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

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.

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.

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).

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