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Objective: To examine sex differences in self-ratings for affective and cognitive empathy for males and females with traumatic brain injury (TBI) and compare these to observer ratings. Method: Self and observer (e.g., spouse) ratings of affective and cognitive empathy were obtained for 160 participants (116 males) with severe TBI, using the Interpersonal Reactivity Index Empathic Concern (EC) and Perspective Taking (PT) subscales, respectively. Results: When compared to sex norms, female self-ratings were significantly lower for both subscales, whereas men’s self-report ratings were only lower for PT. For EC, more women (44%) were found to be substantially below the normative means (≥2 SDs) than men (17%), p < .001. When comparing women and men with TBI, self-report and observer ratings indicated both sexes had similar empathy levels (both subscales). Self versus observer ratings showed that women’s self-ratings were significantly higher than observer’s ratings on PT (p < .001); men’s self-ratings were significantly higher than observer’s ratings on PT (p < .001) and EC (p = .009). Conclusions: In contrast to the typically observed superior female empathy, this study suggests this advantage may disappear after a TBI, and possibly result in a disadvantage compared to their uninjured female peers. Theoretical implications of self-awareness and cultural gender expectations for empathy are discussed.