Woman the Hunter (and soldier)

A few tips for Pete Hegseth, and primary care docs like me

Women are natural born hunters. Many can also be excellent soldiers and servicewomen. Doctors and defense secretaries should be aware of this biologic and physiologic truth. So should husbands.

On Friday night, despite every Democratic senator and three Republican senators voting to the contrary, news anchor Pete Hegseth was confirmed as Defense Secretary. Among his many potentially disqualifying attributes (allegations of sexual assault, public drunkenness, and questions of financial mismanagement at two veterans' groups) is an open hostility towards women in our armed forces.

In his most recent book, The War on Warriors, published last summer, Hegseth argued that “women cannot physically meet the same standards as men. Men are, gasp, biologically stronger, faster and bigger. Dare I say, physically superior,” Hegseth wrote.

In a podcast interview in November, Hegseth said he did not believe women should serve in combat roles.

There are more than 2 million active duty and reserve troops. Around 18% or 360,000 of them are women. Two of them are family members of mine. Several lawmakers, as well as many veterans and some military advocates, warned that Hegseth’s confirmation could be detrimental to recruiting and retaining women in the military, which already has a recruitment crisis and an “epidemic” of sexual assault and harassment.

For example, Senator Warren wrote: “Your rhetoric and behavior toward women would set a tone from the top of DoD that women are not welcome in the military, that their valuable contributions will not be recognized, and that sexual assault, sexual harassment, and other mistreatment of women is acceptable.”

So what does science have to say about women as “warriors?” And how can this possibly be relevant to primary care?!

First, we should consider servicewomen in combat versus non-combat roles. An article in The Atlantic is instructive. While only about 4,800 women currently qualify for Army infantry, armor, and artillery combat roles (with even fewer in elite special operations), the distinction between combat and non-combat positions has become increasingly blurred in modern warfare. This can be demonstrated by the 130+ women who died in Iraq and Afghanistan despite technically being in "non-combat" roles. Physical fitness requirements remain rigorous for all combat positions regardless of gender, though the military has recognized that maintaining gender-based restrictions was unsustainable for military readiness in today's "nonlinear battlefield" where there are no truly safe jobs.

Next let’s consider a great article that was published about a year ago in Scientific American. It challenges the influential "Man the Hunter" theory, which claimed that hunting was exclusively male-dominated and drove human evolution. This theory, popularized in 1968, assumed women were physically inferior and limited by pregnancy and childcare duties. Though the notion of “hunters” is not an exact proxy for considering the overlapping traits needed by women to be “soldiers,” it is pretty close in the imagination.

Recent evidence suggests that the “Man the Hunter” theory is fundamentally flawed. Women are actually better suited for endurance hunting, which was likely a key hunting strategy of early humans. This advantage stems from several physiological factors:

- Estrogen improves fat metabolism and muscle preservation during extended exercise.

- Women have more slow-twitch muscle fibers ideal for endurance.

- Women show less muscle breakdown during exercise.

- Women often outperform men in ultra-endurance events.

Here are some great graphics. I’m going to share them without permission unless SciAm gets mad at me:

Archaeological and anthropological evidence further contradicts the male-only hunter narrative. Neandertal female and male skeletons show identical patterns of wear and trauma, suggesting similar physical activities. Early human burials show no gender-based differences in grave goods, indicating social equality.

Studies of contemporary hunter-gatherer societies reveal that women actively hunt in 79% of documented cases, even while pregnant or nursing.

Anatomically modern humans have been around for at least 300,000 years. The rigid gender roles often associated with hunting appear to be a relatively recent development, emerging with agriculture only about 10,000 years ago. Before that, evidence suggests hunting was a shared activity among all capable group members, regardless of sex. This flexibility was crucial for small nomadic groups' survival, as all members needed to adapt to changing circumstances and fill different roles as needed.

This challenges not just anthropological assumptions but also contemporary beliefs about gender roles and physical capabilities now being installed at the highest level of our American Armed Forces. But perhaps Pete Hegseth was being sincere in softening his positions under Senate fire during his confirmation hearings. If you have a connect, please forward this article to him.

