Mechanical circulatory support (MCS) is important therapeutic option for severe heart failure such as cardiogenic shock (CS) and advanced heart failure (AHF). While significant progress has been made in MCS in the last few decades, gender-specific concerns have been noted in both temporary and durable MCS. Females represent a distinct spectrum of etiologies and presentations of CS and AHF and often require specific consideration when implementing MCS. Sex disparities in utilization, complications, comorbidities, and mortality are found in almost in all MCS devices. In contrast to the ample evidence of gender differences in MCS outcomes, little is known about their exact reasons. The underrepresentation of female patients in MCS calls for collaborative efforts from clinicians and researchers to understand gender differences better and to improve the outcomes of MCS in women.