Association Between Circulating Levels of Sex Steroid Hormones and Barrett's Esophagus in Men: A Case-Control Analysis

Michael B. Cook*, Shannon N. Wood, Brooks D. Cash, Patrick Young, Ruben D. Acosta, Roni T. Falk, Ruth M. Pfeiffer, Nan Hu, Hua Su, Lemin Wang, Chaoyu Wang, Barbara Gherman, Carol Giffen, Cathy Dykes, Veronique Turcotte, Patrick Caron, Chantal Guillemette, Sanford M. Dawsey, Christian C. Abnet, Paula L. HylandPhilip R. Taylor

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

32 Scopus citations


Background and Aims: Esophageal adenocarcinoma is believed to result from the progression of gastroesophageal reflux disease to erosive esophagitis and re-epithelialization of the esophagus with a columnar cell population termed Barrett's esophagus (BE). Men develop BE and esophageal adenocarcinoma more frequently than women, yet little is known about the mechanisms of this difference. We assessed whether sex steroid hormones were associated with BE in a male population. Methods: We analyzed data from the Barrett's Esophagus Early Detection Case Control Study, based at the Walter Reed National Military Medical Center. Blood samples were collected from 174 men with BE and 213 men without BE (controls, based on endoscopic analysis); 13 sex steroid hormones were measured by mass spectrometry and sex hormone binding globulin was measured by enzyme-linked immunosorbent assay. We also calculated free estradiol, free testosterone, and free dihydrotestosterone (DHT). We used multivariable logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for age, race, smoking status, alcohol consumption, body mass index, heartburn, regurgitation, and gastroesophageal symptom score (excluding heartburn and regurgitation). Results: Levels of free testosterone and free DHT were associated positively with BE risk; patients in the highest quartile for these hormones were most likely to have BE (free testosterone: OR, 5.36; 95% CI, 2.21-13.03; P= .0002; free DHT: OR, 4.25; 95% CI, 1.87-9.66; P= .001). Level of estrone sulfate was associated inversely with BE risk (P for trend= .02). No other hormone was associated with BE risk. Relationships were not modified by age or BMI. Conclusions: In an analysis of men, levels of free testosterone and free DHT were significantly associated withBE.

Original languageEnglish
Pages (from-to)673-682
Number of pages10
JournalClinical Gastroenterology and Hepatology
Issue number4
StatePublished - 1 Apr 2015
Externally publishedYes


  • Cancer Risk
  • Esophageal Neoplasms
  • Gonadal Steroid Hormones
  • SHBG


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