Denmark’s two-decade medication map shows the famous female-male drug gap is collapsing

For as long as prescription statistics have existed, one finding has repeated itself with almost boring regularity: women take more medications than men. A new nationwide analysis of Danish pharmacy records, spanning 2005, 2015 and 2025, now shows that this famous gap is not merely shrinking but actively reshaping itself across the human lifespan. Drawing on complete dispensing records for the entire adult population, which grew from 4,210,832 individuals in 2005 to 4,878,879 in 2025, the study reveals a two-decade transformation in who takes what, when, and how much. Women still use more medications overall, but their share of the national drug volume has fallen from 60 percent in 2005 to 52 percent in 2025. More strikingly, after midlife the pattern reverses entirely, with men becoming the heaviest consumers of prescription drugs, driven by an avalanche of cardiovascular medications that begins earlier and runs more intensely in males than in females.

The study, a repeated cross-sectional analysis built on the Danish National Prescription Registry, captured every prescription redeemed at outpatient pharmacies across three full calendar years. Medications were classified with the Anatomical Therapeutic Chemical system, and consumption volumes were quantified in Defined Daily Doses, a standardized metric that allows drug classes as different as antidepressants and statins to be counted on a common scale. Because the registry is retrospectively updated to apply the most current ATC codes throughout its entire data history, the researchers could compare 2005 and 2025 using a single, consistent classification, ensuring that apparent shifts in prescribing reflect real changes in practice rather than bookkeeping artifacts. Age-adjusted female-to-male rate ratios were estimated with Poisson regression using restricted cubic splines to model the non-linear relationship between age and drug use, and a formal likelihood ratio test confirmed that age acts as a powerful effect modifier of the association between sex and medication consumption.

The raw numbers tell the headline story. In 2025, total Danish medication consumption reached 3,818 million Defined Daily Doses, equivalent to 7.8 million DDDs per 10,000 inhabitants. Women accounted for 52 percent of that volume, at 8.0 million DDDs per 10,000 females, while men accounted for 48 percent, at 7.7 million DDDs per 10,000 males. Two decades earlier the split had been 60 percent female and 40 percent male, and in 2015 it stood at 55 and 45 percent. Consumption rose in every age group and both sexes between 2005 and 2025, but the female excess, once a near-universal constant, has steadily eroded. The authors attribute part of this convergence to demographic change itself: Danish men have experienced particularly marked gains in survival, so a growing proportion now live long enough to enter the age bands where medication use climbs steeply.

The life-course picture is where the data turns genuinely surprising. Among adults aged 18 to 40, women’s consumption follows a plateau of roughly 300 DDDs per woman per year, while young men start from rates more than twice as low and rise more linearly. Excluding hormonal contraceptives partially erases this difference, although young women’s use remains double that of young men. Then, from roughly ages 40 to 45, the gap narrows as use climbs in both sexes. Between ages 50 and 55, men’s drug use surpasses women’s, and it stays higher for the remainder of life. The female-to-male rate ratio is highest in early adulthood, declines progressively, reverses around ages 60 to 75, and approaches unity again in the oldest groups. The sharp post-55 rise in both sexes is largely attributable to cardiovascular medications, with the male peak arriving earlier and more intensely, while sex hormone use shows the opposite dynamic, female-dominated early and male-dominated late.

Class-by-class analysis of the 14 major ATC categories shows women redeeming prescriptions at higher rates nearly everywhere. The Nervous System class was the heaviest in 2025, redeemed by 45 percent of women and 33 percent of men, followed by the Cardiovascular System at 35 versus 34 percent and systemic anti-infectives at 30 versus 20 percent. The most pronounced female predominance appeared in Systemic Hormonal Preparations, with an age-adjusted rate ratio of 2.18, and in Genito-Urinary System and Sex Hormones at 2.13. Among the 30 most prescribed pharmacological groups, thyroid preparations topped the female skew at 4.41, followed by drugs affecting bone structure and mineralization at 4.35, antidepressants at 1.68, systemic antihistamines at 1.56, hypnotics and sedatives at 1.49, and analgesics at 1.36. Men, by contrast, dominated benign prostatic hyperplasia treatments at 0.01, urologicals at 0.16, antithrombotic agents at 0.64, insulins at 0.67, ACE inhibitors at 0.69, and angiotensin II receptor blocker combinations at 0.74, with Blood and Blood Forming Organs the only major class where men redeemed more prescriptions overall.

