Skyrizi Does Not Decrease Estradiol Levels
There is no evidence that Skyrizi (risankizumab) affects estradiol levels. Risankizumab is a humanized IgG1 monoclonal antibody that specifically targets the p19 subunit of interleukin-23, a mechanism that does not interact with sex hormone production or metabolism 1.
Mechanism of Action
Skyrizi works by inhibiting IL-23-dependent cell signaling in inflammatory pathways relevant to psoriasis, Crohn's disease, and ulcerative colitis 2, 3. This immunologic mechanism has no known effect on:
- Ovarian function
- Steroidogenesis pathways
- Sex hormone-binding globulin (SHBG)
- Estrogen metabolism
Evidence Review
The provided evidence includes:
- FDA drug labels for Skyrizi showing extensive safety and efficacy data for psoriasis, Crohn's disease, and ulcerative colitis 1
- Multiple clinical trials evaluating risankizumab through 6 years of continuous treatment 4
- No reports of hormonal effects or changes in estradiol levels in any clinical trial data
The evidence documents discussing estradiol levels 5, 6, 7, 8 exclusively address:
- Menopausal hormone therapy
- Chemotherapy effects on estradiol
- Hormone replacement therapy formulations
None of these sources mention risankizumab or any IL-23 inhibitors affecting estradiol levels.
Clinical Implications
Patients taking Skyrizi should not expect any changes in their estradiol levels. If estradiol monitoring is clinically indicated for other reasons (such as menopausal symptoms, fertility concerns, or hormone-sensitive conditions), Skyrizi therapy should not confound these measurements.
Important Caveats
- If a patient on Skyrizi experiences symptoms potentially related to hormonal changes, investigate other causes rather than attributing them to risankizumab
- No drug-drug interactions between Skyrizi and hormone therapies (including oral contraceptives or hormone replacement therapy) have been reported
- The extensive safety database through 6 years of treatment shows no endocrine-related adverse events 4