Evaluation of sex hormone proﬁles and seminal ﬂuid analysis in psoriatic patients and their correlation with psoriasis severity
1Department of General Surgery and Specialized Surgery, Faculty of Medicine, Yarmouk University, 21163 Irbid , Jordan
2Department of Clinical Sciences, Faculty of Medicine, Yarmouk University, 21163 Irbid , Jordan
3Department of Clinical Dermatology, Jordanian Royal medical services, 11855 Amman, Jordan
4Princess Aisha Bint Al-Hussein College of Nursing and Health Sciences, Al-Hussein Bin Talal University, 71111 Maan, Jordan
Submitted: 13 May 2021 Accepted: 24 June 2021
Online publish date: 19 July 2021
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
Mohammad Al-Zubi,Khaled Seetan,Bashar Jarrar,Asem Aldebei,Yousef Rubbai,Salah Daradkeh. Evaluation of sex hormone proﬁles and seminal ﬂuid analysis in psoriatic patients and their correlation with psoriasis severity. Journal of Men's Health. 2021.doi:10.31083/jomh.2021.075.
 Naldi L, Gambini D. The clinical spectrum of psoriasis. Clinics in Dermatology. 2007; 25: 510–518.
 Langley RG, Krueger GG, Griffiths CE. Psoriasis: epidemiology, clinical features, and quality of life. Annals of the Rheumatic Diseases. 2005; 64: ii18–ii23.
 Lomholt G. Prevalence of skin diseases in a population; a census study from the Faroe Islands. Danish Medical Bulletin. 1964; 11: 1–7.
 Henseler T, Christophers E. Psoriasis of early and late onset: characterization of two types of psoriasis vulgaris. Journal of the American Academy of Dermatology. 1985; 13: 450–456.
 Jobling R, Naldi L. Assessing the impact of psoriasis and the relevance of qualitative research. Journal of Investigative Dermatology. 2006; 126: 1438–1440.
 Samet JM, Wipfli H, Platz EA, Bhavsar N. A dictionary of epidemi-ology. 2009. Available at: https://academic.oup.com/aje/article/170/11/1449/116394 (Accessed: 13 August 2020).
 Zachariae H. Pathologic findings in internal organs in psoriasis. International Journal of Dermatology. 1994; 33: 323–326.
 Davidovici BB, Sattar N, Prinz J, Puig L, Emery P, Barker JN, et al. Psoriasis and systemic inflammatory diseases: potential mechanistic links between skin disease and co-morbid conditions. Journal of Investigative Dermatology. 2010; 130: 1785–1796.
 Anderson DJ, Politch JA. Role of Seminal Plasma in Human Female Reproductive Failure: Immunomodulation, Inflammation, and Infec-tions. Advances in Experimental Medicine and Biology. 2015; 868: 159–169.
 Azenabor A, Ekun AO, Akinloye O. Impact of Inflammation on Male Reproductive Tract. Journal of Reproduction & Infertility. 2015; 16: 123–129.
 Pentikäinen V, Erkkilä K, Suomalainen L, Otala M, Pentikäinen MO, Parvinen M, et al. TNF down-Regulates the Fas Ligand and Inhibits Germ Cell Apoptosis in the Human Testis. Journal of Clinical Endocrinology & Metabolism. 2001; 86: 4480–4488.
 Perdichizzi A, Nicoletti F, La Vignera S, Barone N, D’Agata R, Vicari E, et al. Effects of Tumour Necrosis Factor-α on Human Sperm Motility and Apoptosis. Journal of Clinical Immunology. 2007; 27: 152–162.
 Said TM, Agarwal A, Falcone T, Sharma RK, Bedaiwy MA, Li L. Infliximab may reverse the toxic effects induced by tumor necrosis factor alpha in human spermatozoa: an in vitro model. Fertility and Sterility. 2005; 83: 1665–1673.
 Tomaszewska-Zaremba D, Herman A. The role of the immunological system in the regulation of gonadoliberin and gonadotropin secretion. Reproductive Biology. 2009; 9: 11–23.
 Cutolo M, Balleari E, Giusti M, Intra E, Accardo S. Androgen replacement therapy in male patients with rheumatoid arthritis. Arthritis and Rheumatism. 1991; 34: 1–5.
 Wallgren M, Kindahl H, Rodriguez-Martinez H. Alterations in testicular function after endotoxin injection in the boar. International Journal of Andrology. 1993; 16: 235–243.
 O’Bryan MK, Schlatt S, Gerdprasert O, Phillips DJ, de Kretser DM, Hedger MP. Inducible nitric oxide synthase in the rat testis: evidence for potential roles in both normal function and inflammation-mediated infertility. Biology of Reproduction. 2000; 63: 1285–1293.
 Caldarola G, Milardi D, Grande G, Quercia A, Baroni S, Morelli R, et al. Untreated Psoriasis Impairs Male Fertility: a Case-Control Study. Dermatology. 2017; 233: 170–174.
