Background: Medical students regularly report poorer mental health outcomes than students from other faculties and in other degree programmes. Gender and year of study have been discussed as factors influencing mental health. However, study results for both factors are inconclusive. Moreover, little is known about the associations between gender and study progression with perceived study demands.

Methods: The purpose of this study was to analyse medical students’ self-reported mental health status and perceived study demands with particular focus on gender differences and study progression. We conducted an online survey in two German universities across three data collection waves during the winter terms of the academic years 2021, 2022, and 2023. We included 1,083 medical students (73% women) in our analyses: bivariate t-tests and ANOVAs with gender, study progression, and university as predictors of depression, exhaustion, six dimensions of study demands, and satisfaction with learning and study.

Results: Our results demonstrated gender differences regarding mental health and study demands, favouring men on all outcomes in t-tests and ANOVAs. We did not find differences between beginners and advanced students in mental health, but beginners reported greater difficulty with performance pressure and self-structuring.

Conclusions: Our findings confirm persistent gender differences in mental health and study demands, with women reporting higher distress. We did not find differences in terms of satisfaction with studies or learning. To improve medical students’ well-being, we suggest targeted interventions for vulnerable groups using gender-sensitive approaches and designs. Beginners likely benefit from support with self-structuring and managing performance pressure.