Increase of serum estradiol in cirrhotic men treated by transjugular intrahepatic portosystemic stent shunt

Background/Aims: Liver cirrhosis is frequently associated with sexual dysfunction and hormonal abnormalities. To evaluate the effect of portosystemic shunting on sex steroid serum concentrations, a prospective study was performed in cirrhotic patients treated consecutively and electively by transjugular intrahepatic portosystemic stent shunt (TIPS). Methods: In 27 patients with liver cirrhosis we measured serum levels of testosterone (T), sexual hormone binding globulin (SHBG), luteinizing hormone, follicle-stimulating hormone, dehydroepiandrosterone sulfate, androstenedione (A), estradiol (E2), 17-OH-progesterone and the T/SHBG ratio before and 3 months after TIPS. Results: In men (n=17) 3 months after TIPS, A and E2 significantly increased, with mean serum levels rising from 4.4±2.5 to 5.6±2.9 ng/ml (P=0.04) and from 27±9 to 40±19 pg/ml (P=0.003), respectively. In contrast to A the increase of E2 persisted at 9 and 15 months after TIPS. Erectile dysfunction increased from 30% before TIPS to 70% after TIPS. In women (n=10) A and E2 levels did not change significantly after TIPS. Conclusions: TIPS aggravated hormonal dysbalance of sex steroids in favor of estrogens (hyperestrogenism) in men.