Estrogen as a therapeutic agent: Targeting endotheliopathy and coagulopathy in trauma

The evidence suggests that estrogen plays a critical, context-dependent role. One of the most compelling benefits is estrogen's capacity to maintain endothelial integrity, thereby correcting trauma-induced endotheliopathy. This mechanism, coupled with its inherent procoagulant effect, underlies the observed female survival advantage. Targeting this sex-based mechanism is a promising avenue to enhance trauma management. Future large-scale, randomized controlled trials are needed to validate the efficacy of direct estrogen supplementation and the strategic utilization of female-donated blood products in trauma resuscitation.