With modernized bicycle designs in the late 1800s, women started riding in greater numbers (1). Gender-based independence was expanding in this epoch, yet female cyclists faced societal judgement, sexism, and pseudoscientific theories (2). Specifically, cycling could remove women from the home and might induce “adverse” physical effects, such as muscle growth or a so-called “strained face” (1). Since bicycling was normatively framed as a masculine pursuit during this time, questions of sexuality and even morality arose (3). Some of this conjecture was conditioned by changes in women's fashion, including billowing skirts, which could impede riding (1). Interestingly, this led women to register for a significant proportion of cycling-specific clothing patents (4, 5). Again, however, clothing innovations were considered both masculine and provocative, and the women who wore them were frequently derided (5).

In the same epoch, women were encouraged to compete in cycling races as an exposition of “speed and skill”; nonetheless, this has been viewed more as a financial ploy exploiting societal curiosity towards women competing in minimal attire, rather than a framework for proto sporting equality (2). Cycling races were considered to be entertainment and therefore, women's ability to attract large crowds to the velodrome conferred value (2). Nevertheless, societal motivations aside, female riders were committed, dedicated, and persistent (6). This was exemplified by early professionals like Tillie Andersen (1875–1965), who worked full-time while simultaneously breaking records and earning sponsorships (6).

Despite this initial popularity, women's professional racing largely diminished until the late 1950s, in part due to the rise of other sports and the availability of automobiles (6). Aside from limited attempts to reestablish women's racing in 1937 and 1958, it was not recognised in the Olympics until 1984, the same year that the female Tour de France was originally instituted (6). Notably, this event has continually experienced disruption and inconsistencies in its scheduling and format.

Today, women's cycling is overseen by the Union Cycliste Internationale (UCI) and is organized into professional World Teams (WT) and Continental Teams (CT). Races are categorized across four divisions, namely: Women's World Tour, UCI ProSeries, Class 1 and Class 2 (7). As of 2022, there were two hundred and thirty-nine riders over fifteen WT and sixty CT encompassing seven hundred and nine riders (7, 8). For 2023, thirty races were scheduled, comprising both single-day events and stage races (8). There has been an 80% increase in professional riders from 2012 to 2020 (9), and with the introduction of the Paris-Roubaix Femmes in 2021, women's racing is receiving more acclaim (10), as demonstrated by expanding spectator support and more challenging course designs (11, 12).

However, although the notion of a female riding a bike no longer deemed controversial in nearly all societies, the professional sport continues to endure inherent challenges. Many of these have socioeconomic origins, culminating in lower wages and limited resources (13, 14). Other concerns stem from harmful behaviours and unbalanced power dynamics, leading to abusive and coercive experiences (15, 16). While governing bodies seek to strengthen the discipline, there may still be a broader lack of confidence in the sporting ability of professional female cyclists (17), predicated on gender-based dynamics. For instance, Lucas has identified three persistent attitudes: female cyclists lack speed, strength, and stamina; they are not well-suited to long-distance racing; and there is still great sensitivity around public urination (17).

Against this background, substantial socioenvironmental challenges and sport-specific vulnerabilities may be evident across women's cycling, demanding greater scrutiny and tailored responses. Although anecdotal evidence reveals prevailing concerns, the mental health of female riders has been largely neglected in current scientific literature and by other stakeholders in the sport. One professional cyclist articulated this sense of inertia: “There just isn't any other option—so we just have to put up with it” (16). As an emerging subdiscipline, sports psychiatrists have a responsibility to investigate these detrimental paradigms and inform recommendations to safeguard riders. In the authors' opinion, the burgeoning popularity of women's cycling presents an opportunity to facilitate real change. To that end, this perspective paper explores the current mental health landscape within women's cycling, underscoring the necessity of enhanced resources and robust actions to support athlete welfare and advance gender equity.

Despite recent progress, substantial economic challenges remain across women's professional cycling, which can present psychosocial burdens for athletes. For instance, the average budget for a men's team may range between ∼20 and 35 million USD depending on category and classification, whereas women's teams may operate within a substantially smaller budget bracket of ∼150,000 USD (14, 18). These disparities can detrimentally affect salaries, access to health resources, and personal self-esteem, amongst other aspects (19).

We acknowledge that laudable developments have occurred in this area, like the introduction of a minimum wage in 2020 (∼35,000 USD annually) (13). Nevertheless, this only applies to WT riders, meaning that 52% of female cyclists must pursue a secondary form of employment and 20% of CT riders receive no remuneration (18). Additionally, many participants, even those earning below the minimum salary, are responsible for expenses, like travel costs or repairs following a crash (20, 21). Consequently, even top-performing athletes still experience economic insecurity, with resulting mental health effects, as exemplified by a two-time Giro Rosa champion working part-time to supplement her income: “it becomes depressing (our italics) […] you can only keep putting your whole heart into something for so long when you feel it doesn't matter” (22).

WT men's teams have a mandated minimum wage which is significantly higher than WT women (14, 18, 23). Even still, efforts to equalize pay have been criticized and there is a lack of awareness about sex-based discrepancies [e.g., (24)]. This wage gap correlates with a resource gap, leaving many female athletes without access to the same services as their male counterparts, which may compromise health outcomes (15, 21). For example, men's support staff typically include physical therapy professionals and chef-nutritionists, who assist with recovery (25). Consequently, discussions about the inequities between men's and women's team budgets often illustrate a vicious chain of events; in women's cycling a lack of media coverage leads to a lack of societal interest, in turn leading to a lack of investment. Yet, this neglects the role of the media in perpetuating negative stereotypes about women's sports or choices not to cover them at all; instead, recent viewership figures underline the flawed basis for these decisions and, encouragingly, certain media are beginning to actively champion the sport (21, 26, 27).

