Casas Grandes Medio–period (A.D. 1200–1450) human effigies are unique in the North American Southwest in that they depict primary and secondary sexual traits, making determination of sex and gender roles possible. Here, we build on previous discussions by considering the importance of depictions of clothing (e.g., belts and sashes), personal adornments (e.g., necklaces and bracelets), facial decorations, and other aspects of dress. We find that Medio-period symbolism for males and females was based on gender complementary that combined the productive, reproductive, and ritual activities of men and women within a single symbolic and ritual system. Some clothing styles are found on both males and females (e.g., arm bands), but there are also sex-based differences. Women wear low horizontal belts across their hips, whereas men primarily wear sandals and elaborate headbands. Aspects of dress also appear to be continued from previous cultures such as the Classic Mimbres (A.D. 1000–1150) and continued into historic northern Mexican and southwestern groups (e.g., headgear and some sandal types). Ultimately, we find that males have more elaborate dress and are associated with a specific set of ritually important symbols. Females are associated with cloud/fertility symbolism, sternal decorations, and birds.