In the United States, approximately one-fourth of university presidents are female. The lack of women in senior leadership roles at higher education institutions mirrors other industries, and research has shown that institutions and organizations which lack female representation are less effective. To ascend to senior leadership roles, including the presidency, women persist through existing macro, meso, and micro levels of gender-based barriers. Thus, the primary research question guiding this study was: "What factors contribute to the self-efficacy of women presidents in higher education?" The theories of self-efficacy and transformational leadership provide the framework through which the concepts of women as leaders, American college presidents, gender-based barriers, and support structures were explored. This study resulted in six major findings: (a) Women presidents in higher education institutions are highly self-efficacious yet aspire to even greater levels of efficacy and professionalism; (b) Women presidents in higher education institutions are authentic, relationship-focused, and goal-oriented; (c) Women presidents in higher education institutions experience a multitude of gender-based barriers on their leadership journeys and in their presidencies; (d) Mentoring and leadership or professional development programming are essential components of the leadership journey for women presidents in higher education institutions; (e) Misalignment exists between the gender-based barriers and support structures identified by women presidents of higher education institutions; and (f) Women presidents of higher education institutions are committed to supporting the next generation of leaders.