The influence of cyclosporine A therapy on sex hormone levels in pre- and post-menopausal women with primary biliary cirrhosis

Abstract

The mechanism underlying sex hormone disturbances in post-menopausal women with primary biliary cirrhosis is unclear, but these alterations may occur as a consequence of liver disease. As cyclosporine may have some therapeutic potential is this condition, we have evaluated short-term alterations in plasma sex hormone levels in 11 pre- and 19 post-menopausal women with primary biliary cirrhosis following randomisation to cyclosporine A or placebo therapy. Baseline sex hormone binding globulin levels were markedly depressed in all pre-menopausal women but were elevated for the post-menopausal group when compared to standard reference ranges. Testosterone and dihydrotestosterone levels were low or markedly depressed in both patient groups. Androstendione concentrations tended to be higher than the normal range in the post-menopausal group. Oestradiol levels were within the normal range for the pre-menopausal group but were relatively higher in the post-menopausal group than in other normal post-menopausal women. Cyclosporine A therapy resulted in significant decreases in sex hormone binding globulin levels (26.6 +/- 5.0 to 16.2 +/- 4.6 nmol/l; p < 0.05) in the premenopausal group and reduction in total (336 +/- 163 to 140 +/- 132 pmol/l; p < 0.01) and free (6 +/- 5 to 2 +/- 3 pmol/l; p < 0.05) oestradiol levels in the post-menopausal group at 6 months. There were no significant alterations in other hormonal parameters. No temporal changes occurred in the placebo group. Cyclosporine A therefore induces significant but variable sex hormone changes in both pre- and post-menopausal women with primary biliary cirrhosis.