It is well established that androgen concentrations are low in patients with rheumatoid arthritis (RA).1 There are three possibilities: (1) Low androgen values are a consequence of RA. (2) Low androgen values are a consequence of its treatment. (3) Low androgen values are a partial cause of RA.

Undoubtedly the facts are complex, but in what I take to be an excess of methodological correctness, Masi et al¹ write: ‘The available evidence reviewed does not allow definitive response to the question of a primary versus secondary role of sex hormone perturbations in RA’. I shall treat the three above possibilities in turn to suggest that (in contrast with Masi et al 1) a definitive response is possible.

(1) Low androgen concentrations in men are a consequence of many forms of illness² including severe inflammatory disease,3 so it may be accepted that …