Research findings in gout result predominantly from studies among men, and might not be generalizable to women. To improve insight into sex differences, this study compared clinical characteristics and comorbidities between female and male gout patients and explored the influence of menopausal state on these differences.Data from patients referred to two rheumatology services and diagnosed with gout were used. Clinical characteristics and comorbidities between sexes were compared univariately. Sex difference in comorbidities were further explored in multivariable logistic regressions adjusting for age, body mass index, smoking and alcohol consumption in the total group and in those with gout onset ≥55-years (as surrogate for menopausal state).954 patients of which 793 (83%) men were included. Women were on average older (65 vs 62 years), were more often obese (54 vs 36%), had a higher serum uric acid level (0.53 vs 0.49 mmol/L), used more often diuretics (60 vs 30%), and consumed less frequently alcohol (47 vs 72%). Additionally, women had more frequently a reduced renal function (64 vs 31%), hypertension (78 vs 56%), heart failure (23 vs 12%), and type 2 diabetes (39 vs 17%) (all p<0.05). In those with gout onset ≥55-years differences in comorbidities were less pronounced and disappeared after adjusting for lifestyle.This study confirms sex differences in clinical characteristics and comorbidities among newly diagnosed gout patients, and revealed that sex differences in comorbidities among those with gout onset beyond the age of female menopause were strongly attenuated and fully explained by lifestyle.