Few large studies have evaluated the emergence of sexual dimorphism in fat distribution with appropriate adjustment for total body composition. The objective of this study was to determine the timing and magnitude of sex differences in regional adiposity from early childhood to young adulthood. Regional fat distribution was measured using dual-energy X-ray absorptiometry (trunk and extremity fat using automatic default regions and waist and hip fat using manual analysis) in 1,009 predominantly white participants aged 5-29 years. Subjects were divided into pre (Tanner stage 1), early (Tanner stages 2-3), late (Tanner stages 4-5), and post (males > or =20 years and females > or =18 years) pubertal groups. Sexual dimorphism in trunk fat (adjusted for extremity fat) was not apparent until late puberty, when females exhibited 17% less (P < 0.001) trunk fat than males. By contrast, sex differences in waist fat (adjusted for hip fat) were apparent at each stage of puberty, the effect being magnified with age, with prepubertal girls having 5% less (P = 0.027) and adult women having 48% less (P < 0.0001) waist fat than males. Girls had considerably more peripheral fat whether measured as extremity or hip fat at each stage. Sex differences in regional adiposity were significantly greater in young adults than in late adolescence. Exclusion of overweight participants did not materially affect the estimates. Sexual dimorphism in fat patterning is apparent even prepubertally with girls having less waist and more hip fat than boys. The magnitude of the sex difference is amplified with maturation, and particularly from late puberty to early adulthood.