Abstract / Summary
Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent among patients with Type 2 diabetes mellitus (T2DM). Although various noninvasive assessment tools for MASLD are currently available, few have been specifically validated in T2DM populations. Furthermore, the role of sex hormones in MASLD and their potential influence on cardiovascular and renal outcomes remain incompletely understood.
Methods: In this cross-sectional study of 731 Chinese patients with T2DM, we evaluated associations of testosterone and estradiol with MASLD, cardiovascular risk, and renal function. Sex hormone-based logistic regression models were constructed and compared with established noninvasive MASLD scores to assess their discriminative performance.
Results: In male patients, higher testosterone, T/E2 ratio, FSH, and LH levels were inversely associated with MASLD, whereas higher DHEA levels were associated with an increased likelihood of MASLD. In female patients, higher DHEA levels were positively associated with MASLD, whereas prolactin showed a modest inverse association. After multivariable adjustment, testosterone remained independently and inversely associated with MASLD in males. Sex hormone-based models demonstrated better discriminative performance than conventional noninvasive scoring systems for MASLD. Additionally, testosterone was inversely associated with the ApoB/ApoA1 ratio in males, whereas estradiol was positively associated with eGFR in females.
Conclusion: In patients with T2DM, testosterone and estradiol showed sex-specific associations with metabolic outcomes. Sex hormone-based models may provide a useful noninvasive approach for MASLD screening and risk assessment in T2DM patients.