Serum Testosterone and Estradiol in Men with Psoriasis and Their Association with Disease Severity among Adult Male Patients.

Psoriasis is a chronic, immune-mediated systemic disease with skin manifestations and multisystem involvement, including effects on the reproductive system. Its pathogenesis involves genetic, environmental, and immunological factors. Cytokines (TNF-α, IL-1, IL-6, IFN-γ) released during inflammation inhibit Leydig and Sertoli cells of testes and affect aromatase activity, leading to testosterone and estradiol imbalance. The study was designed to evaluate serum testosterone and estradiol levels in male psoriasis patients and their association with disease severity. This cross-sectional analytical study was conducted in the Department of Biochemistry, Dhaka Medical College from July 2023 to June 2024 with 50 diagnosed male psoriatic patients (Group A) and 50 healthy controls (Group B) selected from Out-Patient-Department of Dhaka Medical College Hospital. The study subjects were matched according to age, sex and other socio-demographic factors. Subjects were assessed via history, examination, and biochemical tests. Disease severity was evaluated using Psoriasis Area and Severity Index (PASI) and erectile dysfunction via International Index of Erectile function (IIEF-5) questionnaire. Serum total testosterone and estradiol were measured by competitive fluorescence immunoassay. Mean ages were 33.04±6.02 years (Group A) and 29.64±5.71 years (Group B). In Group A, 44.0% had mild (PASI <10) and 56.0% had moderate-severe (PASI ≥10) psoriasis; 26% had a family history and 34% reported erectile dysfunction. Median testosterone was 1.9ng/ml in Group A vs. 6.4ng/ml in Group B (p=0.001) and estradiol was 7 pg/ml vs. 18.5 pg/ml (p=0.003). Moderate-severe psoriasis patients had lower testosterone (1.7ng/ml) and estradiol (4.6pg/ml) than mild cases (3.7ng/ml and 8.8pg/ml, respectively). PASI scores showed significant negative correlations with testosterone (rho = -0.809, p=0.001) and estradiol (rho = -0.715, p=0.001). Psoriasis severity was significantly associated with erectile dysfunction. Male psoriatic patients have significantly lower testosterone and estradiol levels than healthy controls, with severity negatively correlating with both hormones and associated with erectile dysfunction.