To determine whether damage in normal-tension glaucoma is more pronounced in men or in women, we analyzed visual-field damage, intraocular pressure, age, frequency of acral vasospastic reaction on local cooling, and frequency of headache in 28 consecutive patients with newly diagnosed normal-tension glaucoma. The difference between genders with regard to mean visual-field defect was significant (9.4 +/- 1.3 dB in men and 6.7 +/- 1.0 dB in women; p = 0.034). This difference could not be explained by other variables. Because the population tested was relatively young, this study suggests normal-tension glaucoma to be more severe in men, in an earlier stage of the condition.