Dilated cardiomyopathy（DCM）exhibits significant gender differences，the incidence is approximately 2-3 times higher in males than in females，and male patients often present with more severe clinical phenotypes and poorer prognoses. As pathogenic genes related to DCM，X chromosome-linked genes（such as DMD，regulated by X chromosome inactivation），Y chromosome-related genes（such as SRY and SOX families），and some autosomal genes（such as TTN，RBM20，LMNA）have higher penetrance or pathogenicity in males. At the molecular level，estrogen exerts cardioprotective effects mainly through estrogen receptor（ER）α/ERβ- mediated activation of the PI3K/Akt signaling pathway，while testosterone，via androgen receptor（AR）signaling，promotes fibrosis and maladaptive cardiac remodeling. Additionally，male patients tend to exhibit greater mitochondrial dysfunction and heightened inflammatory responses. Based on these gender - related molecular mechanisms，researchers have proposed and developed a series of gender-tailored precision therapies，with the aim of providing new approaches for individualized treatment of DCM.