In this review, the sex-specific effects of estrogen and testosterone on cardiovascular risk are described to better understand the gender disparities such as the higher incidence of cardiovascular disease (CVD) in men compared to women of similar age and the menopause-associated increase in CVD in women. Sex hormone deficiencies are involved in adipose tissue distribution as to the gynoid shape in women and the android shape in men. This latter adipose tissue distribution is associated with increased abdominal adiposity, an important CVD risk factor. Estrogens have a beneficial vascular effect in men and women. More precisely, estrogens have a positive effect on lipoprotein profile in women and are probably protective against the development of type 2 diabetes and atherosclerosis. Estrogen hormone therapy alone or in combination with progestins in women has a possible protective effect on coronary heart disease if started early after the onset of menopause, but long term data is lacking. On the other hand, testosterone has a similar beneficial effect in men while its effect on women depends on estrogen concentrations. In men, low testosterone is associated with high blood pressure, insulin resistance and the onset of type 2 diabetes while testosterone therapy induces a significant reduction of waist circumference and inflammatory markers. Epidemiological studies have reported that low testosterone levels in men are associated with increased CVD risk but its effect in men depend upon its aromatization with estradiol. Thus, the overall cardiovascular effect of sex hormones seems to be cardioprotective. However, hormonal therapy in post-menauposal women should not be used as a treatment for CVD at this time.
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