Two in three individuals with Alzheimer’s disease (AD) are women. Crucially, sex differences in AD pathology burden are apparent even in clinically normal adults, which in turn may explain higher incidents of AD among women. This study investigates sex differences in tau pathology and whether Abnormal βamyloid (Aβ) strengthens this association between sex and tau. In a novel analysis, we also seek to investigate the mechanisms behind sex differences in AD pathology, testing the influence of hormone therapy (HT) exposure and menopause on higher tau retention in women. This work has clear implications for gender biology, sex differences and women’s health research.