Can androgen resistance be caused by celiac disease?

Celiac Disease and Androgen Resistance

There is no established evidence that celiac disease directly causes androgen resistance, but celiac disease is associated with multiple endocrine disorders including reproductive abnormalities that could affect androgen function.

Relationship Between Celiac Disease and Endocrine Disorders

Celiac disease is an immune-mediated disorder triggered by gluten consumption in genetically predisposed individuals. It has well-established associations with various endocrine and autoimmune conditions:

Established Endocrine Associations with Celiac Disease

• Autoimmune thyroid disease: 1.5-6.7% prevalence of celiac disease in patients with autoimmune thyroid disease 1
• Type 1 diabetes: 5.4% of individuals with type 1 diabetes have circulating autoantibodies to tissue transglutaminase 1
• Reproductive disorders: Celiac disease is associated with:
  • Delayed menarche
  • Fewer live births
  • Higher rates of miscarriage
  • Unexplained infertility (2.1-4.1% prevalence of celiac disease) 1

Androgen Function and Celiac Disease

While the guidelines do not specifically mention androgen resistance as a direct consequence of celiac disease, research evidence suggests potential connections:

• A study from 1983 found that untreated celiac disease patients showed a pattern of abnormalities indicative of androgen resistance, including:

  • Increased plasma testosterone
  • Reduced dihydrotestosterone (testosterone's potent peripheral metabolite)
  • Raised serum luteinizing hormone 2

• These hormone abnormalities appeared to improve as jejunal morphology improved with treatment of celiac disease 2

• The study noted this pattern of androgen resistance was not present in other disease control groups (Crohn's disease, rheumatoid arthritis, Hodgkin's disease) and appeared relatively specific to celiac disease 2

Clinical Implications and Screening Recommendations

The American Gastroenterological Association recommends:

• Testing for celiac disease should be considered in symptomatic individuals who are at high risk 1
• Adult patients with type 1 diabetes should be screened for celiac disease in the presence of gastrointestinal symptoms, signs, or laboratory manifestations suggestive of celiac disease 1
• Celiac disease screening is recommended in individuals with autoimmune disease and accompanying symptoms suggestive of celiac disease 3

Diagnostic Approach

If androgen resistance is suspected in a patient with potential celiac disease:

1. Serologic testing: IgA tissue transglutaminase antibody (tTGA) is the preferred initial test 1
2. Confirm with biopsy: If serology is positive, upper endoscopy with duodenal biopsies is recommended 1
3. Endocrine evaluation: Measure testosterone, dihydrotestosterone, sex-hormone binding globulin, and luteinizing hormone levels

Treatment Considerations

• Gluten-free diet: Essential for treating celiac disease and may improve associated endocrine abnormalities 1
• Nutritional supplementation: May be necessary to address deficiencies that could affect hormone function 4
• Endocrine monitoring: Regular follow-up of hormone levels to assess improvement after celiac disease treatment

Key Pitfalls to Avoid

• Failing to consider celiac disease in patients with unexplained reproductive or endocrine disorders
• Initiating a gluten-free diet before completing diagnostic testing (can lead to false-negative results) 1
• Attributing all symptoms to a single condition without considering comorbidities

In summary, while direct causation between celiac disease and androgen resistance is not definitively established in current guidelines, research suggests a specific pattern of androgen abnormalities in celiac disease that improves with treatment. Clinicians should consider screening for celiac disease in patients with unexplained androgen resistance or reproductive disorders.