because a man standing next to her changed how she was treated. This is not a coincidence and it is not new. Women bring their husbands, their fathers, their adult sons, to medical appointments the way you’d bring a lawyer to a custody hearing, because a second, male voice in the room tends to get a plan produced where a woman on her own gets a shrug.
Add to that the jargon: doctors who explain a fracture risk score or a bone density result in language built for other doctors, then act mildly surprised when the patient nods without understanding a word of it. Osteoporosis isn't simple: there's a measurement scale, several treatment paths, each with its own trade-offs, and a pile of lifestyle advice on top. Women leave these appointments feeling stupid, which is an odd thing to feel after being the one who asked questions and tried to engage.
So women do the only thing left available to them, which is homework. They arrive at appointments with symptom diaries, printed articles, a rehearsed order of arguments and counter-arguments. Women know their bodies; what they don’t have is the authority to be believed about them without a folder of supporting evidence.
Modern medicine was substantially built, tested and calibrated on male bodies, and women were folded in afterwards on the assumption that the results would simply transfer over.
For decades after the thalidomide disaster, which caused birth defects in over 10,000 children across 46 countries, including thousands born in the UK, regulators across the US, Europe and Australia responded with the same instinct: keep women of childbearing age out of early drug trials altogether. Europe, working through its own post-thalidomide caution, ran clinical research that was overwhelmingly male until the 1990s. It took until 1993 for the US to reverse its policy in law, and Europe and Australia followed a similar trajectory rather than leading it. The exclusion aimed to protect. It also meant that, for the better part of two decades, whole regulatory systems agreed to test medicine on one body and publish the results as if they applied to both.
The gap didn’t fully close when the laws changed. A 2022 analysis of over 1,400 trials worldwide found women still made up barely 41% of participants on average. Australia is currently dealing with shortages of common pregnancy medications, because drugs proven safe for pregnant women are the ones least likely to have been tested on them in the first place, and therefore the least commercially attractive to keep making. There are women currently collecting their pension, in London, Sydney, Toronto and everywhere in between, who were born before their own medication was properly tested on anyone who looked like them.
It gets pettier than pharmaceuticals, too. Tampons and pads have been tested for absorbency using saline solution since the 1980s, not blood, because blood is expensive and mildly hazardous to handle and saline is neither of those things. Nobody thought to check whether saline actually behaves like blood until 2023, when a team of researchers finally ran the comparison and found that several products absorb meaningfully less than their packaging claims.3 An entire industry built around one specific, exclusively female bodily function had simply never been tested against the thing it claims to manage, for the better part of half a century.
Heart disease presents differently in women than the textbook description, which was written around men, so women having a heart attack are more likely to be sent home with a diagnosis of anxiety. Pain reported by women is consistently rated as less severe than the same pain reported by men, and more likely to be filed under stress or attributed to weight before anyone investigates further.
Formal menopause education – for a transition that will affect roughly half the population – is patchy at best: a 2021 UK review found only 59% of medical schools required any menopause teaching at all, and a separate study found more than half of medical textbooks worldwide don't mention menopause once.4
Dr Clara Moerman of the University of Amsterdam frames it plainly, as a question of justice: research that leaves women out simply fails to produce any knowledge about them, and any differences that surface once women are included should be treated as exactly the kind of thing researchers are supposed to be curious about, not an inconvenience. Protecting an unborn child is a legitimate goal, she points out, but not all women of childbearing age in a trial are planning to get pregnant, and researchers who are genuinely worried can simply ask participants to use contraception for the study’s duration – “a barrier which can usually be overcome,” as she puts it.5
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♡ Ta!
Add race, disability or class to gender and the gap widens considerably. Black women’s pain is documented, repeatedly, as being taken less seriously and treated less adequately than white women’s. The Pitt dramatised this with a storyline in which a Black woman having a sickle cell crisis arrives at the emergency room screaming in pain and is restrained and labelled drug-seeking by paramedics before a doctor recognises the condition. Studies on real sickle cell patients bear this out clearly: the disease disproportionately affects Black people. They wait significantly longer to be seen than patients with comparably painful conditions, despite presenting with higher pain scores and more urgent triage ratings.
Underneath all of this sits something we’re taught long before we ever see a doctor: that female pain is simply part of life – periods hurt, childbirth hurts more, menopause arrives with its own catalogue of issues. Somewhere in there, most women absorb the lesson that discomfort is the price we pay for having this particular body. By the time an actual medical problem shows up, many women have had decades of practice minimising exactly the kind of symptom they now need to describe clearly and insistently to someone who is inclined not to listen anyway.
I’m lucky: my own doctor is thorough, explains things without making me feel small for asking, and treats a question as a question rather than a challenge to her authority. I’ve had more patience and empathy from her in fifteen-minute appointments than I’ve had from people who are supposed to know me well, which says something about how low the bar has been set that competent, ordinary kindness from a doctor feels remarkable enough to mention in an article.
But I’m not going to close this by telling you to advocate harder, print out more research, or ask for a second opinion, because that puts the solution back on women. Women with endometriosis for example already wait years for a diagnosis despite doing everything right: tracking symptoms, requesting scans, laying the case out before doctors who dismiss it anyway. More research and more assertiveness will not fix a system that inherently doesn’t believe women. Policy makers need to write the enhancement of gender equality in clinical research into law. Medical school needs to include gender differences in their curriculum.
My friend still hasn’t booked the infusion. I’ve sent her the studies. But sending her the studies is exactly the workaround I’m annoyed about being necessary in the first place.
If you’ve hit a wall like this with a doctor, or found a way through one, I’d like to hear about it.
Sources
5 https://cordis.europa.eu/article/id/27270-exclusion-from-clinical-trials-harming-womens-health
More reading:
The good girl problem
·
Jun 20
——— There is a version of girlhood that has been the default for a very long time and it will feel very familiar: quiet, accommodating, likeable. Hair tidy, make-up subtle, voice soft, low-maintenance. The good girl doesn’t take up too much space, doesn’t want too much, doesn’t say too much. Don’t make a fuss.
She bought the house. He ran the other way.
·
May 22
——— A woman goes on a first date. It goes well – the kind of well where you’re already doing the arithmetic of a second one. At some point she mentions she’s buying a house.
The Equitable Home
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