<p>Adult growth hormone (GH) deficiency is associated with increased body fat mass, abdominal obesity, dyslipidaemia, reduced exercise capacity, impaired cardiac function, reduced self-reported well-being, impaired quality of life, as well as increased morbidity. Randomised controlled trials and cohort studies, together with meta-analyses, have shown improved outcome in adult patients with hypopituitarism receiving GH, with a reassuring safety profile. Women with GH deficiency and hypopituitarism have greater morbidity and mortality than men, particularly in relation to metabolic and cardiovascular outcome. The response to GH replacement is also less favourable in women than in men. The reason for these differences in women and men with hypopituitarism is not entirely clear, but is likely related to the interaction between sex steroid and the somatotroph axis. In this narrative review we summarize the burden of GH deficiency in adults with hypopituitarism, and the impact of GH replacement, with focus on differences among women and men.</p>