Background <p>Although sex specific differences in carbohydrate, amino acid, and lipid metabolism are well established, tumor metabolism is still largely studied and interpreted independently of sex.</p> Objective <p>This study aimed to highlight sex-specific differences in tumor metabolism as well as their relevance for interpreting [¹⁸F]fluorodeoxyglucose and [¹⁸F]fluoroglutamine metabolic imaging.</p> Methods <p>We review the current literature on sex-dependent glucose and glutamine utilization, focusing on mechanistic and clinical studies, metabolic phenotypes, imaging findings, and therapeutic response across cancers.</p> Results and conclusion <p>Male and female tumors show distinct metabolic dependencies, influencing prognosis and treatment response. Systematic integration of sex into study design and imaging interpretation may improve precision oncology.</p>