Association between ethylene oxide exposure and sex steroid hormone levels in male adults in the United States

Sex steroid hormones play important roles in maintaining our health systems, including reproductive function and developmental health. Ethylene oxide (EtO) is a reactive organic compound that is widely used in the gas sterilization of materials such as foods, spices, and medical devices. Previous studies have suggested that EtO exposure is associated with carcinogenic risk, neurotoxicity, and reproductive toxicity. However, no studies focusing on the relationship between EtO exposure and changes in sex steroid hormone levels have been performed in human. The present study investigated the association between blood EtO levels and serum sex steroid hormone levels in 1,635 adult men from the NHANES 2013-2016. Multivariate linear regression analyses, a positive correlation between blood EtO and total testosterone levels, and the testosterone to estradiol ratio. Moderate EtO exposure was associated with a decrease in estradiol levels, but no relationship was found at the highest exposure range. No significant associations were observed between EtO exposure and free testosterone, bioavailable testosterone, or sex hormone-binding globulin levels. These findings suggest EtO exposure could impact human sex steroid hormone production, although analysis in females and further verification through prospective studies should be performed.