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Introduction Sex disparities in suicide mortality persist worldwide, with male rates 2–4 times higher than female rates, but age-specific patterns over time remain insufficiently understood.Aim To examine long-term trends in suicide mortality in Spain (2000–2023), focusing on sex-specific and age-specific differences and the evolution of the male-to-female suicide rate ratio.Methods We conducted a longitudinal study using national mortality data from the Spanish Statistical Office. Crude and age-adjusted suicide rates were calculated by sex and age group. Joinpoint regression assessed temporal trends and male-to-female rate ratios across 15 age groups.Results The overall age-adjusted rate showed no significant change (average annual percent change: –0.4%), with a significant decrease among men (–0.7%) and stable overall rates among women, while increases were observed in selected female age groups. Rates increased with age, particularly among men aged 70+. The male-to-female ratio widened with age, reaching 10.74 in the 95+ group, but narrowed over the study period in four age groups (15–29, 50–54, 75–79, 80–84), mainly due to declining male rates.Conclusion Despite modest changes over time, marked age-related sex disparities persist. Older men remain the highest-risk group, while increases among women in midlife warrant targeted prevention.