Sex Differences in Cardiac Disease: Pathophysiology, Presentation, Diagnosis and Management: Chapter 25: Sex Hormones and Their Impact on Cardiovascular Health

Elsevier, Sex Differences in Cardiac Diseases, 2021, Pages 539-565
Sasha De Jesus, Eugenia Gianos, Stephanie Trentacoste McNally, Dawn C. Scantlebury, and Stacey E. Rosen

The sex steroids (hormones), the androgens, estrogens, and progestogens, are all present to variable levels in each sex. Aside from typically considered feminizing and masculinizing effects, through their interactions with the sex steroid receptors present in the heart and vasculature, and their metabolic effects, they play a vital role in cardiovascular (CV) health. These effects are complex, with both negative and positive effects being noted. Endogenous estrogen in women appears to infer protection from cardiovascular disease (CVD), but exogenous estrogen has been associated with increased CVD risk. Androgens appear to exert positive effects on the vasculature and myocardium and reduced testosterone levels are associated with higher CVD risk. However, exogenous testosterone shows mixed effects on CV outcomes. Therapies targeting hormones include menopause hormonal therapy, testosterone replacement therapy, hormonal antagonism in the treatment of cancer, contraception, and gender-affirming therapy in transgender individuals. The varying effects of hormonal manipulation on CV health mandate a methodical and integrated approach to their use, considering comorbidities and patient risks.