The impact of sex and pre-implant variables on clinical outcomes in patients using left ventricular assist devices for destination therapy was unknown. The participation of preimplant clinical, demographic, and clinically judged psychosocial characteristics to time until death, heart transplant, device explant due to recovery, or complication-related device replacement was evaluated using INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) data from 6,771 men and 1,690 women with left ventricular assist devices as destination therapy (2006–2017). Cumulative incidence functions and event-specific. Cox proportional hazards models were used to assess the relationship between sex and time until each competing outcome. Women were younger, more likely to have nonischemic illnesses, and reported less substance misuse than men, but more likely to be single, unemployed, overweight, and sad. Women had higher chances of recovery (3.7% compared to 1.6%, P<0.001) and device replacement (12.1% vs 10%, P=0.019) than males after 2 years, but not of death or transplant (P>0.12). After adjusting for confounders, the gender differences maintained (adjusted hazard ratio [HRadj] recovery, 1.85; 95% CI, 1.30–2.70; P<0.001; HRadj device replacement, 1.22; 95% CI, 1.04–1.33; P=0.015). Women’s improved recovery rates were aided by female-specific diagnoses (e.g., postpartum heart failure). Women’s greater incident rates were unrelated to demographic or psychological characteristics. Women had a greater device replacement and recovery rate in destination therapy than males. Female-specific diagnosis contributed to the latter. To understand the relationship between psychosocial traits and sex disparities in outcomes, standardized assessments of psychosocial factors were required.