Significant data exist to suggest that women with coronary artery disease (CAD) have worse outcomes than men. One explanation is that women present with more advanced disease because of a lack of screening and early detection. To examine this, we performed a claims-based analysis of exercise treadmill testing (ETT) within an urban managed care population. We analyzed all claims for 57,793 covered lives. Utilization rates for ETT were calculated for men and women by age group. ETT utilization between men and women demonstrated significant differences: 49.2 tests/1,000 men versus 25.0 tests/1,000 women (p < 0.001). This 2:1 ratio was observed across multiple age strata. Significant differences in ETT utilization exist between men and women, even in older populations in which the incidence of CAD in women exceeds that in men. ETT often is the initial screening test for detecting CAD; these gender differences in ETT utilization may result in underdetection of CAD in women and treatment at later stages of disease when interventions are less effective.