Separately, female riders have noted a culture of secrecy around wages and some teams may actively discourage athletes from discussing salaries, concomitantly undermining organizational trust and intra-team relationships (15). Several women have claimed that contracts were misrepresented or changed without review and some found it difficult to receive any remuneration (14, 20). Other riders have described the harmful psychological impact of what they depict as “economic manipulation”, with one conceding: “you quickly reach the point where it just doesn't seem like it's worth it. And there is basically nowhere else to go” (20).

Performance, physiological, and sociocultural pressures may engender adverse health concerns amongst some female athletes. As a sport, cycling has historically favored lighter competitors with higher power-to-weight ratios, meaning that unsafe dieting, harmful behaviours, and body shaming can be commonly observed phenomena across both men's and women's disciplines (28). In women's cycling, alarming patterns have emerged, including athletes being forcibly restricted from eating or mocked for their body size by coaches and subsequently developing career-ending eating disorders (ED) (20, 29, 30). One female cyclist outlined a teammate's experiences of “fat-shaming”, which “was so terrible that this poor girl was falling apart by the end of her first training camp” (20). Another revealed how a teammate received a penis-shaped “trophy” from a coach because she was the first rider that he had made cry that season (20).

Additionally, performance-enhancing drugs (PEDs) are becoming an increasingly prominent concern, prompting rigorous testing measures from the UCI (31). Again, external dynamics can contribute to individual behaviours, with some athletes suggesting that support staff encouraged them to change their attitude towards doping (20). Discussing an interaction, one rider stated: “He told me everyone does cortisone, like, that made it okay for me to use it, too?” (20). Significantly, athletes may experience long-term harms from PED use and substantial penalties or suspensions can be enforced when doping infractions are detected (31, 32).

As another controversial issue, attending to basic needs such as urination during competition presents further concerns (15). In certain contexts, sociocultural stigma towards women urinating in public persists, meaning that race facilities must be adapted at additional cost (17). Unlike male riders, the need to cease riding to urinate has been considered a weakness of female cyclists, rather than a biological reality (15). This has been appropriated to justify the reluctance of race organizers to increase stage lengths, as well as being used as evidence to support a lack of competitive drive (17). Yet, the consequences of restricted urination are stark; female cyclists have developed urinary tract infections due to the inability or inconvenience of urinating during competitions, which can require antibiotics and may even lead to severe kidney disease (17). Additionally, riders have been penalised for taking “nature breaks”, inhibiting broader inclinations to urinate (33, 34). Inadequate sanitation facilities are likely to render some women at-risk for intra-race anxiety and other psychological issues since they are unable to manage this basic need (35).

Across women's sport, abusive incidents are well-documented, which again raises concern for athlete welfare (36). In cycling-specific settings, commentators have argued this behavior may be used to coerce and manipulate riders into conforming to male-centric training and performance frameworks (37, 38). In this regard, sexist assumptions support the ideology that women are weaker than men and that hostility and aggression can enhance strength and performance (24, 38). Power imbalances within the athlete-coach dynamic may contribute to this, particularly since most coaches in women's cycling are men (37, 39, 40). Wider representations may further encourage humiliation and abasement, as shown by negative media depictions that heighten sexist attitudes towards the sport (41). Moreover, past reports illustrate how cyclists have been dehumanized, verbally and emotionally abused, pitted against teammates, humiliated, and sexually harassed (15, 20, 37, 38). One rider described these situations: “I was nearly held prisoner—on the promise of racing in the World Tour” (20).

Again, a culture of secrecy can predominate within women's cycling teams and beyond, meaning athletes seldom come forward to disclose their experiences, fearing retribution and the reporting protocols (20). Notably, the UCI reporting system is an anonymous email address and the subsequent investigation process has been criticized for lacking full confidentiality (20). This may compromise the mental health of athletes, as again has been identified within the sport: “It was so damaging that it really started to affect my confidence. I began to think that maybe I shouldn't even try to be a cyclist […] and this was when I was already riding for an elite professional women's team” (20).

Many athletes characterized the structural and organizational aspects of professional cycling as exclusionary and problematic. Dixon and colleagues found that the practice of mixing competitive categories was a participation barrier, with women not being afforded the same opportunities as men (9, 19). Female UCI races are generally shorter and sometimes restructured to have less challenging terrain and/or less climbing, decreasing the prestige of the competition (and prize money) in comparison to men's races (14, 15). For example, the 2023 Men's Tour de France encompassed 21 stages over 3,500 km, as compared to the 2023 Tour des Femmes with 8 stages over 1,029 km (42).

Some race directors continue to have safety concerns about women's abilities, sometimes cancelling or changing races (43). These discrepancies can result in lower self-esteem and possible internalized feelings of being weaker (15). Again, a prominent reason for shorter races assumes that riders are unable to complete the men's course, despite women being physiologically well-suited and even having certain advantages, as shown in endurance sport (44–46). Other controversial issues are evident, including debates about trans athletes competing (47), and questions around physical and mental health management in the wake of tragic accidents (48, 49).