Background. Currently, the studies of gender characteristics of schizophrenia that include the assessment of the incidence, clinical picture, course of the disease, response to the therapy, are actively proceeding. Methods. We examined 86 inpatients who met the criteria of the first episode, including 52 men (60.5%) and 34 women (39.5%). The study used psychopathological method, scale assessment (PANSS, UKU). A brief assessment of cognitive functions in schizophrenia scale (BACS) was used to characterize cognitive functioning. Results. Data on the earlier beginning and more severe course of schizophrenia in men was confirmed. It was shown that there are sexual differences of the clinical picture of the disease already at the early stage of the disease. In male patients with the first episode of schizophrenia, negative symptoms predominate, structural disturbances of thought are more pronounced, while affective disorders are more pronounced in women. Sex differences in the cognitive functioning of patients with the first episode were shown. Women had better auditory memory, speed of processing and attention, and men had shown better problem-solving behavior. It was established that patients with schizophrenia of different sexes differ in response to antipsychotics, and in women the therapeutic response is better. Women are characterized by a greater frequency and a variety of side effects. Women prevailed among patients who, due to the presence of affective disorders, had combined therapy consisting of antipsychotics and antidepressants. There were no differences in the frequency of rehospitalizations in patients with the first episode of different sex within 2 years of the disease. Conclusion. The revealed features of the clinical picture, including specific cognitive impairment, that can contribute to the individualization of pharmacological and psychosocial interventions in patients with the first episode of schizophrenia. The high risk of the side effects of psychotropic therapy in women with the first episode emphasizes the urgency of the safety priority in the pharmacotherapy of these patients. Taking into account the gender differences of the clinical features, the course and the therapeutic response in patients with the first episode of schizophrenia will contribute to the improvement of the effectiveness of treatment and rehabilitation in these patients.