To the Editor:We appreciate Dr Balak's thoughtful commentary 1 on our work and agree that there are many factors other than income that affect the numbers and percentages of women entering the neurosurgery workforce. While the Global Gender Gap Index attempts to capture some of these various components, it does not fully capture them, and that is why we see a statistically significant, but relatively weak, association between Global Gender Gap Index and the percentage of female neurosurgeons in our analysis. 2 This is an excellent point to look at the density of female neurosurgeons (number of neurosurgeons per 100 000 capita). We had initially calculated this but did not include these numbers in our final manuscript for purposes of brevity. That being said, Dr Balak has highlighted important points regarding the higher density of female neurosurgeons in Europe and the Western Pacific that is another important finding here. We are grateful for these comments on our work.