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review aims reinforce importance improving sex balance preclinical trials sex gender diversity proportional balance clinical trials enrollment influences interpretation stroke clinical trials also aims identify strategies improvement data collection pubmed search conducted publications english using mesh terms sex sex characteristics gender identity transgender gendernonconforming persons clinical trials topic stroke 249 search results 217 human animal studies related stroke majority reviews secondary analyses stroke clinical trials meta analyses retrospective studies subject methods sex gender acquisition per primary data source articles reviewed noting inclusion absence sex gender definitions trial design selected articles supplemented united states food drug administration national institutes health national academy science engineering medicine publications majority preclinical studies continue report sex binary variable majority stroke clinical trials report sex gender interchangeable binary mindful trial design statistical analysis improve accuracy interpretation sex gender differences guidance exists improve reporting currently accepted sex gender definitions recommended data collection instruments appropriate statistical analyses despite acknowledgement failed achieve diverse proportionally balanced enrollment sex gender imbalance across research continuum remains prevalent responsible incorporation sex gender stroke clinical trials achieved thoughtful study design use contemporary sex gender definitions inclusive prospective data collection balanced enrollment prespecified goals appropriate statistical analysis