Associations between clinically diagnosed testicular hypofunction and systemic lupus erythematosus: a record linkage study.
Pakpoor J., Goldacre R., Goldacre MJ.
Systemic lupus erythematosus (SLE) has a high female predominance with a 9:1 female-to-male sex ratio, but males have poorer clinical outcomes than females. Gonadal hormones may mediate gender differences in SLE, but their role in SLE remains largely uncharacterised. We aimed to investigate a potential association between testicular hypofunction (TH), as a proxy for low testosterone levels, and SLE in males. A retrospective cohort study was conducted by analysing linked English national Hospital Episode Statistics (HES) and mortality data from 1999 to 2011. We calculated rates for SLE following TH, and TH following SLE, stratified and standardised by age, calendar year of first recorded admission, region of residence, and quintile of patients' Index of Deprivation score. The adjusted rate ratio (RR) of SLE following TH was 7.7 (95% confidence interval (95% CI) 2.5-18.1, p