Gender-affirming psychiatry: a minority stress and phenomenological framework for child and adolescent mental health.

Over the past two decades, the gender composition of the medical workforce has undergone a substantial transformation. In Germany, women now represent a clear majority of medical students, accounting for approximately 60–65% of enrolments in human medicine - a proportion that has remained stable in recent years and mirrors trends observed across most high-income countries []. This sustained feminization of the medical pipeline ensures that the future physician workforce will, at the point of entry into professional training, be predominantly female. Despite this demographic shift, surgical specialties in Germany remain strongly male-dominated. Women continue to be underrepresented in surgical training programs and more markedly so at senior and leadership levels. Depending on the subspecialty, female surgeons account for only 15–25% of board-certified surgeons, with particularly low proportions in general surgery, visceral surgery, and orthopedic surgery []. This discrepancy illustrates a persistent ‘leaky pipeline,’ whereby women enter medical school in high numbers but are lost disproportionately along the pathway to surgical careers - a structural concern with direct implications for workforce sustainability in the German healthcare system.