Somewhere between the school office and the GP’s waiting room, you learned what “anxious” means when a professional says it. It means they have stopped looking. Your daughter was “just anxious” for two years before anyone said the word autistic. Now it is your turn: your chest pain, your exhaustion, your bleeding, your pain that will not shift, and a doctor who reaches for the same word and the same leaflet. If that is familiar, a new review of the medical literature says it is not in your head. It is in the data.
What the review found
Researchers at the University of St Andrews School of Medicine went looking for studies that compared how men and women with the same clinical condition were actually treated. They screened 1,112 records and ended up with 41 studies, published between 2018 and 2023, that made a direct comparison.
The finding is blunt. Of the 38 retrospective case series, 33 reported a significant difference in treatment between the sexes, and the direction was almost always the same: women with similar clinical characteristics were less likely than men to be offered invasive or intensive treatment (surgery, stents, transplant referral, deep brain stimulation) and, when they were managed with medication instead, were more likely to be given a weaker version of it. The pattern held across cardiology, neurology, surgery, transplant medicine, emergency care and beyond.
The authors are careful people. They say the review cannot prove that every difference is unfair, because some may reflect legitimate clinical judgement. But they also found that almost none of the studies pointed to any guideline that recommends treating men and women differently. Co-author Dr Andrew O’Malley put it plainly: doctors more often attribute women’s symptoms to anxiety and make more diagnostic errors, and much of the evidence base rests on data from men. His colleague Dr Miriam Veenhuizen said that the direction of the findings was not a surprise, but the consistency was.
Consistency is the word to hold on to. One study showing that women get less is an anomaly. Thirty-three of thirty-eight is a system.
The word they reach for
Every mother in our community knows the anxiety script, because she has heard it about her daughter. She seems fine at school. Have you tried a reward chart. It is probably anxiety. The word does a very specific job: it moves the problem out of the environment and into the child, and it closes the file.
This review shows the same word doing the same job in adult medicine. A woman describes a symptom, the clinician hears anxiety, and the active treatment that a man with the same results would be offered is not offered. Nobody has to be a villain for this to happen. It only takes a guideline written from male data, a busy clinic, and a lifetime of being told that women are the emotional ones. The system does not need to be cruel to fail you. It only needs to be built for someone else.
Autistic women get it twice
If being a woman makes a clinician less likely to look, being an autistic woman makes it less likely still, and most of our community are both.
We have written before about what autistic adults told University of Exeter researchers about breast cancer care: the minimising language, the rotating strangers, the appointments survived by complying, masking and falling apart in the car park afterwards. That study named a triple empathy problem in healthcare, where the ordinary mismatch between autistic and non-autistic communication is made worse by the power gap between patient and doctor. [Shaw et al., 2024, as cited in Goodwin et al., 2026.] Put the two pieces of research side by side and the picture is uncomfortable. A woman is already less likely to be offered active treatment. An autistic woman is also less likely to be believed when she describes her pain, more likely to under-report it because she has learned to be the easy patient, and more likely to be read as “anxious” because a flat voice, no eye contact and a written list of symptoms look, to an untrained eye, exactly like anxiety.
Add the fact that autistic adults already delay seeking help, even for symptoms that might be life-threatening [Doherty et al., 2022, BMJ Open], and that so many of the women in our community were only identified as autistic in their forties or later, after years of being treated for the wrong thing, and you begin to see why “women’s health” and “autistic women’s health” are not the same conversation. One is about being under-treated. The other is about being under-treated, disbelieved and misread, all at once, and paying for every appointment in energy you do not have.
Our earlier piece on hormones, autism and ADHD made the same argument from the other end: menstruation, PMDD, pregnancy and menopause all land harder on neurodivergent women, and the research on them barely existed until recently. This review explains part of why. If women are missing from the trials, and autistic women are missing from the women, then the guidelines were never written with us in mind.
A two-thousand-year-old story
None of this is new, which is the most infuriating thing about it. Elinor Cleghorn’s Unwell Women: Misdiagnosis and Myth in a Man-Made World traces the same pattern from the ancient idea of the wandering womb through the invention of hysteria to the modern misdiagnosis of endometriosis and autoimmune disease. The label changes. Hysterical, nervous, hormonal, anxious. The function does not. It is a way of not investigating.
What you can do with this
If you are the patient: take the review into the room with you, literally if you like. The question it gives you is simple and hard to dodge. “Would you offer this treatment to a man with my results?” Put your reasonable adjustments in writing before the first appointment using our free Healthcare Passport: ask for written information, a named clinician, a longer slot, permission to bring your symptom list and read from it. Being a prepared, list-reading, flat-voiced patient is not anxiety. It is how you communicate, and it is a reasonable adjustment, not a red flag.
If you are the mother: you already know how to do this. You did it with the school. The same instinct that told you “just anxious” was not an answer for your daughter applies to your own body, and you are allowed to use it.
If you work in health: the authors ask clinicians to check that treatment is being offered on clinical grounds rather than assumption. That is a fair ask and it is not a big one. Our training for health and social care professionals covers masking, communication and why autistic women so often go unrecognised until crisis, and it will make that check easier to do.
And if you want to talk it through with people who will get it on the first sentence, our Facebook community of 36,000 is full of women who have been “just anxious” in a lot of waiting rooms, and who are done with it.
Source
Veenhuizen, M. and O’Malley, A. (2026). Measured treatment differences between sexes and genders: a scoping review. PLOS One. https://doi.org/10.1371/journal.pone.0356176 (open access).
A note on language: the studies in the review compared patients by the sex recorded in their medical records, which the authors acknowledge does not capture gender identity. We have used “women” throughout because that is what the data measured; our community includes gender-diverse people, and the point stands for anyone a clinician reads as female.
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