Men undergo deep brain stimulation (DBS) surgery for Parkinson's disease at nearly three times the rate of women, even though recent studies show the disease affects men and women almost equally. Since the FDA approved DBS in the 1990s, men have consistently made up 70% or more of these procedures. Researchers at the University of Colorado are now uncovering why women are being left behind and what can be done about it .

Why Are Women Less Likely to Get Referred for Parkinson's Surgery?

The gap isn't because women don't need the surgery. Previous research suggested men were 1.5 to 2 times more likely to develop Parkinson's, but newer evidence shows the incidence is much more balanced, with men only 1.18 times more likely to be diagnosed. This means the 70% male dominance in DBS procedures doesn't match the actual disease distribution .

Dr. Michelle Fullard, an associate professor of neurology at the CU Anschutz School of Medicine, investigated this disparity and found a troubling pattern. "Women face more barriers at nearly every step, from diagnosis to referral to recovery at home," she explained. The barriers include physician bias, differences in how symptoms present in women, and social factors that influence decision-making .

One striking example comes from orthopedic surgery research. In a Canadian study using standardized patients, orthopedic surgeons were 22 times more likely to recommend surgery to a man than a woman, even when both presented with identical symptoms and imaging results. The men received conversations centered on shared decision-making with discussion of risks and benefits, while women were steered toward more conservative treatments .

How Do Parkinson's Symptoms Differ Between Men and Women?

Part of the diagnostic challenge stems from how Parkinson's presents differently in women. Many women see multiple doctors before getting a diagnosis, often being told their symptoms are anxiety or menopause instead. The disease affects dopamine production in the brain, which controls smooth, coordinated movement, but the initial warning signs can vary significantly by sex .

Women more commonly experience non-motor symptoms like depression, anxiety, gastrointestinal issues, and pain. Men, by contrast, tend to report disrupted sleep, cognitive impairment, and sexual dysfunction. Because these early symptoms in women are non-specific and overlap with other conditions, they're frequently dismissed or misattributed .

"We need to be careful not to dismiss women's experiences by just calling it anxiety or menopause. These certainly can cause a lot of symptoms, but they don't account for everything. We need to figure out what's going on so she can get to the right person to be evaluated," said Dr. Michelle Fullard.

Dr. Michelle Fullard, Associate Professor of Neurology at CU Anschutz School of Medicine

What Social and Family Factors Influence Women's Treatment Decisions?

Even when women are referred for DBS, they're less likely to choose it. Research shows this isn't simply a matter of preference. Women with Parkinson's are more likely to live alone and have less social support at home. When weighing the risks and benefits of surgery, women often consider not just their own health but the impact on their families and caregiving responsibilities .

In interviews, women described needing extensive coordination for post-surgery recovery. Almost all men said their wives would handle recovery logistics, but many women had to arrange for friends to stay with them or coordinate family members to fly in. This additional burden of planning can make surgery feel less feasible, even when it would significantly improve their symptoms .

• Social Support Gap: Women with Parkinson's are more likely to be divorced and have less family support available for appointments and post-surgery care compared to men.
• Caregiving Burden: Women tend to be primary caregivers in their families and may be reluctant to step away from that role during recovery, even temporarily.
• Decision-Making Focus: Women weigh surgical risks not just for themselves but for how the surgery might affect their ability to care for family members.

How Are Women Underrepresented in Parkinson's Research?

The problem extends beyond clinical practice into research itself. Since 2010, approximately 55% of Parkinson's-related clinical trials have enrolled mostly men, with men making up more than 60% of all participants overall. This means we know far less about how treatments work specifically in women .

One critical gap is understanding estrogen's role in Parkinson's. Some evidence suggests symptoms worsen during perimenopause and menopause due to drops in estrogen levels. Studies have also shown that women's Parkinson's medications become less effective when estrogen levels fluctuate during the menstrual cycle. Without adequate representation in research, it's harder to determine whether treatments are truly effective for women or to develop therapies tailored to their needs .

"We call women 'atypical' because they don't fit the male presentation. But that's because we're not studying women," said Dr. Fullard.

Dr. Michelle Fullard, Associate Professor of Neurology at CU Anschutz School of Medicine

How to Make Better Parkinson's Treatment Decisions

To address these gaps, Dr. Fullard developed an evidence-based decision-making tool that helps patients understand deep brain stimulation and feel confident about whether to pursue surgery. The tool is now freely available and is being shared through Parkinson's organizations .

• Clear Information: The tool guides patients through easy-to-follow information about the risks, benefits, and realistic expectations for DBS surgery.
• Personalized Symptom Reports: Patients receive a customized report showing how likely their specific symptoms are to improve with surgery, grounding decisions in realistic outcomes rather than general statistics.
• Improved Confidence: Early results show most patients using the tool reported improved understanding, reduced uncertainty, and better preparation for conversations with their doctors.
• Consistent Conversations: The tool supports more informed, standardized discussions between patients and providers, reducing the chance that bias influences recommendations.

The tool, available at DBSDecisionTool.com, was built using feedback from actual patients and tested in clinical settings. At the Neurosciences Center at UCHealth University of Colorado Hospital, 2025 data suggests an increase in the number of women undergoing DBS, indicating the tool may be helping close the gender gap .

Dr. Fullard is also implementing an ambassador program that connects women and men who have had DBS. Many women in her research expressed wanting to talk to another woman about the experience but couldn't find one. Simple guidance, such as preparing meals in advance or arranging for someone to stay for two days post-surgery, would have helped women coordinate support more effectively .

The broader message is clear: the future of Parkinson's care depends on recognizing and addressing gender differences in diagnosis, referral, research participation, and decision-making support. When women have equal access to information and support, they're more likely to choose treatments that can significantly improve their quality of life.