Does Alcohol Affect Men and Women Differently?

Recent reports show a narrowing gender gap between male and female alcohol consumption. While closing a gender gap is typically a cause for celebration, catching up in alcohol consumption is not a race women are necessarily looking to win. 

With a rise in female drinking trends and alcohol-related harms, we’re urged to take a closer look at how alcohol affects men and women differently. While many individual differences can influence the way alcohol affects us, gender is a significant factor that we’ll want to take note of. Let’s pop open the cork and pore over the gender disparities of alcohol and why it’s important. 

Why Does Alcohol Affect Men and Women Differently?

While we may be aware of the biological differences between men and women, it’s the subtle impacts of these differences that create a notable disparity in how alcohol affects men and women differently.

Several reasons that alcohol can affect men and women differently include the following:

• Metabolization. Alcohol metabolization refers to the process in which our body breaks down alcohol with help from the enzymes alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH). Research shows that women do not process alcohol as well as men because of decreased activity of gastric ADH — a major component of first-pass metabolism. First-pass metabolism of alcohol refers to the initial breakdown of alcohol in the stomach before it reaches our liver, which is tasked with a majority of alcohol metabolism. 
• Body size and composition. Generally speaking, men tend to have a larger body size and weight than women. Men also tend to have a greater ratio of muscle to fat than women. Since fat contains less blood than muscle, alcohol may be more diluted in a man’s body due to the higher volume of blood. If a man and a woman were to drink the same amount of alcohol, differences in their body size and composition would cause a higher blood alcohol concentration (BAC) in the woman than the man.
• Fluid volume. Due to differences in body size, men typically have a greater water volume than women. This means that if a man and a woman drink the same amount of alcohol, it may be more diluted in the man’s body due to having a higher fluid volume.
• Hormones. While alcohol disrupts hormones in males and females, differing hormones between the two sexes can impact the way alcohol interacts with our body. A study on the female menstrual cycle found that alcohol-induced disinhibition was almost doubled during the late follicular/luteal phase (or around ovulation). This means that women may be more sensitive to the effects of alcohol during this period. While this phase typically only lasts about a week, oral contraceptives mimic the luteal phase for 3 out of 4 weeks — elongating the period that women are subjected to increased effects from alcohol. Since males don’t follow the same hormonal cycle, they don’t experience these added sensitivities to alcohol. 

Now that we fully understand why alcohol can affect men and women differently, let’s closely examine what the consumption differences look like between men and women.

Male vs. Female Alcohol Consumption

According to the Centers for Disease Control and Prevention (CDC), 58% of adult men reported drinking within the past month and 49% of adult women reported drinking within the past month. Similarly, a higher percentage of men report binge drinking at 21% compared to 13% of women. 

The data shows that female consumption is lower, but a recent CDC analysis reported that while alcohol-related mortalities increased for both males and females, it increased disproportionately in females with a difference of 7.9%. While this may be attributed to a number of different factors, it urges us to take a closer look at how alcohol can affect men and women differently and why it may be important. 

How Does Alcohol Affect Men and Women Differently?

Alcohol affects men and women differently in various facets. Let’s further explore what these may be.

Acute Impacts

Our level of intoxication (or how drunk we feel) is based on our BAC. Since the same level of alcohol may raise a woman’s BAC more than a man’s, a woman may get intoxicated more quickly and more severely. 

Alcohol intoxication involves cognitive, behavioral, and physical effects which may vary depending on the level of intoxication. Some common symptoms of mild alcohol intoxication include the following:

• Slurred speech 
• Loss of coordination
• Blurry vision
• Increased heart rate 
• Lowered inhibitions 
• Nausea 

More severe alcohol intoxication includes the following symptoms:

• Confusion
• Lack of motor control
• Vomiting
• Mood variability 
• Hypothermia 
• Loss of consciousness 
• Risk of coma or death 

Level of intoxication can vary on a number of individual factors and can be extremely dangerous for men and women alike. However, since women may become intoxicated more quickly and more severely, women are at greater risk of these adverse effects.

Long-Term Effects

Along with immediate effects, prolonged or excessive alcohol use also causes long-term impacts. Health conditions from long-term alcohol use are actually the leading cause of alcohol-related mortalities — underlining the potentially fatal effects of regular drinking for men and women. 

Despite alcohol’s potential to cause detrimental long-term harm to anyone, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports that women may be at greater risk. More specifically, women are at greater risk of developing cardiovascular disease, liver inflammation, certain cancers, and alcohol dependence. Women are also found to have a faster progression of alcoholic liver disease and alcohol use disorder. 

Gender-specific diseases also have a disproportionate effect on women. The main male-specific condition that may be affected by alcohol is prostate cancer, whereas female-specific conditions include breast cancer and all conditions falling under fetal alcohol spectrum disorders (which can harm the pregnant woman as well). While women may be at higher risk of alcohol-related long-term conditions, other factors can also have significant influences — suggesting that anyone could benefit from quitting or cutting back on alcohol.  

Mental Health 

Alcohol is associated with poor mental health due to its impacts on areas of our brain that control our mood and stress. The NIAAA reports that the prevalence of anxiety, depression, and other psychiatric conditions is much higher in those of us with alcohol use disorder. 

