This article assesses whether the Fagerstrom Test for Nicotine Dependence (FTND), adequately reflects sex, gender and diversity related differences in nicotine dependence. Available studies on the FTND were reviewed and a sex, gender and diversity analysis (SGBA) of this instrument was conducted. Results indicate that sex and gender differences in nicotine dependence may undermine the ability of the FTND to present an adequate picture of dependence. Conducting a SGBA on this Fagerstrom test reveals that sex and gender differences likely limit the ability of this instrument to present an accurate picture of dependence in diverse groups. Further research is needed to enhance the sensitivity of the FTND.