The soy isoflavone genistein attenuates growth factor- and cytokine-stimulated proliferation of both normal and cancer cells. This article reviews our current understanding of the potential mechanisms of action of genistein. In membrane preparations from mammalian cells, genistein is a potent and specific inhibitor of tyrosine autophosphorylation of the epidermal growth factor (EGF) receptor. However, in several cell systems in which it inhibits growth, genistein does not alter tyrosine phosphorylation of the EGF receptor or other tyrosine kinase substrates thought to be involved in signal transduction pathways, suggesting that other mechanisms may be responsible for its action. Alternatives include inhibition of DNA topoisomerase II activity, regulation of cell cycle checkpoints, and antiangiogenic and antioxidant activity. Experiments in our laboratory suggest a new concept, that genistein may inhibit cell growth by modulating transforming growth factor (TGF) beta1 signaling pathways. Such a link between genistein action and TGFbeta1 function is supported by preliminary results of studies in patients with hereditary hemorrhagic telangiectasia (a genetic disorder involving mutations in proteins that regulate TGFbeta receptor complex formation and signaling) in which several patients had dramatic attenuation of their symptoms after 1 wk of ingesting soy-based beverages. These preclinical studies in combination with our cell culture data suggest that the mechanism of genistein involves, if not requires, TGFbeta1-signaling.