To examine how gender and health risk attitudes relate to maximum acceptable risk (MAR) for side effects for deep brain stimulation (DBS) and focused ultrasound (FUS) among individuals with essential tremor (ET).

Choosing between DBS and FUS requires balancing trade-offs in reversibility, uncertainty, and risks of functional loss. Understanding how gender and health attitudes influence acceptance of these procedures may clarify observed gender disparities in surgical uptake.

Ninety-one adults with ET (M_age = 71.71 ± 8.86 years; 32% women) completed the Health Risk Attitude Scale and scenario-based measures of acceptance and MAR for DBS (infection, bleeding, dysarthria) and FUS (abnormal sensation, gait disturbance) risks. Analyses examined gender differences and the predictive value of three health risk attitude domains, namely health disengagement, willingness to take health-related risks, and ambiguity tolerance, adjusting for age, disease severity, and caregiving burden.

Across risk scenarios, participants showed trend-level higher MAR for DBS than for FUS, F(1, 82) = 3.31, p = .073. Women reported significantly lower acceptance (β = -0.66, p = .003) and MAR (β = -0.34, p = .001) for FUS-related gait disturbance. Ambiguity tolerance predicted higher acceptance (β = 0.39, p < .001) and MAR (β = 0.32, p = .005) for gait disturbance, and health disengagement similarly predicted higher MAR (β = 0.21, p = .044). No significant gender/risk attitude interactions were detected, likely due to limited power in this preliminary sample.