Using self-report data from representative community samples of Moscow and Toronto adults, we examine the effects of sex, masculinity, and femininity on alcohol use. Consistent with prior research, our results show that men in Moscow and Toronto drink significantly more than women; women in both samples tend more toward conventional femininity than men; and masculinity levels are greater among Toronto men relative to Toronto women. Moscow men and women, however, show comparable masculinity levels. Neither masculinity nor femininity explains the sex gap in alcohol use in either sample. However, sex- and sample-specific effects are identified. In Toronto, femininity is associated with higher alcohol use among women. In Moscow, masculinity is associated with lower use among men and higher use among women. The findings provide preliminary support for our assertion that the characteristics of national contexts, such as drinking norms and "Soviet-style socialism" [Cockerham, Snead, and Dewaal (2002). Journal of Health and Social Behavior, 43, 42-55] interact with traditional gender role orientations to influence alcohol use patterns. We suggest that a movement toward culturally sensitive policies that consider sex-specific social expectations and responses may contribute to improved health outcomes across nations.