The incidence and the rate of progression of non-diabetic renal disease is generally greater in men compared with age-matched women, suggesting that the female sex is protective and/or that the male sex is as risk factor for the development and progression of non-diabetic renal disease. In diabetes, even though the male sex still appears to be a risk factor, this relationship is not as strong as it is in non-diabetic renal disease. While the data regarding the actual sex differences in the incidence and/or progression of diabetic renal disease are equivocal, what is certain is that women with either type 1 or type 2 diabetes exhibit a much higher incidence of renal disease compared with non-diabetic women. These observations indicate an interaction between diabetes, renal disease and ones sex and implicate sex hormones in the pathophysiology of diabetic renal disease. Further supporting the role for sex hormones in diabetic renal disease is the fact that diabetes is a state of an imbalance in sex hormone levels, however, whether these changes correlate with the decline in renal function associated with diabetes is unclear. Furthermore, diabetic renal disease rarely develops before puberty and the onset of puberty accelerates microalbuminuria, supporting the idea of the involvement of sex hormones in the development and progression of the disease. However, other than a handful of experimental studies indicating that treatment with or removal of sex hormones alters the course of diabetic renal disease, very few studies have actually directly examined the correlation between sex hormones and the disease development and progression. Further studies are necessary to determine the precise contribution of sex hormones in the pathophysiology of diabetic renal disease in order to develop novel and potentially sex-specific therapeutic treatments.