 Cemil BC, Cengiz FP, Atas H, Ozturk G, Canpolat F. Sex hormones in male psoriasis patients and their correlation with the Psoriasis Area and Severity Index. Journal of Dermatology. 2015; 42: 500–503.
 Herrmann M, Scholmerich J, Straub RH. Influence of cytokines and growth factors on distinct steroidogenic enzymes in vitro: a short tabular data collection. Annals of the New York Academy of Sciences. 2002; 966: 166–186.
 Capellino S, Straub RH, Cutolo M. Aromatase and regulation of the estrogen-to-androgen ratio in synovial tissue inflammation: common pathway in both sexes. Annals of the New York Academy of Sciences. 2014; 1317: 24–31.
 Tsilidis KK, Rohrmann S, McGlynn KA, Nyante SJ, Lopez DS, Bradwin G, et al. Association between endogenous sex steroid hormones and inflammatory biomarkers in US men. Andrology. 2013; 1: 919–928.
 Özer İ, Temiz SA, Ataseven A, Dursun R, Uyar M, Özer M. Is prenatal testosterone‐estrogen balance associated with psoriasis? Dermatologic Therapy. 2020; 33: e14213.
 Saad F, Haider A, Gooren L. Hypogonadal men with psoriasis benefit from long-term testosterone replacement therapy—a series of 15 case reports. Andrologia. 2016; 48: 341–346.
 Tengstrand B, Carlström K, Felländer-Tsai L, Hafström I. Abnormal levels of serum dehydroepiandrosterone, estrone, and estradiol in men with rheumatoid arthritis: high correlation between serum estradiol and current degree of inflammation. Journal of Rheumatology. 2003; 30: 2338–2343.
 Straub RH. The complex role of estrogens in inflammation. Endocrine Reviews. 2007; 28: 521–574.
 Ramonda R, Foresta C, Ortolan A, Bertoldo A, Oliviero F, Lorenzin M, et al. Influence of tumor necrosis factor α inhibitors on testicular function and semen in spondyloarthritis patients. Fertility and Steril-ity. 2014; 101: 359–365.
 Ataseven A, Temiz SA, Eren G, Özer İ, Dursun R. Comparison of anti-TNF and IL-inhibitors treatments in patients with psoriasis in terms of response to routine laboratory parameter dynamics. 2020. Available at: https://www.tandfonline.com/doi/abs/ 10.1080/09546634.2020.1801975 (Accessed: 6 June 2021).
 Yiu ZZN, Griffiths CEM, Warren RB. Safety of biological therapies for psoriasis: effects on reproductive potential and outcomes in male and female patients. British Journal of Dermatology. 2014; 171: 485–491.
 Heppt F, Colsman A, Maronna A, Uslu U, Heppt MV, Kiesewetter F, et al. Influence of TNF-alpha inhibitors and fumaric acid esters on male fertility in psoriasis patients. Journal of the European Academy of Dermatology and Venereology. 2017; 31: 1860–1866.
 Perez-Garcia LF, Dolhain R, te Winkel B, Carrizales JP, Bramer WM, Vorstenbosch S, et al. Male Sexual Health and Reproduction in Cutaneous Immune-Mediated Diseases: a Systematic Review. Sexual Medicine Reviews. 2020. (in press)
 Tang W, Zhuang X, Ma L, Qiao J, Hong K, Zhao L, et al. Correlation between body mass index and semen quality in male infertility patients. Turkish Journal of Medical Sciences. 2015; 45: 1300–1305.
 Hargreave TB. Human Infertility. London: Springer. 1994; 52: 1–16.
 Duarte GV, Calmon H, Radel G, de Fátima Paim de Oliveira M. Psoriasis and sexual dysfunction: links, risks, and management challenges. Psoriasis. 2018; 8: 93–99.
 Gham G, Schill WB, Hafez ES. Regulation of male fertility. Nether-lands: Springer. 1980.
 Plessis S, Agarwal A, Sabanegh ES. Male infertility: A complete guide to lifestyle and environmental factors. Netherlands: Springer. 2014.
Science Citation Index Expanded Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.
Social Sciences Citation Index Social Sciences Citation Index contains over 3,400 journals across 58 social sciences disciplines, as well as selected items from 3,500 of the world’s leading scientific and technical journals. More than 9.37 million records and 122 million cited references date back from 1900 to present.
Current Contents - Social & Behavioral Sciences Current Contents - Social & Behavioral Sciences provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in the social and behavioral sciences.
Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.
SCOPUS Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.
DOAJ DOAJ is a community-curated online directory that indexes and provides access to high quality, open access, peer-reviewed journals.
CrossRef Crossref makes research outputs easy to find, cite, link, assess, and reuse. Crossref committed to open scholarly infrastructure and collaboration, this is now announcing a very deliberate path.
Portico Portico is a community-supported preservation archive that safeguards access to e-journals, e-books, and digital collections. Our unique, trusted process ensures that the content we preserve will remain accessible and usable for researchers, scholars, and students in the future.