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

• 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