From the Guidelines
Yes, liver disease can increase estrogen levels in the body. The liver plays a crucial role in metabolizing and clearing hormones, including estrogen. When liver function is compromised due to conditions like cirrhosis, hepatitis, or fatty liver disease, the liver cannot effectively break down and eliminate estrogen from the bloodstream. This leads to elevated estrogen levels, particularly in men and postmenopausal women. The phenomenon, sometimes called hyperestrogenism, can manifest in physical symptoms like gynecomastia (enlarged breast tissue in men), spider angiomas (small, spider-like blood vessels visible on the skin), palmar erythema (reddening of the palms), and testicular atrophy in men.
The mechanism involves reduced activity of liver enzymes responsible for estrogen metabolism and decreased production of sex hormone-binding globulin, which normally binds to estrogen in the bloodstream, as noted in a study published in Hepatology in 2021 1. Additionally, in advanced liver disease, portosystemic shunting allows estrogen-containing blood to bypass the liver entirely, further contributing to elevated levels.
Key points to consider include:
- Elevated estrogen levels are more common in men with advanced liver disease, due to increased peripheral conversion of androgens to estrogen 1.
- Women with advanced liver disease may experience altered estrogen metabolism, leading to anovulation, amenorrhea, and infertility 1.
- The use of estrogen-containing agents, such as oral contraceptives, should be avoided in patients with decompensated cirrhosis, Budd-Chiari syndrome, hepatocellular adenomas, and transplant recipients with graft failure 1.
- In patients with non-advanced primary sclerosing cholangitis (PSC), oral contraceptives can be used safely, with regular monitoring of serum liver tests 1.
Treatment focuses primarily on addressing the underlying liver condition rather than directly targeting hormone levels. Addressing the underlying liver disease is crucial to managing elevated estrogen levels and preventing associated complications.
From the Research
Liver Disease and Estrogen Levels
- Liver disease can have a complex relationship with estrogen levels, with some studies suggesting that estrogen plays a protective role in certain forms of liver disease, while others indicate that increased estrogen levels may be implicated in the progression of liver disease 2.
- Estrogen receptors are expressed in the liver, and their impaired expression and function have been linked to obesity and liver-associated metabolic dysfunctions 2.
- Clinical studies have reported increased estrogen levels in patients with chronic liver diseases, although the exact mechanisms underlying this relationship are not fully understood 2, 3.
Specific Liver Diseases and Estrogen
- In polycystic liver disease (PLD), estrogen has been identified as a potential target for future therapies, with evidence suggesting that estrogen supplementation can enhance liver growth and that female sex is a significant risk factor for the presence and severity of the disease 4.
- In primary biliary cholangitis (PBC), the relationship between estrogen and disease progression is less clear, although some studies suggest that hormonal factors may play a role in the development and progression of the disease 5, 6.
Key Findings
- Estrogen receptors are present in human liver tissue and may play a role in the development and progression of liver disease 3.
- Increased estrogen levels have been reported in patients with certain forms of liver disease, including chronic liver diseases and PLD 2, 4.
- Further studies are needed to fully understand the relationship between estrogen and liver disease, particularly in terms of the molecular mechanisms underlying this relationship 2, 4.