Objectives: We determine how gender or culture influence new medical students' specialty preferences and work-life issues and explore the relation between work-life issues and each specialty preference. Methods: In a cross-sectional study, we surveyed first year Dutch and Swedish medical students (N=1173, cohorts from 2006-2009) on their preferences for specialties, full-time or part-time work, and agreement to eleven work-life issues. We tested differences by gender or culture using chi square and logistic regression. Results: Over 93% of all students responded (N=1095). Almost no male first year student preferred gynecology as a specialty. Dutch male students were more often interested in surgery, Dutch female students in paediatrics. In the Netherlands, male students in particular preferred full-time work. In Sweden gender did not influence working hour preferences. Women in both countries expected equality in career-opportunities and care-tasks more than men, and agreed more often that their career would influence their family life. Women with a preference for surgery most often emphasized equality in career opportunities and care tasks. In most preferred specialties female gender related to a lower degree to full-time work. A gender gap in preferred working hours was larger for Dutch students preferring surgery or paediatrics than for Swedish students. For most of the specialty preferences studied, Swedish students anticipated childcare by day cares and Dutch students' informal day care. Conclusions: Early in training, medical students have gendered specialty preferences and work-life preferences which relate to each other. Gender differences are signifi-cantly more pronounced in the Netherlands than in Sweden. ; Gender challenges in medical education