Objectives <p>It is yet unknown how steroidal hormones from male sex interact with rheumatoid arthritis (RA). Thus, the primary goal of this study was to look into any possible connections between RA and sex-steroidal hormones.</p> Methods <p>The data utilized in this study was obtained from the National Health and Nutrition Examination Survey (NHANES) conducted from 1999 to 2004. After fasting overnight, blood samples were collected from the participants. These samples were tested for levels of male sex steroid hormones, including total E2, testosterone (TT), and sex hormone binding globulin (SHBG). The free androgen index (FAI) was calculated using the TT to SHBG ratio. A self-report questionnaire was also used to establish the diagnosis of RA. The possible relationship between sex steroid hormones and the incidence of RA was investigated by multivariate logistic regression analyses, as well as in-depth subgroup analyses of the stability of this relationship in different subgroups. Additionally, the analysis of receiver operating characteristic (ROC) curves was utilized to investigate the potential impact of sex steroid hormones on the detection of RA.</p> Results <p>A total of 758 male participants were ultimately included in the study, 34 of whom had RA. The latest research results suggested that an elevated FAI was associated with a lower occurrence of RA, with an odds ratio of 0.88 and a 95% confidence interval of (0.80, 0.97). This association was consistent across the remaining subgroups except for race (P &gt; 0.05 for all interactions). ROC curves revealed that steroids have approximately 76% diagnostic value for RA.</p> Conclusion <p>In adult males in the US, the FAI is positively correlated with RA. Large-scale prospective studies are required to properly examine the role that the FAI plays in RA.</p>