This literature review examines the evidence of suicide risk among young female substance misusers in comparison with their male counterparts, and considers arguments that suicide risk is underestimated for this group due to the methodological difficulties presented by small cohort numbers. Existing evidence indicates significant gender differences in comorbidities associated with young suicidal substance misusers, with a greater prevalence of depressive symptoms and psychological distress among female substance misusers. Suicide trajectories suggest that young female substance misusers are likely to present more often, and to a more marked degree, with comorbid disorders that would increase assessed suicide risk among a general youth population. An examination of methodological problems indicates that female gender may be overestimated as a protective factor for suicide among young substance misusers in the context of other factors associated with young female substance misuse. It is proposed that it is no longer good enough to accept female gender as a protective factor without a female-specific evidence base. (Contains 1 table.)