Despite extensive studies of lifestyle and dietary habits, little is known of the function of steroid hormones in the development of coronary heart disease in men. This study reports plasma hormone and lipid levels in rural vegetarian South African black men at low risk for coronary heart disease and in North American black and white men at high risk for coronary heart disease, and the effect of diet modification of these parameters. Black South African men had lower plasma cholesterol and triglyceride levels, higher high-density lipoprotein cholesterol and estradiol and lower urinary estrogen and androgen excretion than North American black and white men. Feeding a Western diet to black South African men increased triglyceride and cholesterol, decreased the percentage of high-density lipoprotein cholesterol plasma testosterone, and increased the urinary excretion of testosterone, while in black North American men a vegetarian diet decreased plasma lipids and the urinary excretion of testosterone. Young menstruating black South African women who were also studied for the comparison of the sexes had higher plasma estradiol levels but comparable plasma lipid levels to their North American counterparts. Data indicated plasma estrogen and androgen metabolism in men can be altered by diet and that application of the 'risk prone' Western diet may alter steroid hormone metabolism which alters lipoprotein metabolism and increases the risk of coronary heart disease.