The Impact of Cirrhosis Severity and Spironolactone on Sex Hormone Levels in Men.

BACKGROUND AND AIMS: Men with cirrhosis frequently experience endocrine dysfunction which is worsened with use of spironolactone for ascites. Both decreased testosterone and increased estrogen levels have been incriminated for these effects.

METHODS

A cross-sectional study was conducted on 45 men with cirrhosis. A comprehensive clinical assessment of cirrhosis severity and sex hormone profile [total testosterone (TT), free testosterone (FT), total estrogen, estrone (E1), estradiol (E2) levels, and ratios] were performed. The relationship between cirrhosis severity and spironolactone therapy (ST) with hormone levels was assessed.

RESULTS

Forty-five men with cirrhosis (age 31-76 years, mean 60.3 ± 8.6) were evaluated, including 17 on ST and 28 not on (no history of spironolactone therapy). Low testosterone and elevated estrogen levels were present in 12 (26.7%) and 29 (65.9%) of the subjects, respectively. Elevated E1 and E2 levels were found in 26 (57.8%) and 19 (43.2%) of subjects, respectively. Cirrhosis severity and ST were not associated with T levels but were with elevated E levels and E/T ratios. Total estrogen, E1, and E2 levels and E1/TT and E1/FT ratios were higher in those with Child-Turcotte-Puch class B/C compared to those with class A cirrhosis (P < .05). E1 level was the only predictor of Child-Turcotte-Puch class B/C cirrhosis on multivariate analysis (P = .035). Subjects with Na-model for end-stage liver disease ≥15 had higher E1/TT and E1/FT ratios than those with Na-MELD <15 (P = .013 and P = .022, respectively). ST was associated with increased E1, E2 levels and E1/TT, E1/FT, E2/TT, and E2/FT ratios among subjects with Na-MELD <15 (P < .05).

CONCLUSION

Increased estrogen levels, especially E1, correlate with cirrhosis severity and ST.