Several findings upend long-standing assumptions. Within the diuretic class, the sexes diverge sharply: thiazide diuretics are redeemed preferentially by women at 1.19, while high-ceiling diuretics skew male at 0.92, a subclass split the authors describe as an original observation for nationwide sex-difference research. Non-insulin glucose-lowering drugs, historically redeemed roughly 25 percent more often by men, reached near-parity by 2025 at 1.08, slightly favoring women. A post-hoc analysis explains why: use of GLP-1 receptor agonists and the class containing tirzepatide was twice as high among women, even though obesity prevalence is comparable across sexes, while the remaining antidiabetic classes retained a predominantly male pattern. ADHD medications, absent from the most-redeemed lists in 2005 and 2015, emerged as a new entry in 2025 and were redeemed more often by women at 1.25, consistent with the documented surge in ADHD diagnosis and treatment initiation among females in Denmark and beyond. Anti-infective prescriptions, meanwhile, declined steadily in both sexes, from 27 to 20 percent among men and 40 to 30 percent among women.

Polypharmacy, defined as five or more distinct medication classes per year, follows its own age-specific choreography. Among 18-to-24-year-olds, only 27 percent of women redeemed no prescription at all in 2025, compared with 58 percent of men, and 9.8 percent of young women met the polypharmacy threshold versus 2.5 percent of young men. At ages 45 to 49, the rates stood at 22 percent for women and 14 percent for men. But after age 65 the gap collapses: at ages 70 to 74, 75 to 79, and 80 to 84, polypharmacy prevalence was virtually identical, at 54 versus 52, 61 versus 60, and 67 versus 67 percent. Beyond 84, the gap reopens in women’s favor, at 73 versus 70 percent for ages 85 to 90 and 75 versus 71 beyond 90, a late-life re-widening the authors partly attribute to differential survival, since very old men represent a select, healthier subgroup. Sensitivity analyses excluding hormonal contraceptives and systemic antibiotics attenuated the young-adult gap but left the overall architecture intact.

Interpreting these shifts requires care, and the authors are explicit that the study is descriptive, not causal. Differential medication use does not automatically signal inequity, since disease prevalence and age of onset vary by sex, and the registry contains no diagnostic information to separate justified treatment differences from genuine over- or under-treatment. Still, the data raise pointed questions. The thiazide skew toward women persists despite their greater risk of hyponatraemia in older age, and no clinical guideline recommends preferential diuretic choice by sex; the authors suggest it may partly reflect women seeking treatment earlier, at an uncomplicated hypertension stage where thiazides remain first-line, while men more often present with established cardiovascular comorbidities that prompt other agents. Yet sex differences in antihypertensive prescribing persist even after comorbidity adjustment, hinting that pharmacokinetic, pharmacodynamic, and gender-related factors all contribute. The convergence in metabolic therapy may likewise blend improved diabetes detection with stronger gendered societal pressure around obesity experienced by women.

The study has clear boundaries: it counts dispensed prescriptions rather than actual adherence, excludes over-the-counter sales and hospital-administered drugs, covers adults only, and derives from a single tax-funded healthcare system with universal coverage, so the Danish patterns may not generalize to settings with different financing or prescribing cultures. Its clinical implications nonetheless land with force. Because medication burden evolves differently across the lifespan in women and men, the authors argue that prescribing, deprescribing, and pharmacovigilance strategies should explicitly integrate both sex and age, particularly at transition points such as midlife. The convergence in polypharmacy at ages 70 to 84, a parity that did not exist in 2005 or 2015 when the female excess widened relentlessly with age, suggests that hyper-polypharmacy dynamics are themselves changing. Continued population-level surveillance, the authors conclude, is essential to understand how shifting disease epidemiology, evolving clinical guidelines, and changing social norms interact to keep rewriting the pharmacological map of the sexes, one redeemed prescription at a time.

Subject of Research: Health

Article Title: Sex- and age-specific trends in prescription medication use, 2005–2025: a nationwide repeated cross-sectional study

Article References: Roland, N., Ernst, M. T., Linde, J. J., Rasmussen, L., & Pottegård, A. (2027). Sex- and age-specific trends in prescription medication use, 2005–2025: a nationwide repeated cross-sectional study. The Lancet Regional Health – Europe, 72, Article 101909. https://doi.org/10.1016/j.lanepe.2026.101909

Image Credits: AI Generated

DOI: 10.1016/j.lanepe.2026.101909

Keywords: Sex-, age-specific, trends, prescription, medication, nationwide, repeated, cross-sectional, scientific research