Heart failure (HF) is a significant cause of morbidity and mortality. Although there are inconsistencies, epidemiological studies have implicated sex hormones (SHs) in pathways that are linked to HF. The age-related decline in SH levels causes physiological changes that differentially impact HF risk in both sexes. Conversely, SHs are tightly regulated by complex feedback loops that become disrupted in chronic HF to create a vicious cycle that further worsens the HF syndrome. By altering the androgenic balance, SHs exert variable effects that could impact HF risk in men and women. Further studies are needed to clarify whether measurement of SH levels can identify future HF patients for early intervention, as well as HF patients who may benefit from more intensive treatments.