PurposeWithin the German legal framework, if an unlawful act is committed by a substance-addicted offender, courts shall make a forensic addiction treatment order (referred to as FAT). In 2010–2015, German courts applied this rule to 14,576 individuals. The article aims to explore the development of FAT sex ratios, its relation to other criminological measures and its regional distribution - and to describe gender-related differences within the FAT population. MethodsYearly and state-specific sex ratios in FAT orders were calculated and related to general delinquency figures. Women were compared to men on various variables. We computed chi-square, t- and Kruskal-Wallis tests. ResultsCompared to registered and sanctioned delinquency, women are steadily underrepresented, but the sex ratio differs largely among German states. Compared to men, women are 1 year older, have a less severe criminal history and a different distribution of addiction-related delinquency. Their average concurrent prison sentence is shorter, indicating less severe offences. ConclusionsFindings largely conform to epidemiological knowledge. However, it is unlikely that these effects explain the extent of women's underrepresentation concerning FAT. Instead, FAT-application seems to be influenced by gender-related decision biases in jurisdiction. Regional differences cannot be explained epidemiologically, they seem to indicate different juridical “cultures”.