Sex-specific prolactin disturbance and divergent gonadal hormone correlates in first-episode schizophrenia

Background Hyperprolactinemia and altered prolactin (PRL) levels are well-documented in schizophrenia. However, very few studies have investigated sex-specific differences in the prevalence of PRL disturbances in first-episode patients with schizophrenia. This cross-sectional study investigated sex-specific PRL dysregulation and its interplay with gonadal hormones in first-episode schizophrenia patients. Methods One hundred eighty-nine first-episode patients (96 males, 93 females) with minimally treated (≤2 weeks) were recruited. PRL levels and gonadal hormones were measured in all participants. Results We found a significantly higher prevalence of abnormal PRL levels in males compared to females (32.3% vs. 8.6%, χ2 = 16.2, p<.001). Comparative analysis of gonadal hormones between elevated PRL (n = 39) and normal PRL (n = 150) groups demonstrated elevated follicle-stimulating hormone (Z = 2.7, p=.007) and testosterone (Z = 3.7, p<.001) in the hyperprolactinemic group. In the elevated PRL group, PRL positively correlated with progesterone and testosterone, whereas in the normal PRL group, PRL showed positive associations with estradiol and luteinizing hormone, but negative correlations with progesterone. Conclusions Our findings underscore the complex and sex-specific nature of PRL dysregulation and its association with gonadal hormones in first-episode schizophrenia patients.