Sex Hormones in Psoriatic Disease: A Systematic Review.

In 30 seconds

This PRISMA-guided systematic review assessed clinical associations and immunomodulatory roles of sex hormones in psoriasis (PsO) and psoriatic arthritis (PsA), including clinical and supportive preclinical evidence. It included 72 studies. High-estrogen states such as pregnancy were associated with improvement or low disease activity in PsO, whereas postpartum and menopause were identified as periods of greater relapse risk. Evidence for PsA and menopausal hormone therapy was limited or inconsistent. Reduced testosterone in males was frequently reported and may relate to disease severity and comorbidities.

Key findings

• The review included 72 studies of hormonal factors in PsO and PsA.
• PsO often improved or had low activity during pregnancy; postpartum and menopause were associated with greater relapse risk.
• Evidence on PsA was limited and inconsistent, although postpartum may be a higher-risk period for worsening.
• Reduced circulating testosterone was frequently reported in males and may be associated with disease severity, metabolic comorbidities, and reproductive dysfunction.

Why it matters

Hormonal transitions may coincide with meaningful changes in PsO activity, while androgen and prolactin pathways may also be relevant to disease biology. Recognising these associations can inform clinical awareness of periods when symptoms may change. However, the review highlights substantial uncertainty, particularly for PsA and hormone-based interventions, so these findings do not establish hormonal causation.

What to keep in mind

The review reports that evidence for PsA and menopausal hormone therapy is limited or inconsistent; the included evidence spans clinical and supportive preclinical studies.