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Introduction Urinary incontinence is a prevalent lower urinary tract symptom (LUTS) that significantly impacts quality of life and poses a substantial healthcare burden. Concurrently, depression remains a major public health concern, contributing to disability and diminished well-being. While prior studies have documented a strong association between LUTS and depression, the extent to which gender differences modify this relationship remains unclear. This study investigates whether female patients with LUTS exhibit higher depression scores than their male counterparts, adjusting for demographic factors. Methods Utilizing data from the National Health and Nutrition Examination Survey (NHANES) (August 2021-August 2023), we analyzed the association between LUTS and depression among 2,326 individuals. LUTS was defined based on self-reported urinary leakage, while depression severity was assessed using the Patient Health Questionnaire-9 (PHQ-9). A linear regression model was employed to examine gender differences in depression scores, controlling for age, race, education, and marital status. Results The study cohort had a mean age of 59.47 years and was predominantly female (68.9%). Gender was not significantly associated with depression severity among LUTS patients (β = 0.252, 95% CI: -0.192 to 0.697, p = 0.266). However, age was a significant predictor, with each additional year correlating with a 0.066-point decrease in depression score (p < 0.001). Educational attainment and marital status also influenced depression severity, with college graduates exhibiting significantly lower depression scores (β = -2.267, p < 0.001) and unmarried individuals reporting higher scores (β = 1.411, p < 0.001). Conclusion While depression is generally more prevalent in women, our findings suggest that the presence of LUTS does not significantly modify this gender disparity. Instead, factors such as age, education, and marital status appear to exert a more substantial influence on depression severity in this population. These results underscore the importance of addressing broader sociodemographic determinants when assessing mental health outcomes among LUTS patients. Future research should explore whether specific LUTS subtypes or symptom severity differentially impact mental health in men and women.