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In northern Tanzania, alcohol use disorders (AUD) are under-diagnosed and under-treated, and current services are mostly limited to men in clinical settings despite significant alcohol-related harm in the community. The study objective was to identify sex differences in alcohol use and alcohol-related harms within and across community and clinical settings. This was a congruent triangulation mixed methods study consisting of focus group discussions (FGDs) and cross-sectional surveys. Quantitative analysis was conducted via Drinker Inventory of Consequences (DrInC) and Alcohol Use Disorders Identification Test (AUDIT) data from injury patients presenting for care at the Kilimanjaro Christian Medical Center Emergency Department and community participants. Differences in scores by sex were assessed using unpaired t-tests. K-means algorithms were run independently in both samples. Deductive thematic analysis was conducted on FGDs with community members, injury patients, and injury patient relatives. Differences in mean scores between sexes in the community and patient samples were statistically significant (p<0.05). Men showed higher AUDIT and DrInC mean scores in both samples. K-means separated the community and patient samples into two clusters, one with and one without harmful alcohol use. Of those indicating harmful alcohol use, the community cluster (n = 77, AUDIT = 14.29±9.22, DrInC = 22.67±6.80) was 27% women; the patient cluster (n = 57, AUDIT = 15.00±9.48, DrInC = 27.00±7.76) was 5% women. FGD transcripts revealed sex differences in four themes: alcohol initiation, consumption patterns, risk behaviors, and social stigma. This study identified important sex differences in the manifestation of AUD in northern Tanzania with respect to alcohol initiation, consumption patterns, risk behavior, and stigma. These findings indicate that women may need to be encouraged to seek injury care at the Emergency Department. Future research, prevention, and treatment efforts intended to reduce alcohol-related harms need to account for sex differences to optimize reach and effectiveness., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 McNee et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)