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Table 4 Summary of sex hormone effects on Sjögren’s syndrome (SS)

From: Sex differences in Sjögren’s syndrome: a comprehensive review of immune mechanisms

• Estrogen activates B cells increasing autoantibodies and ICs, testosterone inhibits B cells decreasing autoantibodies and ICs
• Some studies report more autoantibodies in women with SS compared to men
• Exocrine gland inflammation is elevated in women with SS compared to men
• SS in women is associated with other ADs that occur predominantly in women like RA, thyroiditis, and Raynaud’s phenomenon
• Lymphoma occurs more frequently in men with SS
• Most cases of SS occur in women following menopause indicating that, in general, estrogen protects against SS prior to menopause
• Prolactin released during pregnancy may increase premenopausal SS cases
• Prolactin acts synergistically with estrogen to increase Ro/SSA and La/SSB
• Low estrogen levels after menopause continue to elevate autoantibodies
• Estrogen protects against SS-like disease in animal models
• The androgen DHEA protects against SS in patients
• Estrogen and DHEA is decreased following menopause when most SS cases occur
• Low estrogen levels correlate with dry mouth and ocular dryness