Background Cardiovascular disease (CVD) is the leading cause of death in individuals with type 1 diabetes (T1D). Epidemiological studies indicate that women with T1D are at greater risk of CVD compared to men with T1D. The present study sought to investigate differences in vascular health between men and women with T1D. Methods 53 women with T1D and 25 men with T1D participated in this study. The flow-mediated dilation (FMD) test assessed endothelial-dependent conduit vessel function and nitroglycerin (NTG) was used to assess endothelial-independent vasodilation. In addition, cutaneous post-occlusive reactive hyperemia (PORH), local thermal heating (LTH), and iontophoresis of acetylcholine (ACH) were conducted to assess microvascular function, and pulse wave velocity (PWV) and pulse wave analysis (AIx75) were used as indices of arterial and aortic stiffness, respectively. Near-infrared spectroscopy was utilized to assess skeletal muscle oxidative capacity (SMOC). Results Hemoglobin A1c (p=0.904) was similar between men and women with T1D. Women with T1D exhibited higher FMD (p=0.010) and AIx75 (ptextless0.001) compared with men with T1D. There were no differences in PORH, LTH, ACH, PWV, or SMOC between groups (all ptextgreater0.05). Discussion Findings from the present investigation demonstrate that women with T1D exhibit greater conduit vessel endothelial function yet increased aortic stiffness compared to men with T1D. This paradox of enhanced endothelial function and arterial stiffness highlights the complex relationship between vascular structure and function in T1D and the need to assess multiple indices of vascular health when evaluating cardiovascular disease risk in men and women with T1D.