Male and Female Hormone Disorders

Hormone Disorders

Male and Female hormonal disorders

The testes in men and the ovaries in women make the individual sex hormones, although the adrenal gland makes some testosterone in both men and women. Each of these glands is controlled by the pituitary gland which in turn is controlled by the hypothalamus (a part of the brain, above the pituitary gland). Hormones from each of these structures can be measured or assessed indirectly by dynamic endocrine testing. Each level needs to be assessed to achieve a correct diagnosis of sex hormone deficiencies (hypogonadism).

Male Hypogonadism

Testosterone is not only required for normal sexual function, but also to maintain normal bone and muscle mass, red blood cell count and general well-being. Thus men with low testosterone may present with erectile dysfunction, low libido, fatigue, loss of muscle strength, anemia, and low bone density. Pituitary tumors sometimes present this way and these men may have a high level of prolactin from the tumor that may also cause a low testosterone. Traumatic brain injury (TBI) resulting from a sports injury, physical violence, motor vehicle accidents, or a blast injury such as experienced by soldiers from the wars in the Middle East can cause brain or pituitary injury that shows up as hypogonadism. The TBI may have occurred many years ago and only shows up later in life. Long term treatment with pain medications and testicular failure can also cause hypogonadism. As men grow older, their testosterone levels decline; some to the clearly hypogonadal level. There is no clear consensus concerning the ideal treatment of low testosterone in older men, however various types of treatment are available when indicated. To make the diagnosis of hypogonadism in men, a morning blood draw must be obtained for the pituitary and testicular hormone levels and often other pituitary hormones. If confirmed, a MRI of the head may be needed. There are a variety of testosterone replacement therapies available including injections, gels applied to the skin and sometimes under the arm or patches. We strongly encourage our patients’ involvement to achieve the best possible treatment These patients need to be followed in the endocrine clinic to ensure good results are achieved without any worrisome side effects.

Female Hypogonadism

The most common cause of female hypogonadism is menopause. We work with the patient and her gynecologist to determine if replacement hormone therapy is indicated. This is somewhat controversial in older women, but in younger women who may have premature ovarian failure, hormone replacement therapy is often necessary not only to relieve symptoms, but prevent other long term effects of estrogen loss such as osteoporosis. Pituitary abnormalities can also cause female hormone problems such as loss of menstrual periods and sometimes abnormal lactation (galactorrhea) due to high levels of prolactin, another pituitary hormone. Blood and urine tests and sometimes ultrasound, CT scans or MRIs can usually determine the cause of these disorders and guide appropriate therapy. There are many forms of female hormone therapy. We try to present the information as clearly as possible, outlining the pros and cons of various treatments, giving the patients as much time as need to make the best possible choice regarding her health care.

Polycystic Ovarian Syndrome (PCOS)

Polycystic Ovarian Syndrome (PCOS) is a common syndrome involving not on only the ovaries, but other endocrine systems, that may result in abnormal menstrual periods, excessive hair growth (hirsutism), and evidence of insulin resistance including pre-diabetes and obesity. Hirsutism can also be caused by other and sometimes more serious conditions affecting the ovaries, adrenal glands and pituitary. Tests to distinguish these conditions from PCOS would be needed in order to prescribe effective therapy. Meds and sometimes surgery may be indicated. Meds may include hormonal treatments, meds to address the insulin resistance, and anti-androgens to negate the effects of excessive male hormone (androgens) that is often present in these disorders.

Transsexualism

Both the American Association of Clinical Endocrinology and the Endocrine Society have recently released guidelines for the treatment of transsexualism. Working in conjunction with a therapist is particularly beneficial for patients who may be starting this transition. Patients further along in this process often find it beneficial to continue seeing a counselor, but this is not a requirement for hormonal therapy. We welcome these patients to our clinic in a caring, nonjudgmental manner, realizing this can sometimes be a difficult and stressful time for these patients. Baseline endocrine testing may be indicated to rule out rare inborn errors of metabolism that can sometimes be associated with these conditions, but almost always a hormonal regimen can be prescribed to promote the transition effectively based on the individual expectations of the patient. Our goal is to help these patients lead a long, healthy and productive life without side effects of their medical regimen. We have worked with many of these patients over the years and we are very pleased with the feedback we have received.