<p>Fetal alcohol spectrum disorders (FASD) are a group of neurodevelopmental disorders caused by alcohol exposure during pregnancy. FASD is associated with various neurocognitive disorders over the entire lifespan. Comorbid mental health disorders seem to be highly prevalent. Suicide attempts and substance use as well as substance use disorders are also associated with FASD in adults. However, previous studies report small or very selective samples. Little is known about gender differences in larger samples of adults with FASD. Structured clinical interviews based on DSM-5 diagnostic criteria were administered for the diagnosis of mental health disorders, suicidality, and substance use including substance-related disorders. Data was analyzed separately for men and women to identify gender differences. The sample consisted of 238 adults (51.3% female, 48.7% male, 0% non-binary) who live with FASD, 31% of male and 41% of female participants fulfilled criteria for at least one comorbid mental health disorder, primarily anxiety (men = 13.8%, women = 13.1%), major depression (men = 7.8, women = 9.8%), and PTSD (men = 0.9%, women = 4.1). At least one suicide attempt was reported by 32.8% of women and 17.2% of men. Suicide attempts were significantly more prevalent among women. The 30-day prevalence for alcohol was 49.1% for men and 36.1% for women. Alcohol use disorders were present in 2.6% of men and 0.8% of women. The 12-month prevalence for cannabis use was 30.2% for men and 17.2% for women. Cannabis use disorders were present in 1.7% of men and 0.8% of women. This study identified overall high rates of mental health disorders, suicide attempts, substance use, and substance use disorders in women and men with FASD. The results highlight the need for specialized treatment not only targeting FASD-specific symptoms but also addressing the comorbid conditions.</p>