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Prolactin and estradiol levels are elevated in patients with active systemic lupus erythematosusHormone levels vary in people with systemic lupus erythematosus

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Key Takeaway
Note that prolactin and estradiol are elevated in active SLE, while DHEA-S is lower in SLE patients.

This meta-analysis evaluated reproductive hormone levels in 5389 individuals with systemic lupus erythematosus (SLE) compared to healthy controls and between active and inactive disease states. The analysis focused on several hormones, including prolactin, estradiol, DHEA-S, FSH, LH, DHEA, and androstenedione.

Key findings indicate that prolactin is significantly higher in SLE patients (MD 8.07 ng/mL; 95% CI 4.69-11.45; p < 0.001) and specifically higher during flares (MD 5.83 ng/mL; 95% CI 3.88-7.78; p < 0.001). Estradiol was significantly higher in women with active disease (MD 8.55 pg/mL; 95% CI 1.37-15.73; p = 0.03). Conversely, DHEA-S was lower in SLE patients (MD -1.00 μg/mL; 95% CI -1.5 to -0.50; p = 0.002). While FSH and LH were higher in men with SLE, specific effect sizes were not reported.

The authors note several limitations, including inconsistent results for several hormones and a lack of longitudinal studies. Only three small, heterogeneous studies evaluated hormonal changes during flares, and few studies evaluated DHEA-S dynamics during flares. These findings suggest that prolactin excess and androgen deficiency are consistent features of SLE, particularly in women, while elevated gonadotropins are primarily observed in men.

How this fits prior evidence

This meta-analysis addresses a gap in understanding the hormonal profile of systemic lupus erythematosus (SLE). While previous evidence identified galectin-3 as an associated biomarker in SLE, this study provides specific data on reproductive hormones. It confirms that hormonal imbalances, specifically prolactin and estradiol, are associated with active disease states in SLE patients.

Living with systemic lupus erythematosus (SLE) involves more than just managing joint pain or fatigue. It can also impact the body's hormonal balance. A large review of data from over 5,000 people helped clarify how specific hormones behave in those with this condition compared to healthy individuals.

Researchers found that people with SLE often have higher levels of prolactin, a hormone involved in reproduction and milk production. These levels were even higher during active flares of the disease. In women with active SLE, estradiol levels were also significantly higher. Meanwhile, men with the condition showed higher levels of FSH and LH, which are hormones that help regulate reproductive cycles.

While these findings show clear patterns, the evidence is still growing. Some hormone levels showed inconsistent results across different studies, and very few studies looked at how hormones change specifically during a flare. Because these results are based on associations rather than direct causes, talk to your doctor to see how these patterns might affect your specific health journey.

What this means for you:
People with lupus often show higher prolactin and estradiol levels, especially during active disease flares.

Common questions

How do hormone levels change during a lupus flare?

During an active flare of systemic lupus erythematosus, patients showed significantly higher levels of prolactin and estradiol. However, because only three small studies looked at hormonal changes during flares, the full picture of how hormones behave during these periods is still being studied.

Are there specific hormones that differ in men with lupus?

Yes, the data showed that men with systemic lupus erythematosus had higher levels of FSH and LH. These are hormones that help regulate the reproductive system. These findings help doctors better understand how the condition affects different people.

What is prolactin and why does it matter in lupus?

Prolactin is a hormone involved in reproduction. The study found that people with systemic lupus erythematosus had higher prolactin levels than healthy people, with even higher levels during active disease flares. This is a consistent feature of the condition, especially in women.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedOct 2026
View Original Abstract ↓
BACKGROUND: Systemic lupus erythematosus (SLE) shows a marked female predominance during reproductive years, possibly suggesting hormonal factors in its pathogenesis. However, evidence regarding reproductive hormone alterations in SLE remains inconsistent. OBJECTIVES: To systematically review studies assessing reproductive hormone levels in adult SLE patients compared with healthy controls and across disease activity states. METHODS: Following PRISMA guidelines and a pre-registered protocol (PROSPERO CRD42024544730), PubMed and Scopus were searched (May 2024). Eligible observational studies reported estradiol, testosterone, progesterone, prolactin, FSH, LH, DHEA-S, DHEA or androstenedione in SLE patients versus controls or by disease activity. Random-effects meta-analyses were conducted. RESULTS: Eighty-three studies were included (5389 individuals for SLE vs. controls; 2067 for active vs. inactive SLE). Prolactin was consistently higher in SLE (MD 8.07 ng/mL; 95% CI 4.69-11.45; p < 0.001) and even more during flare (MD 5.83 ng/mL; 95% CI 3.88-7.78; p < 0.001). Estradiol showed non-significant overall elevations but was significantly higher in women with active disease (MD 8.55 pg/mL; 95% CI 1.37-15.73; p = 0.03). DHEA-S was found to be significantly lower in SLE (MD -1.00 μg/mL; 95% CI -1.5 to -0.50; p = 0.002) but too few studies evaluated its dynamics during flares. FSH and LH were significantly higher in men with SLE. Other hormones were inconsistent. Only three small heterogeneous studies evaluated hormonal changes during flares. CONCLUSIONS: Prolactin excess and androgen deficiency are consistent features of SLE, particularly in women, while elevated gonadotropins are mainly seen in men. Estradiol is higher during active disease but other data are inconsistent. Longitudinal studies are limited, with prolactin the only hormone consistently linked to disease activity and full hormonal profiles during flares are largely unstudied.
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