High estradiol/testosterone ratio increased the risk of metabolic dysfunction‐associated steatotic liver disease in men with type 2 diabetes mellitus

Background The association between estradiol/testosterone (E2/T) ratio and metabolic dysfunction‐associated steatotic liver disease (MASLD) remains controversial. Moreover, few studies have explored their relationship in men with type 2 diabetes mellitus. We aimed to investigate the association of the E2/T ratio with MASLD in type 2 diabetes mellitus male patients. Methods This real‐world observational study was performed in 1441 male type 2 diabetes mellitus patients. MASLD was determined by abdominal ultrasonography. The clinical characteristics and prevalence of MASLD were compared across the E2/T ratio quartiles. The association of the E2/T ratio and quartiles with MASLD was also evaluated using binary logistic regression. Results After adjusting for age and diabetes duration (DD), MASLD prevalence significantly increased across the E2/T ratio quartiles (37.7%, 42.6%, 53.1%, and 69.3%, respectively, P < 0.001 for trend). Fully adjusted logistic regression showed that both the E2/T ratio (OR: 2.201, 95% CI: 1.380–3.511, P = 0.001) and quartiles ( P = 0.001) were positively associated with MASLD in males with type 2 diabetes mellitus. Furthermore, C‐reactive protein (CRP) levels were significantly higher in patients with MASLD compared with those without ( P < 0.001), and obviously increased across the E2/T ratio quartiles after controlling for age and DD ( P = 0.016 for trend). Conclusions The E2/T ratio was independently and positively associated with the increased risk of MASLD in male type 2 diabetes mellitus patients, which may be attributed to the close association between the E2/T ratio and inflammation. The E2/T ratio may serve as a simple and practical indicator to assess the risk of MASLD in male type 2 diabetes mellitus patients.