The article begins with a description of historical trauma theory in which traditional gender roles as well as the modifications engendered by traumatic Lakota history are briefly examined. Literature on health and mental health problems and their association with trauma are explored, including available data on gender differences, and other risk factors associated with trauma for American Indians are examined. Then, gender is explored in data from a small quantitative study on Lakota historical trauma including an examination of an intervening variable, degree of traditional presentation-of-self. The article concludes with a discussion of prevention, early identification, and intervention of the trauma response which could positively impact the health status of the Lakota. Recommendations for future research are suggested.