Purpose of Review

Given the potential for exogenous hormones to influence risk and course of MS, this narrative review aims to summarize current knowledge from observational and interventional studies of exogenous hormones in humans with MS.

Recent Findings

Large randomized clinical trials for combined oral contraceptives and estriol both show modest effect on inflammatory activity, with the latter showing potential neuroprotective effect. After fertility treatment, large actively treated cohorts have not confirmed any elevated risk of relapse. Preclinical data suggest that androgens, selective estrogen receptor modulators (SERMs), and selective androgen receptor modulators (SARMs) may be neuroprotective but clinical data are lacking. Gender affirming treatment, particularly estrogen in trans-women, could possibly be associated with elevated risk of inflammation. For women with MS entering menopause, hormone therapy appears safe during the appropriate menopausal window, but its long-term effects on neuroprotection are unknown.

Summary

Exogenous hormones, used in varied doses and for diverse indications, have variable effects on MS risk, inflammatory activity, and neuroprotection. Large randomized trials are needed before it is possible to determine the true effect of exogenous hormones in a condition as complex as MS.

中文翻译：

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多发性硬化症的激素疗法：临床数据回顾

 审查目的

鉴于外源性激素可能影响多发性硬化症的风险和病程，这篇叙述性综述旨在总结目前对多发性硬化症患者外源性激素的观察和干预研究的知识。

 最近的发现

联合口服避孕药和雌三醇的大型随机临床试验均显示出对炎症活动的适度影响，而后者则显示出潜在的神经保护作用。生育治疗后，大量积极治疗的队列尚未证实复发风险有任何升高。临床前数据表明，雄激素、选择性雌激素受体调节剂（SERM）和选择性雄激素受体调节剂（SARM）可能具有神经保护作用，但缺乏临床数据。性别肯定治疗，尤其是跨性别女性的雌激素，可能与炎症风险升高有关。对于进入更年期的多发性硬化症女性来说，激素治疗在适当的绝经窗口期似乎是安全的，但其对神经保护的长期影响尚不清楚。

 概括

外源激素以不同剂量和不同适应症使用，对多发性硬化症风险、炎症活动和神经保护具有不同的影响。需要进行大型随机试验才能确定外源激素对多发性硬化症这样复杂的病症的真实作用。