Objective To investigate gender differences in neurometabolite levels within the ventromedial prefrontal cortex (vmPFC) of adolescent patients with bipolar disorder during depressive episodes.Methods We recruited 45 treatment-na?ve adolescents (20 males, 25 females) meeting DSM-5 criteria for bipolar depressive episodes within the past month. Depression severity was assessed using the Hamilton Depression Rating Scale-24 (HAMD-24). Proton magnetic resonance spectroscopy (1H-MRS) quantified vmPFC concentrations of myo-inositol (mI), choline (Cho), N-acetylaspartate (NAA), and creatine (Cr)Results No significant demographic or clinical differences existed between genders (all P > 0.05). Female patients showed significantly higher NAA/Cr ratios than males (P < 0.05). Male patients demonstrated negative correlations between vmPFC mI/Cr and illness duration (r? = -0.467, P < 0.05), while both genders showed positive Cho/Cr-HAMD score correlations (males: r = 0.553; females: r = 0.621; both P < 0.05).Conclusion Adolescent female bipolar depression patients exhibit elevated NAA levels in vmPFC regions compared to males, suggesting sex-specific neurometabolic profiles.