This study investigates gender-specific bile acid profiles in non-alcoholic fatty liver disease (NAFLD) and alcohol-associated liver disease (ALD). The researchers measured bile acids in plasma from adult NAFLD, ALD patients, and healthy controls using targeted mass spectrometry. They found that women with NAFLD had significantly higher concentrations of total bile acids, primary bile acids, cholic acid (CA), chenodeoxycholic acid (CDCA), glycine-conjugated bile acids, and non-12-OH bile acids compared to healthy controls. In contrast, men with NAFLD showed elevated levels of glycocholic acid (GCA) and glycochenodeoxycholic acid (GCDC) subtypes, while CA levels were significantly decreased. The study also found that total bile acids correlated positively with the Enhanced Liver Fibrosis (ELF) score in both sexes, except for ursodeoxycholic acid (UDC) in NAFLD. In ALD, only males showed significant correlations. The findings suggest that women with NAFLD have more severe cholestasis, while men may better compensate for fat storage-driven bile acid dynamics, indicated by higher levels of taurine-conjugated bile acids, which are associated with beneficial metabolic functions. The study highlights the importance of understanding gender differences in bile acid metabolism for better diagnosis and treatment of NAFLD.This study investigates gender-specific bile acid profiles in non-alcoholic fatty liver disease (NAFLD) and alcohol-associated liver disease (ALD). The researchers measured bile acids in plasma from adult NAFLD, ALD patients, and healthy controls using targeted mass spectrometry. They found that women with NAFLD had significantly higher concentrations of total bile acids, primary bile acids, cholic acid (CA), chenodeoxycholic acid (CDCA), glycine-conjugated bile acids, and non-12-OH bile acids compared to healthy controls. In contrast, men with NAFLD showed elevated levels of glycocholic acid (GCA) and glycochenodeoxycholic acid (GCDC) subtypes, while CA levels were significantly decreased. The study also found that total bile acids correlated positively with the Enhanced Liver Fibrosis (ELF) score in both sexes, except for ursodeoxycholic acid (UDC) in NAFLD. In ALD, only males showed significant correlations. The findings suggest that women with NAFLD have more severe cholestasis, while men may better compensate for fat storage-driven bile acid dynamics, indicated by higher levels of taurine-conjugated bile acids, which are associated with beneficial metabolic functions. The study highlights the importance of understanding gender differences in bile acid metabolism for better diagnosis and treatment of NAFLD.