Within the queried period, there were 76,905 male and 90,243 female patients identified as having received a telestroke evaluation. No difference was seen in age, but females had a higher initial NIHSS score (P=0.03). There were no differences in percentage of consults deemed emergent between males and females. Females were received thrombolysis at lower rates than males (4.86 vs 5.99%, P<0.01). Females refused thrombolysis at higher rates than males (3.44 vs 2.78%, P<0.01), while males were more likely to present outside the therapeutic window (46.72% vs 45.43%, P<0.01). Males and females did not receive thrombolysis due to symptom resolution/improvement at similar rates. Males were more likely to be on therapeutic anticoagulation precluding thrombolysis, (P<0.01), while females were more likely to have a nondisabling deficit (P<0.01). There were no differences between TLSW-to-arrival times, arrival-to-call times, and video start-to-thrombolysis decision times between the sexes. There were no differences in consult length times or door-to-needle times between the sexes.