October 12, 2004

Sex hormones in psychotic men

Sex hormones in psychotic men
Thomas J. Hubera, Christian Tettenborna, Eckhard Leifkeb and Hinderk M. Emrich
Psychoneuroendocrinology, Volume 30, Issue 1 , January 2005, Pages 111-114

The authors of this study wanted to look at hormone levels in male patients with psychosis because there has been a theory that estrogen (the female sex hormone) has some kind of protective effect on women. Women with psychosis often have lower levels of estrogen (or similar compounds) in their blood compared to healthy controls. Estrogen may have an impact on the dopamine system (the neurotransmitter in the brain most closely linked to psychosis.) The significance of this observation is not known, but nevertheless the observation has at least been made.

It has also been seen that excess androgens (male sex hormones, like testosterone) can lead to psychosis. Perhaps this is best seen when people take steroids which are similar structurally to male sex hormones and can have profound side effects on their thinking. While certain hormones are often referred to as "male" or "female" sex hormones, it should be noted that while they may be in higher concentrations in particular sexes, both sexes produce an amount of these hormones and they serve various different and similar functions in both sexes.

The authors of this study took blood samples from 34 consecutive male inpatient admissions who met criteria for inclusion (no major medical illnesses, no substance abuse, could not be currently manic, etc.) hormones studied were testosterone, free testosterone, estradiol, oestrone, luteinizing hormone (LH) and follicle stimulating hormone (FSH). They were compared with 34 age and size (BMI) matched controls who were similar in as many ways as possible with the inpatients but they did not have a psychotic disorder.

The study showed that men with psychosis had a statistically significant lower level of estradiol and estrone (which are relatives of estrogen that circulate in the blood) compared to the controls. Both groups had similar levels of testosterone and male sex hormones. Some antipsychotic drugs can influence the production of sex hormones and the authors tried to exlude those effects by excluding patients on the drugs that cause the most significant effect. However, it is possible that some of the effect nonetheless may be due to the influence of the hormone prolactin. Prolactin increases when dopamine is blocked (which is the general mechanism of antipsychotic medications.) Increased prolactin (which is a hormone that regulates breast tissue growth and milk production in women) can have an influence also on the menstrual cycle and on female sex hormone production and likewise may have an impact on the estrogen levels in men. Prolactin levels were not measured in this study and the hormone's effect therefore is not certain in the results. Also, the levels of hormones in the blood may not necessarily correlate exactly with the levels that are around the brain and that could have an impact. Also, this is a small study and so the ability of this study to predict for all people with psychosis is limited.

Ultimately this is an interesting study that at this point does not influence the treatment of schizophrenia. As hormone replacement therapy is currently controversial, and has been shown to have many side effects, this study should not be used as the basis for taking estrogen or estrogn-like products (soy, black cohosh, etc.) to help with psychosis.

Click here to find this article on PubMed

Author: Jocob Ballon


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