Keloids are a fibroproliferative disorder of the skin and can cause physical discomfort and psychological burden. Apart from local factors such as skin tension and infection, increasing evidence has suggested that systemic endocrine factors also contribute to the emergence and development of keloids. Hormone disorders have long been suspected to be a risk factor;however, previous studies have mainly focused on the role of female hormones and neglected the critical role of male hormones. As we reviewed the published literature addressing sex steroids in pathological scars, we speculated that androgens (i.e., male hormones) could become actively involved through sebum-associated hypersensitivity reactions and acne-derived skin lesions, resulting in persistent cutaneous inflammation. This hypothesis was also supported by previous in vitro studies, in which elevated androgen levels and androgenic receptors were detected in keloid tissues. Moreover, relief of pain and pruritus has been observed in patients with keloids who accidently received anti-androgen treatment for other irrelevant indications. Thus, we propose that androgen-related disorders are critical in the pathogenesis of keloids, and systemic treatment targeting sex hormones may provide long-term benefits for predisposed patients with multiple keloids.