Introduction: The need for sex- and gender-responsive anxiety care
Anxiety disorders are the most common class of mental health conditions in Australia, affecting roughly 17% of people annually. This article examines how sex (biological factors) and gender (sociocultural influences) shape both the risk and the management of anxiety disorders, and it outlines future pathways for research, education, policy, and practice within the Australian landscape. While treatments like cognitive behavioural therapy (CBT) and first-line pharmacotherapies remain central, their effectiveness and accessibility are influenced by sex and gender in ways that are only beginning to be systematically addressed.
Prevalence, risk factors and the role of hormones
Data indicate that anxiety disorders are more prevalent among Australian women (lifetime prevalence around 34%) than men (about 23%). This disparity is underscored by the higher burden of anxiety among gender minorities and those experiencing stigma, trauma, and social disadvantage. Hormonal factors play a crucial role in the trajectory of anxiety for many women: puberty, the menstrual cycle, pregnancy, the postnatal period, and perimenopause each bring hormonal fluctuations that can alter threat processing, worry, and fear regulation. Neurobiological mediators such as oestradiol, progesterone, serotonin and GABA systems help explain why some women experience symptom spikes in particular life stages. Understanding these biological pathways is essential for tailoring interventions across the lifespan.
But biology does not act alone. Gendered experiences—care responsibilities, economic inequities, discrimination, and violence—also shape anxiety risk. The COVID-19 pandemic, for instance, magnified anxiety in women due to increased caregiving duties and social stressors. Importantly, stigma can obscure anxiety in men, who may present with different symptom profiles such as externalising behaviours, leading to underdiagnosis if current criteria and practice do not account for gendered expressions of distress.
Sex- and gender-informed care: current gaps
Despite clear evidence of sex and gender influences on anxiety, clinical practice guidelines in Australia remain largely sex- and gender-neutral. Pregnant, perinatal, and menopausal populations receive limited explicit guidance on symptom presentation, treatment modification, or how hormonal status may interact with medication or exposure-based therapies. Moreover, trans and gender-diverse people may face unique risk factors and care needs that are not adequately reflected in guidelines or education. A broader lack of sex- and gender-literacy in medical and psychology training compounds these gaps, leaving clinicians underprepared to address differential risks, trajectories, and treatment responses.
Mechanisms shaping treatment response: CBT, pharmacotherapy and beyond
CBT remains the first-line psychological treatment, targeting avoidance and maladaptive threat appraisals. However, sex- and gender-specific considerations—such as hormonal cycles, perinatal changes, and menopause—may influence symptom patterns and response to exposure-based techniques. In pharmacotherapy, selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are standard, yet hormonal status and contraceptive use can modulate both efficacy and tolerability. Emerging evidence suggests that hormonal contraception may interact with exposure therapy and medication effects, highlighting the need for routine assessment of hormonal factors in treatment planning.
Policy and education: building a sex- and gender-responsive system
Australia has begun to address these gaps through policy statements encouraging researchers to consider sex, gender, variations of sex characteristics, and sexual orientation across the research pipeline. A unified national approach could require systematic reporting of sex- and gender-disaggregated data in trials, guidelines that explicitly discuss perinatal and menopausal anxiety, and education reforms that embed sex- and gender literacy into medical and mental health training. Strengthening guideline development to appraise sex- and gender-specific evidence, and updating accreditation standards to require sex- and gender-responsive competencies, would translate research insights into everyday clinical practice.
Pathways for the future: research, practice and system change
Future research should prioritise: (1) disaggregated analyses by sex and gender in CBT and pharmacotherapy trials; (2) longitudinal studies tracking hormonal influences across puberty, pregnancy, and menopause; (3) investigations into the effects of hormonal contraception on anxiety trajectories and treatment response; and (4) inclusive research that includes transgender, gender-diverse, and intersex populations. In practice, clinicians should: routinely assess hormonal status when evaluating anxiety symptoms; consider life-stage–specific risk factors; and personalise treatment plans accordingly. Policy should support sexual and gender-inclusive curricula, guideline updates, and adequate funding for women’s health initiatives that intersect with mental health. The overarching aim is to deliver personalised health care that acknowledges the diverse ways sex and gender shape anxiety disorders in all Australians.
Conclusion: toward truly personalised care for anxiety
Integrating sex and gender considerations into the management of anxiety disorders requires policy, training, and clinical practice changes at multiple levels. By embracing a sex- and gender-responsive approach, Australia can reduce burden, improve outcomes, and ensure that prevention and treatment reflect the realities of all people’s lives. This shift aligns with international commitments and positions Australia at the forefront of personalised, equitable mental health care.
