Gender parity is a crucial goal in clinical medicine so that women have equal and representation. This has far-reaching effects, from clinical publications in high impact journals to invited speakerships at conferences. Randomized clinical trials (RCTs), are the highest level of scientific evidence. For this reason RCTS are highly respected, and have the potential to positively impact the careers of authors of these articles. This study evaluated the trends in distribution of authorship of RCTs by sex over the past 23 years amongst the highest impact urological literature.

We searched for RCTs published since 2002 in the top 10 urological journals, and top 5 general medical journals by impact factor. A commercially available, validated software (Genderize.io) was used to determine the sex of the senior, first and second authors. RCTs were categorised by subject matter according to European Association of Urology guidelines’ topics. Temporal trends in each authorship position were analysed using linear regression models overall as well as stratified by subject and journal.

3223 articles were included. Sex was able to be predicted for 89.8% of authors. There was a significant increase in the overall proportion of female senior authors (10% to 19%, β = 0.66, p < 0.001), first authors (5% to 33%, β = 0.83, p < 0.001) and second authors (10% to 41%, β = 0.77, p < 0.001) over the study period. Paediatric urology (26%) and sexual health (21%) were the subjects with the highest proportion of female first and senior authors, respectively. No individual journal had a significant increase or decrease in proportion of female authors in position across the study period. There was a significant association between female senior authorship and female first authorship (

There has been a trend towards increasing proportion of female senior, first and second authors of published urological RCTs in the past 23 years. Although reduced compared to 2002, there currently remains a gender disparity in the authorship of urological RCTs. The largest disparity exists in senior authorship positions.