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The general population is voluntarily or unintentionally exposed to heavy metals through ingestion of food, polluted water, or contact with soil, dust, or polluted air. A number of metals are considered as endocrine disruptors and can alter the level of reproductive hormones. This study aims to systematically review the epidemiological studies on the association between heavy metals exposure and sex hormones level. We conducted a systematic search from available databases, including PubMed, Clarivate Web of Science, Scopus, Google Scholar, and Cochrane Collaboration, until April 2021. The relevant studies were selected, and two reviewers conducted the quality assessment. Then, data were extracted based on the inclusion criteria. We identified nine articles related to the association between heavy metals exposure and sex hormones level. We summarized the relevant information. Due to the diversity of metals and the variety of sex hormones, the effect of exposure on hormones level was not clear; however in most studies, at least for one metal, a significant association (inverse or positive) was observed between metals exposure and hormones level. Heavy metals exposure may potentially alter sex hormone levels; however, further research is needed to evaluate the impact of this association., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)