Sex differences in cardiac remodeling are significant in both health and disease, influencing clinical outcomes. Biological sex affects heart structure, function, and signaling, with premenopausal women showing greater protection against adverse remodeling. These differences are influenced by sex hormones and chromosomes, with estrogen playing a key role in cardioprotection. Male and female hearts differ in size, geometry, and cellular composition, with females having a higher proportion of certain cell types. Hormonal and genetic factors contribute to these differences, with estrogen and testosterone affecting cardiac function and remodeling. Sex differences in pathological conditions such as pressure overload, volume overload, and ischemia are also well-documented, with males often experiencing more severe outcomes. Genetic heart diseases also exhibit sex-specific patterns, with women generally having better outcomes in some conditions. Future research should focus on understanding the mechanisms of sex differences, particularly the role of sex chromosomes, to improve therapeutic strategies for both men and women. In vitro models and sex-specific diagnostic criteria are needed to better understand and address these differences.Sex differences in cardiac remodeling are significant in both health and disease, influencing clinical outcomes. Biological sex affects heart structure, function, and signaling, with premenopausal women showing greater protection against adverse remodeling. These differences are influenced by sex hormones and chromosomes, with estrogen playing a key role in cardioprotection. Male and female hearts differ in size, geometry, and cellular composition, with females having a higher proportion of certain cell types. Hormonal and genetic factors contribute to these differences, with estrogen and testosterone affecting cardiac function and remodeling. Sex differences in pathological conditions such as pressure overload, volume overload, and ischemia are also well-documented, with males often experiencing more severe outcomes. Genetic heart diseases also exhibit sex-specific patterns, with women generally having better outcomes in some conditions. Future research should focus on understanding the mechanisms of sex differences, particularly the role of sex chromosomes, to improve therapeutic strategies for both men and women. In vitro models and sex-specific diagnostic criteria are needed to better understand and address these differences.