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Data availability All the data in the present analysis is available at NHANES website Abbreviations NHANES: National Health and Nutrition Examination Survey TST: testosterone EST: estrogens SHBG: sex hormone-binding globulin CDC: Centers for Disease Control and Prevention NCHS: National Center for Health Statistics ID-HPLC-APCI-MS/MS: isotope-dilution high-performance liquid chromatography/atmospheric pressure chemical ionization tandem mass spectrometric LLOD: lower limit of detection ID-LC-MS/MS: isotope dilution liquid chromatography tandem mass spectrometry BMI: body mass index RCS: restricted cubic spline SD: standard deviation References GBD 2019 Diseases and Injuries Collaborators

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