Evaluation of sex hormone profiles and seminal fluid analysis in psoriatic patients and their correlation with psoriasis severity

Background and objective: Psoriasis is a chronic inflammatory skin condition characterized by thick silvery plaques, commonly involving the elbow, knees, lower back, and scalp. Psoriasis also affects the reproductive systems of patients. Males with untreated psoriasis are at risk of impaired fertility due to chronic systemic inflammation, which might affect the hormonal profile and sexual accessory glands. In females, having psoriasis does not affect the chances of getting pregnant. This study aims to assess the effect of psoriasis, as a chronic inflammatory condition, on sex hormone profiles and seminal fluid parameters.

Methods: 87 male patients aged 18−50 with psoriasis who fulfilled the inclusion criteria were included in the study and matched with healthy controls. Demographic and clinical data, including age, severity, duration, and body mass index (BMI) were recorded. All patients underwent a complete physical exam, including a skin and andrological exam, in addition to ultrasound scrotum and seminal fluid analysis. Blood sample tests were conducted for a complete hormonal profile, including luteinizing hormone (LH), follicular stimulating hormone (FSH), testosterone, and estradiol.

Results: The mean age of the case group was 39.5 ± 5.6 years, and the mean BMI was 24.0 ± 2.2. The mean duration of psoriasis was 6.5 ± 3.5 years. The mean levels of testosterone and LH of cases were lower than those of controls, whereas FSH and estradiol were abnormally higher among case groups. Sperm concentration, normal sperm motility, and normal sperm morphology were also found to be lower than in the case group. Age, psoriasis area, and severity index (PASI) scores were significant predictors of sperm concentration (P = 0.000). The BMI was negatively correlated with sperm concentration (−0.249, P = 0.01), motility (−0.198, P = 0.05), and morphology (−0.205, P = 0.05). A negative correlation was found between the PASI score and sperm concentration (−0.519, P = 0.01).

Conclusion: The evaluation of seminal fluid analysis and hormone profiles among psoriasis patients showed marked variability. However, it was evident that the levels of sex hormones and seminal parameters were lower among patients with psoriasis than the healthy controls; this may indicate the possibility of developing sexual dysfunction and infertility among patients with untreated psoriasis. The level of estradiol was found to be abnormally high among psoriasis cases, which may account for a possible compensatory mechanism in ongoing sexual dysfunction among psoriasis patients.

Psoriasis; Semen analysis; Sexual functions; Sex hormones

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