Abstract Background and aims Hormonal imbalances, particularly in cortisol and testosterone, have been implicated in cardiovascular and cerebrovascular diseases. The cortisol/testosterone (C/T) ratio may reflect stress-related endocrine dysregulation and could influence stroke risk, yet evidence in clinical populations remains limited.This study aimed to evaluate the associations of serum cortisol, testosterone, and the cortisol/testosterone (C/T) ratio with stroke risk. Methods A total of 233 participants were enrolled from Al-Azhar University Hospitals between March 2024 and March 2025. Serum cortisol and testosterone levels were measured using liquid chromatography-tandem mass spectrometry. Logistic regression calculated odds ratios (ORs) for stroke, and restricted cubic splines assessed dose-response relationships between hormone levels and stroke risk. Results After adjusting for confounders, higher testosterone levels were inversely associated with stroke in males (per 1 unit increase, OR = 0.84, 95% CI: 0.71–0.98). In contrast, the serum C/T ratio was positively associated with stroke in both sexes (males: OR = 1.15, 95% CI: 1.03–1.32; females: OR = 1.14, 95% CI: 1.01–1.30). Dose-response analysis indicated a significant linear relationship between testosterone, C/T ratio, and stroke risk in males (P 0.05 for overall association; P 0.05 for nonlinearity). Conclusions In this cohort, serum testosterone was inversely associated with stroke in males, while a higher C/T ratio increased stroke risk in both males and females, highlighting potential hormonal markers for stroke risk stratification and early clinical assessment. Conflict of interest Nothing to disclose
Elsayed Abed (Fri,) studied this question.