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Review
. 2024 Jun 12;23(1):e0190.
doi: 10.1097/CLD.0000000000000190. eCollection 2024 Jan-Jun.

Approach to sexual dysfunction in patients with chronic liver disease

Mariko Maxwell  1 , Meagan Alvarado  2 , Vandana Khungar  2
Affiliations
Review

Approach to sexual dysfunction in patients with chronic liver disease

Mariko Maxwell et al. Clin Liver Dis (Hoboken). .
No abstract available

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Conflict of interest statement

The authors have no conflicts to report.

Figures

FIGURE 1
FIGURE 1
HPA and sex hormone axis. (1) Hypothalamic-pituitary-adrenal (HPA) Axis (blue): CRH is released from the hypothalamus in response to stress. CRH then stimulates the pituitary glands to release ACTH, which in turn acts on the adrenal glands to release cortisol and activates a systemic stress response. Elevated cortisol levels act as a negative feedback mechanism on the hypothalamus, shutting down the HPA axis. (2) Sex hormone regulation (green): GnRH from the hypothalamus stimulates the pituitary to produce LH and FSH to stimulate the ovaries and testes. Subsequent testosterone release from the testes provides negative feedback inhibition to the hypothalamus and the pituitary gland, whereas the effects of estrogen release from the ovaries can be inhibitory or stimulating depending on the phase of the reproductive cycle. (3) Impact of chronic liver disease (red): Patients with liver disease have a hyperestrogenic state due to increased levels of SHBG preferentially binding testosterone, in addition to increased peripheral aromatization of androgens to estrogen and increased conversation of testosterone to estradiol in the setting of portal hypertension. Additionally, men with later stages of cirrhosis have lower LH, resulting in decreased stimulation of testosterone release in the testes. Similarly, low levels of LH and FSH can result in anovulation in women due to decreased progesterone secretion. Abbreviations: ACTH, adrenocorticotropic hormone; CRH, corticotropin-releasing hormone; FSH, follicle-stimulating hormone; GnRH, gonadotropin-release hormone; LH, luteinizing hormone; SHBG, sex hormone-binding globulin.
FIGURE 2
FIGURE 2
Workup of sexual dysfunction in chronic liver disease. Abbreviations: FSFI, Female Sexual Function Index; IIEF, International Index of Erectile Function; SSRI, serotonin specific reuptake inhibitor.
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