Sex differences in cognitive ability level and cognitive ability pattern or tilt (e.g., math > verbal) have been linked to educational and occupational outcomes in STEM and other fields. The present study examines cognitive ability tilt across the last 35 years in 2,053,265 academically talented students in the U.S. (SAT, ACT, EXPLORE) and 7119 students in India (ASSET) who were in the top 5% of cognitive ability, populations that largely feed high level STEM and other occupations. Across all measures and samples, sex differences in ability tilt were uncovered, favoring males for math > verbal and favoring females for verbal > math. As ability tilt increased, sex differences in ability tilt appeared to increase. Additionally, sex differences in tilt increased as ability selectivity increased. Broadly, sex differences in ability tilt remained fairly stable over time, were consistent across most measures, and replicated across the U.S. and India. Such trends should be carefully monitored given their potential to impact future workforce trends.