And now to bring this all into a primary care landing. How could an examination of women as hunters and soldiers, evolutionarily equipped with more strength and endurance than we often give them credit for, possibly be of relevance to primary care?

I’m glad you asked. Here are some healthcare ideas to ponder as gleaned and expanded upon from the SciAm article:

1. Exercise recommendations and training programs should be tailored to women's physiological advantages in endurance activities, rather than treating women as smaller versions of men.

… females experienced less muscle breakdown than males after the same bouts of exercise. Tellingly, a separate study… found that males supplemented with estrogen suffered less muscle breakdown during cycling than those who didn't receive estrogen supplements. In a similar vein, research… found that females were able to perform significantly more weight-lifting repetitions than males at the same percentages of their maximal strength.

If females are better able to use fat for sustained energy and keep their muscles in better condition during exercise, then they should be able to run greater distances with less fatigue relative to males. In fact, an analysis of marathons… demonstrated that females tend to slow down less as a race progresses compared with males.

If you follow long-distance races, you might be thinking, wait—males are outperforming females in endurance events! But this is only sometimes the case. Females are more regularly dominating ultraendurance events such as the more than 260-mile Montane Spine foot race through England and Scotland, the 21-mile swim across the English Channel and the 4,300-mile Trans Am cycling race across the U.S. Sometimes female athletes compete in these races while attending to the needs of their children. In 2018 English runner Sophie Power ran the 105-mile Ultra-Trail du Mont-Blanc race in the Alps while still breastfeeding her three-month-old at rest stations.

2. Primary care providers should be aware that pregnancy and lactation don't necessarily preclude intense physical activity, as evidenced by both ancient and modern examples. According to the present American College of Obstetrics and Gynecology:

• At least 150 minutes of moderate intensity aerobic activity per week during pregnancy and the postpartum period are recommended in women capable of it.

• Concerns that regular physical activity during pregnancy may cause miscarriage, poor fetal growth, musculoskeletal injury, or premature delivery have not been substantiated for women with uncomplicated pregnancies 8 9 10 11 12.

• In the absence of obstetric or medical complications or contraindications, physical activity in pregnancy is safe and desirable, and pregnant women should be encouraged to continue or to initiate safe physical activities.

3. Current health guidelines for women may need revision to account for their superior fat metabolism and muscle preservation during endurance activities.

4. Sports medicine and research needs more female-focused studies, as only 23% of nutrition studies and 6% of athletic performance studies have focused on women!

5. The protective effects of estrogen on muscle tissue and exercise recovery suggest potential therapeutic applications, particularly for post-menopausal women. However, as Dr. Jen Gunter astutely sums up in a helpful post about menopause hormone therapy (MHT):

In simpler terms, while MHT should be used to treat appropriate (menopausal) symptoms, the Women’s Health Initiative Study (WHI) does not support using MHT for disease prevention, and the WHI should not be misinterpreted as saying that it does.

So overall, these insights could lead to better-tailored exercise prescriptions and health interventions for women across their lifespan.

Conclusion

We should challenge the perception that women are physically inferior soldiers (and hunters), as expressed by our new Secretary of Defense, by examining scientific evidence. Research shows women have physiological advantages in endurance activities due to estrogen's effects on fat metabolism and muscle preservation. Archaeological findings reveal that prehistoric hunting was quite gender-neutral, and women actively hunt in 79% of documented hunter-gatherer societies. These insights can be used to connect to modern military service, where women comprise 18% of troops. Relevant to my world, even primary care recommendations like exercise guidelines should be tailored to women's unique physiological strengths rather than treating them as smaller versions of men. This research has implications for military policy, healthcare guidelines, and challenging gender-based assumptions about physical capabilities.

And if the threads tying a new Defense Secretary to his comments about women in the military, to women as hunters, to changing societal assumptions about women’s healthcare are tenuous… then at least let’s go home with this conclusion:

Now when you think of "cave people," we hope, you will imagine a mixed-sex group of hunters encircling an errant reindeer or knapping stone tools together rather than a heavy-browed man with a club over one shoulder and a trailing bride. Hunting may have been remade as a masculine activity in recent times, but for most of human history, it belonged to everyone.