Purpose. To study gender characteristics of the severity of hematuria and compensatory mechanisms of the proaggregant component of hemostasis in patients with nephrolithiasis when prescribing litokinetic therapy (LCT), including nonsteroidal anti-inflammatory drugs (NSAIDs). Material and methods. The prospective study included 60 patients (group 1 – 30 men; group 2 – 30 women) with imaging signs of the presence of stones in the urinary tract. For 7 days, patients underwent standard LCT, including NSAIDs, an α1A-blocker (tamsulosin) and antibiotics. In vitro, the activity of the TP receptor for TxA2 and purine P2Y receptors (P2Y1 and P2Y12) was studied on a platelet suspension after 24, 48, 72 hours, 5 and 7 days. Platelet aggregation was assessed using the turbidimetric method using a ChronoLog analyzer (USA). Results. At the hospitalization stage, in both groups (before the introduction of NSAIDs), hyperreactivity of the TP-receptor was observed, and in men the activity of the TP receptor was lower, and hematuria (p<0.05) was higher than in women. The pharmacokinetics of NSAIDs in men was characterized by inhibition of cyclooxygenase (COX) in two time periods – 72 hours and 7 days, as a result of which the synthesis of TхA2 in platelets decreased and hematuria increased 4.4 times (p<0.001) compared with the hospitalization stage. In women, COX inhibition occurred within 5 days; At the same time, the preservation of normal reactivity of the TP-receptor and purine P2Y receptors ensured the implementation of a compensatory platelet response, limiting the severity of hematuria. Conclusion. Analysis of the mechanisms of gender differences in hematuria in nephrolithiasis is important for developing a personalized medicine strategy when prescribing NSAIDs.