While alcohol increases the risk of developing mental health conditions for men and women, the National Institute of Mental Health (NIMH) notes that women are more susceptible to mental health conditions such as anxiety and depression, due to both biological and psychosocial factors. A study on stress-related alcohol use also found that women are more likely to drink in times of stress than men. With these factors added up, alcohol can cause greater mental health impacts in women vs men. 

Other Impacts

Disparities exist between alcohol’s effects on men and women in other areas. These areas include the following:

• Safety. Alcohol is the leading substance involved in date rape or sexual assault. Since alcohol impairs our judgment, it can increase our risk of harm. And since domestic violence and sexual assault affect women at higher rates, alcohol consumption also disproportionately affects women’s safety. 
• Likelihood of accessing treatment. Research shows that women are less likely to access treatment for alcohol misuse than men due to many reasons. Some of them include stigma, logistical barriers, and lack of female-only treatment.
• Hormone replacement therapy (HRT). HRT is used for various reasons with the most common being to treat menopause symptoms and for gender-affirming therapy. According to the National Cancer Institute, menopausal hormone therapy is associated with an increased risk of cancer and is not recommended for women with endometrial cancer, ovarian cancer, uterine sarcoma, or a history of breast cancer. Alcohol, which is also linked with an increased risk of developing cancer, may further heighten risks for women or transgender women taking HRT.
• Social perception. In an experiment conducted by the Worcester Polytechnic Institute, participants were asked to look at images of men and women who were either holding a bottle of water or a bottle of beer. The study found that images of women holding beer were associated with negative descriptions in comparison to those who were holding a bottle of water. However, there were no such discrepancies in the images with men holding beer or water. Researchers concluded that women who drink are judged more harshly than men who drink. This negative social bias can impact women socially and may discourage women to seek treatment.

Through many different effects of alcohol, we can see the differences in the way it affects men and women. Acknowledging and understanding the unique risks that women and men face when drinking helps us better prevent alcohol-related harm. 

Comparison in Alcohol-Related Harm

The CDC’s Alcohol-Related Disease Impact (ARDI) tool provides a breakdown of alcohol-related deaths using averages from 2020-2021. Through this report, we can see the differences in alcohol-related harms between males and females. 

Through the data, we can see that alcohol-related mortalities are generally higher in males. However, this can be attributed to a number of factors including the following:

• Alcohol consumption. Since alcohol consumption is higher in males, the number of alcohol-related mortalities is more likely to be higher for males than females. However, for some causes female mortality rates don’t trail far behind, and some such as hypertension even exceed the number recorded for males. 
• Long-term health effects. Long-term health conditions are the leading contributor to alcohol-related mortalities. Since alcohol consumption has been more common for males throughout history, long-term health conditions are likely to be more common in males. However, as female consumption continues to rise, the current data may not reflect the disproportionate impact alcohol has on women’s health.
• Recent trends. The current data shows that most alcohol-related mortality rates are higher in males than females. However, the CDC analysis looking at mortality rates from 2016-2021 noted that alcohol-related deaths increased 26.8% for males and 34.7% for females during this period — a more current and thorough representation of alcohol-related harm in males vs females.

Through these statistics, we can see that there are differences within alcohol-related harms for males and females, so are drinking guidelines the same or different for men and women?

Differences in Drinking Guidelines for Men and Women

The CDC guidelines for alcohol consumption note that 2 drinks or less in a day for men and 1 drink or less in a day for women is considered drinking in moderation. This difference is attributed to how alcohol affects men and women differently. 

It’s also important to note that the CDC’s moderate consumption guidelines refer to standard drinks. A cocktail we order at the bar or a beverage we buy at the store may not always be equal to one standard drink. Calculator tools created by the US National Institutes of Health can help us determine the number of standard drinks in our alcoholic beverages. Let’s explore some other tools we can use to practice more mindful drinking.

Tips for Reducing Alcohol Consumption

Quitting or cutting back on drinking can seem like an impossible feat. However, implementing mindful drinking practices is a small, but effective step in helping us reduce our overall consumption. Some actions we can take include the following: 

• Understand limits. Knowing our own limits is important, as we’ve learned that many individual factors can influence the way alcohol affects us. After determining our limits, we can then set actionable goals to reduce our consumption.
• Track consumption. Sometimes we can’t even remember what we ate yesterday. Tracking our alcohol consumption helps us get a better look at our drinking habits and implement strategies to cut back. 
• Find alternatives. Having alcohol-free alternatives for alcoholic beverages and drinking gives us a healthier option to turn to. Having a list of mocktail options we can order at the bar lets us enjoy a night out without the consequences of alcohol. Similarly, exploring new hobbies and interests can take up our free time with positive activities.
• Develop a support system. Having an accountability buddy or being able to lean on family and friends can help us get through more challenging moments when quitting or cutting back on alcohol. 

Although we’ve concluded that alcohol affects men and women differently, these mindful drinking practices can be for anyone!

The Bottom Line

Alcohol negatively affects both men and women. However, research shows that drinking disproportionately impacts women in many different ways. This includes all facets of health including physical, emotional, and social well-being. While it remains true that alcohol affects us differently due to individual differences, understanding the unique risks of drinking that occur between men and women helps us create more functional prevention strategies. While alcohol may be biased, quitting or cutting back on alcohol isn’t — it's for anyone and everyone.