# Hormonal transitions across the lifespan shape susceptibility to Sjogren’s disease

## TL;DR

Hormonal changes throughout life influence the likelihood of developing Sjogren’s disease, with sex differences in prevalence linked to natural hormone fluctuations.

## Contribution

This study reveals that age-related hormonal transitions, not static hormone levels, correlate with sex-specific Sjogren’s disease risk.

## Key findings

- Male prevalence of SjD peaks in early childhood and declines during puberty, aligning with testosterone and estradiol trajectories.
- Hormone levels in SjD patients and controls are not significantly different, suggesting physiological transitions—not abnormal levels—drive risk.
- The female-to-male prevalence ratio shifts with age, challenging the traditional 9:1 sex bias in SjD.

## Abstract

Sjogren’s disease (SjD) shows a strong female predominance, but the contribution of age-related hormone changes to this sex bias remains uncertain. We investigated whether natural hormonal transitions across the lifespan align with variation in male and female prevalence of SjD.

Electronic health records from 101 856 SjD patients and 1.33 million controls were analysed. Sex-specific prevalence was compared with serum testosterone, oestradiol and SHBG levels. Population-level hormone distributions from the National Health and Nutrition Examination Survey (NHANES) were incorporated using imputation. Generalized linear models evaluated associations between hormone fluctuations and sex prevalence across age groups.

Male prevalence among SjD patients peaked during early childhood (30.1% [95% CI: 26.2–34.1]), declining sharply in late puberty into adulthood (9.8% [95% CI: 9.5–10.2]) and rose again in older adults (13.5% [95% CI: 13.3–13.8]). These non-linear shifts paralleled age-dependent trajectories of testosterone and oestradiol. Hormone concentrations did not differ significantly between SjD patients and controls, indicating that physiological transitions, rather than abnormal levels, align with disease risk.

Age-dependent hormonal changes correspond with evolving sex bias in SjD, challenging the static 9:1 female-to-male paradigm. These findings highlight the role of age-related hormonal dynamics in shaping autoimmune susceptibility.

Graphical Abstract