When Hillary Clinton began mapping out her presidential campaign, she knew that clearing the hurdle to become the first woman commander in chief would be paramount. What she didn’t know or fully understand 18 months ago was how her age would work against her in subtle and cruel ways, and how ageism and sexism can combine in a double whammy undermining her candidacy.

Unfounded rumors spread by Donald Trump and his allies about Clinton’s allegedly poor health and lack of stamina found their mark Sunday in a video gone viral that shows Clinton stumbling as aides help her into a waiting car. Her doctor’s statement released several hours later revealed Clinton had been diagnosed the previous Friday with pneumonia, a common and treatable condition, but which takes longer to recover from if you’re over 65; Clinton is 68, soon to be 69.

CNN covered Clinton’s near collapse all afternoon, bringing in Dr. Sanjay Gupta, the network’s chief medical correspondent, to recall Clinton’s 2012 concussion and her history of blood clots. NPR’s Cokie Roberts said on Monday’s Morning Edition that Democrats were discussing “sotto voce” how to replace Clinton as their candidate should that become necessary. Joe Biden is their top choice, she said, and he’s five years older than Clinton with a history of brain aneurysms.

It’s worth pointing out that Trump is 70 and while he doesn’t have pneumonia, he’s not exactly a picture of health. The point is that we as a society give the guys a lot more leeway than we give the women. We’re accustomed to older men in leadership positions. John McCain and Bob Dole were both over 70 when they ran for president. The media didn’t obsess over it, though we rightly scrutinized their vice-presidential picks, and McCain’s choice of an obviously unqualified Sarah Palin cost him votes.

Both these older candidates lost, and the contrast of youthful energy conveyed by their much younger opponents, Barack Obama and Bill Clinton, contributed to those losses.

If Democrats are saying anything sotto voce, it’s how grateful they are that Clinton isn’t facing Marco Rubio.

The problem Clinton has there is no Golda Meir leading the way for her. The “Iron Lady” of Israel was elected prime minister when she was 70, and she successfully prosecuted the Yom Kippur war when she was 75. She was ageless, and given her age and demeanor, sexless. In the first days of the 1973 war, it was said she smoked 90 cigarettes a day instead of her usual 60.

We think of ourselves as a youthful country even though the U.S. population is aging. We like more recently to elect presidents who are in their prime, in their forties and fifties, and we indulge them in their inexperience. Clinton defies recent history as someone who is highly qualified but struggles to excite and inspire. Bernie Sanders surprised everybody becoming a rock star as a septuagenarian. He even had a doppelganger in the comedian Larry David to connect with voters.

Clinton is on her own to make her way. There is no template for a woman of her vintage. “Ageism is rampant these days, but of course it’s worse for a woman,” says Deborah Tannen, a professor of linguistics at Georgetown University. “Why is there more fuss about Hillary’s age than Donald’s? Because an older man looks distinguished,” she says, although that’s not the first adjective one would apply to Trump.

“Older women are invisible,” says Tannen, in the sense they are insignificant in public life. The medical flap sticks to Clinton and becomes “Healthgate” in a way it wouldn’t for a man because it plays into an existing suspicion that a woman in this role is “not quite right for this,” says Tannen.

The point is we’re not sure what to make of an older woman with ambition vying for the most powerful job in the world. Women who support Clinton and are her age or older admire her for her resilience and wonder why she would want to put herself through such a wringer. Younger women seem to regard her as something out of Jurassic Park. They can’t relate to her, and they don’t get Trump either. He’s like a corporate version of the Kardashians.

The real problem isn’t Clinton’s age or her health; it’s her lack of transparency. Millennials embrace transparency as the religion of the internet. People want to know everything, and Clinton is an old school candidate who wants things kept private. But the 90-minute gap on Sunday before her campaign released a statement about what was happening may be the last gasp of privacy for Clinton.

Her campaign announced on Monday that it would be releasing more information about her general health. If there are lessons to be learned from this for Clinton, it’s to heed a health warning and not try to power through, and to let go of that 20th century notion of a zone of privacy.

Her bout of pneumonia has gotten more attention than FDR’s polio or JFK’s multiple ailments at comparable points in their campaigns. If the voters knew more about their health challenges, we might have missed out on their leadership. Clinton needs to convince the voters and the right-wing conspiracy theorists that she doesn’t have some underlying condition that she’s hiding. And she needs to convince the rest of us, and perhaps herself, that at her age she has the wisdom to take a health scare seriously.