PURPOSE: To explore the relationship between hormone levels and diabetic retinopathy (DR). METHODS: This cross-sectional study recruited 2432 patients with type 2 diabetes from Tianjin Medical University General Hospital between 2016 and 2019. Logistic regression was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for the association between hormone levels and DR. RESULTS: DR was diagnosed in 953 patients (39.19%), with no significant gender difference in prevalence. Among men, DR prevalence increased with testosterone level increasing (Q4 vs. Q1: odds ratio [OR] = 1.64
95% confidence interval [CI], 1.11-2.41) but decreased with prolactin levels increasing (Q4 vs. Q1: OR = 0.65
95% CI, 0.44-0.96). Among women, high follicle-stimulating hormone (FSH) (Q4 vs. Q1: OR = 2.22
95% CI, 1.40-3.52) and luteinizing hormone (LH) levels (Q4 vs. Q1: OR = 1.77
95% CI, 1.20-2.63) were linked with increased DR prevalence. No associations were found in premenopausal women, but postmenopausal women with high prolactin level had increased DR prevalence (Q2 vs. Q1: OR = 1.56
95% CI, 1.01-2.19). Dose-response relationships were suggested for FSH (P = 0.087) and testosterone (P = 0.088) with DR prevalence, though caution is advised due to the risk of type I error arising from multiple comparisons. Other risk factors included low body mass index (OR = 0.98), smoking (OR = 1.32), long diabetes duration (OR = 1.02), and high systolic blood pressure (OR = 1.01). CONCLUSIONS: Prolactin (negatively) and testosterone (positively) were correlated with DR risk in men. FSH and testosterone showed suggestive dose-response relationship with DR prevalence in postmenopausal women. Further research is needed for type 1 diabetes. TRANSLATIONAL RELEVANCE: Sex hormones play a crucial role in DR development, affecting men and women differently.