While individual variability often outweighs gender differences in response to altitude training, the female athlete presents specific physiological nuances that require meticulous coaching management for optimal adaptation. Women may experience marginally slower initial acclimatization due to factors such as lower cardiorespiratory capacity and a potentially blunted ventilatory drive; however, they benefit equally from hypoxic exposure when key health parameters are addressed. Iron status is a critical factor; due to monthly blood loss, prealtitude testing, and routine iron supplementation are crucial to support erythropoiesis and successful adaptation. Coaches must also account for the dynamic influence of the menstrual cycle on subjective well-being and training response, adjusting loads based on the athlete’s input and physiological monitoring. Research confirms that female athletes successfully utilize various hypoxic training modalities, including intermittent and resistance training, to enhance performance. The key to unlocking potential lies in moving beyond a gender-neutral approach to embrace individualized load management and careful attention to hormonal rhythms.