Background <p>Obesity is strongly associated with increased cardiovascular morbidity and mortality. Although traditional risk factors are incorporated into widely used cardiovascular risk scores such as the Framingham Cardiovascular Risk Score, hormonal alterations accompanying obesity, particularly changes in serum androgen levels, may also contribute to cardiovascular risk. This study aimed to investigate the relationship between serum androgen levels and estimated 10-year cardiovascular risk in individuals with obesity.</p> Methods <p>This retrospective study included 203 adults with obesity followed in an obesity clinic over a five-year period. Demographic, anthropometric, clinical, and laboratory data were collected. Cardiovascular risk was assessed using the Framingham Cardiovascular Risk Score (FRS), and patients were stratified into low, intermediate, and high risk categories. Associations between hormonal parameters and cardiovascular risk were evaluated using correlation analyses, multivariable linear regression models including only non-FRS components, and ordinal logistic regression analyses.</p> Results <p>Serum dehydroepiandrosterone sulfate (DHEAS) levels showed a significant inverse correlation with the FRS in the overall cohort and in both sexes (<i>p</i> &lt; 0.05). In multivariable linear regression analysis adjusted for age, body mass index, HbA1c, triglycerides, and waist-to-hip ratio, DHEAS levels remained independently associated with the Framingham Cardiovascular Risk Score (<i>p</i> &lt; 0.001). DHEAS and estradiol levels decreased across increasing cardiovascular risk categories, whereas body mass index and total testosterone did not differ among risk groups. In ordinal logistic regression, lower DHEAS levels were independently associated with higher cardiovascular risk category (<i>p</i> = 0.005). Age-stratified analyses demonstrated that the inverse association between DHEAS and estimated cardiovascular risk was predominantly observed in individuals aged 30–44 years. Measures of central adiposity demonstrated stronger associations with cardiovascular risk than body mass index.</p> Conclusion <p>Lower serum DHEAS levels are associated with higher estimated cardiovascular risk in individuals with obesity, independent of selected metabolic risk factors. The association appears more pronounced in younger individuals. Central adiposity measures may be more informative than body mass index for cardiovascular risk stratification. Prospective studies are required to determine whether DHEAS independently predicts future cardiovascular events.</p>