<p>Attention deficit hyperactivity disorder (ADHD) impacts markedly on juvenile development and daily function of young and adult patients. Global prevalence and drug prescription rates are consistently on the rise, particularly in young women. Personal experience in daily psychotherapy practice supports sex differences in how the disorder manifests and how the patients respond to treatment. We review sex differences in therapeutic and adverse responses to the cornerstone ADHD pharmacotherapies methylphenodate and amphetamines, under consideration of preclinical mechanistic insights, clinical studies, and relevance for real-life psychotherapy practice. Overall, many gaps in knowledge remain regarding sex differences on all levels of ADHD disease manifestation, diagnosis, and therapy, and the underlying mechanistic basis. Certain treatment strategies may be more or less appropriate, safe, and effective in specific patients, an aspect which warrants further attention in future guideline reforms.</p>