Prevention of coronary artery disease in men: male hormone, female hormone, or both?

Sex hormones play an important role in coronary artery disease. Although both male and female hormones have been well-documented to be able to influence vascular biology, the preventive use of sex hormones in CAD is not established. Recent progress suggests a necessity of rethinking of the use of sex hormones for CAD in both sexes. We hypothesize that a long-term and appropriate low-dose combination of male hormone and female hormone could be an effective preventive strategy for men with a high risk of but not developed CAD. This hypothesis is supported by the fact that estrogen has favorable profiles on several key CAD-associated risk factors regardless of sexes. Testosterone supplementation has been linked to a reduced risk of CAD specifically in men. In animal models the reduced risk of CAD in males administrated with testosterone is due to the conversion of testosterone into estrogen; and sex hormone ratio changes rather than each individual sex hormone were found to be the predictor of CAD in a human study, suggesting the importance of a proper ratio of estrogen:testosterone in the development of CAD. In addition, the controversy surrounding the use of hormone replacement therapy in women in turn indicates a potential beneficial effect of sex hormones in men in the prevention of CAD because of the fundamental difference between sexes. Therefore, the combined use of estrogen and testosterone for CAD in men deserves a full investigation and could provide useful information in understanding of the preventive and/or therapeutic application of sex hormones in both sexes.