Men choose brain surgery more than women to treat their symptoms of Parkinson’s disease. Since deep brain stimulation (DBS) was approved by the Food and Drug Administration in the 1990s, men have consistently accounted for 70% or more DBS procedures.
Previous evidence suggested that men were 1-1/2 to two times more likely to get Parkinson’s. But recent studies show a more even split, with only a 1.18 times higher incidence of Parkinson’s in men.
If Parkinson’s rates are nearly equal, why don’t more women choose DBS?
Key points:
Men account for about 70% of deep brain stimulation (DBS) surgeries, despite similar Parkinson’s rates between sexes.
Women are less likely to be referred for DBS, potentially due to physician bias.
Women are underrepresented in clinical trials, limiting understanding of treatment effects.
A new decision-making tool improved patient understanding, confidence and satisfaction with treatment decisions.
Michelle Fullard, MD, MSCE, associate professor of neurology at the CU Anschutz School of Medicine, wanted to know why. What she found was not a single explanation, but a pattern: Women face more barriers at nearly every step, from diagnosis to referral to recovery at home – and they continue to be underrepresented in Parkinson’s studies.
Fullard has taken her research a step further by developing a tool to support shared decision making. The free online tool helps ensure Parkinson’s patients receive clear, consistent information about their care options, including DBS.
Parkinson’s disease is a progressive brain disorder caused by the loss of dopamine-producing neurons deep in the brain. It affects movement, mood and thinking, with common symptoms including tremor, slowness and stiffness. While there is no cure, treatments such as DBS can help manage symptoms.
“We used to think of Parkinson’s as a disease mainly affecting older white men,” said, explaining that it’s one reason a woman’s journey to a diagnosis isn’t easy. Many women see multiple doctors and are told their symptoms are due to anxiety or menopause. Parkinson’s nonmotor symptoms in women can present as depression, anxiety, gastrointestinal issues and pain – different from men’s symptoms of disrupted sleep, cognitive impairment and sexual dysfunction.
“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,” Fullard said.
Deep brain stimulation (DBS) is a surgical treatment for Parkinson’s disease that works like a pacemaker for the brain. It involves implanting electrodes deep in the brain that deliver electrical pulses from a battery-powered device placed near the collarbone. These pulses help disrupt harmful signals caused by damaged neurons, improving symptoms such as tremor, slow movement and rigidity. While DBS does not cure Parkinson’s, it can significantly improve quality of life.
Women are referred to movement disorder specialists less often, Fullard said, acknowledging that it’s unknown if this is based on patient preference or if it’s due to physician bias.
Considering literature from orthopedic surgery, recommendations for surgery can be biased. Fullard cites a study in Canada that used standardized patients to receive diagnostic workups. One man and one woman saw the same providers, giving them the exact same scripted story and X-rays.
The orthopedic surgeons in the study were 22 times more likely to recommend surgery to the man, Fullard said. Women received recommendations for more conservative therapies, while conversations with men centered around shared decision making, outlining the risks and benefits of surgery.
“We all have bias,” said Fullard. “So I think this definitely plays a role.”
Fullard explained that women with Parkinson’s disease are more likely to live alone and have less support in their home. When it comes to decision making, the women she interviewed weighed the risk and benefits of surgery not just for themselves, but for their families as well.
“Women tend to be caregivers in our society and may be less able to step away from that role. Or they may be worried about what the surgical risk could do to that role,” she said.
“When women have a chronic illness, they’re more likely to be divorced and have less social support, so they don’t have someone to come to their appointments or help them after surgery.”
“The future of Parkinson’s care depends on us being able to consider gender differences and rethink how we design trials and research studies to make sure that women can participate.” – Michelle Fullard, MD
Women remain underrepresented in Parkinson’s research.
“We call women ‘atypical’ because they don’t fit the male presentation. But that’s because we’re not studying women.”
Since 2010, about 55% of Parkinson’s-related clinical trials have enrolled mostly men, with men making up more than 60% of participants overall.
For example, not enough research has been done on estrogen’s impact on Parkinson’s, Fullard said. Some evidence shows that Parkinson’s symptoms get worse in perimenopause and menopause due to dips in estrogen. Studies also have shown that when women with Parkinson’s are still menstruating, their medications aren’t as effective when estrogen wanes during the menstrual cycle.
“Without adequate representation in research, it is harder to determine the effectiveness of treatments in women.”
Fullard developed an evidence-based decision tool to help people with Parkinson’s better understand deep brain stimulation and feel more confident weighing whether to pursue the surgery. The tool guides patients through clear, easy-to-follow information about risks, benefits and expectations, and includes a personalized symptom report that shows how likely their specific symptoms are to improve, which helps ground decisions in realistic outcomes.
Built using patient feedback and tested in clinical settings, the tool is now freely available at DBSDecisionTool.com and is being shared through Parkinson’s organizations. Early results show strong uptake and satisfaction, with most patients saying it improved their understanding, reduced uncertainty and helped them feel more prepared to make a decision, while also supporting more consistent, informed conversations between patients and providers.
At the Neurosciences Center at UCHealth University of Colorado Hospital, 2025 data suggests an increase in the number of women undergoing DBS, Fullard said.
“It was so interesting. Almost all of the men said, ‘No – my wife does that.’ But many of the women described needing to do much more coordination, asking friends to stay or having family fly in.” – Michelle Fullard, MD
After listening to DBS experiences during patient interviews, Fullard began working to implement an ambassador program that connects women and men who have had DBS.
“We heard from so many women that they wanted to talk to another woman and hear about their experience, but they couldn’t find them,” Fullard said.
One woman in her study shared how talking to another woman would have helped her.
Simple guidance, such as preparing a week’s worth of meals in advance or arranging for someone to stay with her for two days post-surgery, would have helped her coordinate support with friends, she said. But she didn’t know what to expect or what she would need, highlighting how clearer information could reduce barriers to care.
During the study, Fullard asked both men and women if they were concerned about the support they would need around the time of surgery.
“It was so interesting. Almost all of the men said, ‘No – my wife does that.’ But many of the women described needing to do much more coordination, asking friends to stay or having family fly in.”
Having a better understanding of the barriers women face is a first step toward increasing the number of women who choose DBS to manage their symptoms. The decision-making tool can help facilitate informed conversations. Yet Fullard’s biggest hope remains that more women get involved in Parkinson’s research.
“We're not going to know how therapies work or what the trajectory looks like in women if we don't get women involved,” she said, adding that what she’s learned about women and DBS needs to inform how to get more women involved in research.
“The future of Parkinson’s care depends on us being able to consider gender differences and rethink how we design trials and research studies to make sure that women can participate,” she said.