Objective Active acromegaly is subject to sex differences in growth hormone (GH) and Insulin like growth factor 1 (IGF‐I) patterns as well as clinical features but whether this also pertains to controlled disease is unclear. Design In a cross‐sectional, multi‐centre study, 84 patients with acromegaly (F = 43, M = 41), who were considered controlled after surgery alone (n = 23) or during continued somatostatin receptor ligand (SRL) treatment (n = 61), were examined. Methods Serum concentrations of GH, insulin, glucose and free fatty acid (FFA) were measured during an oral glucose tolerance test (OGTT) together with baseline serum IGF‐I and completion of two HR‐Qol questionnaires (acromegaly quality of life questionnaire AcroQol and Patient‐assessed Acromegaly Symptom Questionnaire PASQ). Results The mean age at the time of the study was 57 (±1.1) years and the majority of females (were postmenopausal. Females had significantly higher fasting GH but comparable IGF‐I standard deviation scores (SDS). Using fasting GH < 1.0 µg/L as cut off, disease control was less prevalent in females (F: 56% vs. M: 83%, p = .007) whereas a comparable figure was observed using IGF‐I SDS < 2 (F:79% vs. M:76%, p = .71). Compared with males, female patients showed impaired AcroQol physical score (p = .05), higher fasting FFA (p = .03) and insulin concentrations during the OGTT (p = .04). Conclusion In patients with acromegaly considered controlled, postmenopausal females exhibited higher GH levels than males despite comparable IGF‐I levels, which also translated into impaired metabolic health and well‐being. Our findings point to the relevance of including GH measurements in the assessment of disease control and suggest that disease‐specific sex differences prevail after treatment.