Abstract
Systemic lupus erythematosus (SLE) has a high female predominance with a 9:1 female-to-male sex ratio, but males have poorer clinical outcomes than females. Gonadal hormones may mediate gender differences in SLE, but their role in SLE remains largely uncharacterised. We aimed to investigate a potential association between testicular hypofunction (TH), as a proxy for low testosterone levels, and SLE in males. A retrospective cohort study was conducted by analysing linked English national Hospital Episode Statistics (HES) and mortality data from 1999 to 2011. We calculated rates for SLE following TH, and TH following SLE, stratified and standardised by age, calendar year of first recorded admission, region of residence, and quintile of patients’ Index of Deprivation score. The adjusted rate ratio (RR) of SLE following TH was 7.7 (95% confidence interval (95% CI) 2.5–18.1, p < 0.0001). The adjusted RR for TH following SLE was 6.5 (95% CI 2.1–15.1, p < 0.0001). The positive association between TH and SLE supports a hypothesis that low testosterone levels may influence the development of male SLE. Of clinical importance, it suggests that males with SLE are at increased risk of co-morbid TH (regardless of which precedes which) and this may warrant consideration in the management of patients.
Highlights
The demographic profile of systemic lupus erythematosus (SLE) is an interesting, distinctive feature of the disease
We aimed to investigate a potential association between testicular hypofunction (TH), as a proxy for low testosterone levels, and SLE in males using a linked dataset of English national hospital records
The strong positive association between TH and SLE gives some support to a hypothesis that low testosterone levels may influence the development of male SLE
Summary
The demographic profile of systemic lupus erythematosus (SLE) is an interesting, distinctive feature of the disease. Gonadal hormones may be important in mediating gender differences in SLE and may contribute to its likely complex multifactorial pathophysiology incorporating genetic, hormonal, and environmental factors. This notion is supported by animal models of autoimmune diseases suggesting a potential immune-modulatory role of testosterone [5]. Some cross-sectional studies have suggested lower testosterone levels in both males and females with SLE [8,9,10]. We aimed to investigate a potential association between testicular hypofunction (TH), as a proxy for low testosterone levels, and SLE in males using a linked dataset of English national hospital records
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