Abstract: Steroid hormone synthesis begins with cholesterol as the primary substrate, and occurs mainly in mitochondria and endoplasmic reticulum. As important organelles for energy storage in cells, lipid droplets play a crucial role in maintaining intracellular lipid homeostasis through their dynamic turnover. In steroidogenic cells, cholesterol derived from lipid droplet catabolism is an important source of substrates for steroid hormone synthesis, and the dynamic distribution and quantity changes of lipid droplets can influence the functions of mitochondria and endoplasmic reticulum. Meanwhile, various proteins involved in regulating the formation, catabolism and functional homeostasis of lipid droplets not only maintain the dynamic balance of intracellular lipid droplets, but also participate in the regulation of steroid hormone synthesis. In the clinical application of lipid-lowering drugs such as statins and proprotein convertase subtilisin/kexin type 9 inhibitors, as well as exogenous hormonal drugs including glucocorticoids and oral contraceptives, some patients may exhibit abnormal steroid hormone secretion. This review summarizes the effects of lipid droplets on steroid hormone synthesis, aiming to provide some reference for further understanding the association between intracellular lipid homeostasis and steroid hormone synthesis.