DISORDERS OF SEX HORMONES

DISORDERS OF SEX HORMONES 

The sex hormones are a group of hormones responsible for controlling puberty, reproduction, birth and lactation. Sex hormone disorders, also referred to as reproductive hormone disorders, medical conditions that affect the different glands and organs of the body responsible for the production of the sex hormones. The sex hormones, which include testosterone (male) and estrogen (female) are substances that are essential in almost every body function, but more so in sexual functions and reproduction. Both testosterone and estrogen are present in males and females, but the levels differ according to sex. Males have higher levels of testosterone and females have higher levels of estrogen. Sex hormone disorders disrupt the normal production of hormones, which results in a reduced sex drive (libido), vaginal dryness, infertility, or excessive body hair, alopecia (hair loss) and may have long-term effects on metabolic, cardiovascular and bone health. 

Disorders of Sex Hormones In Females 

Polycystic Ovarian Syndrome (PCOS) 

This disorder is characterized by oligomenorrhea (irregular menstrual cycles) or amenorrhea (no menstrual cycles) with symptoms of hyperandrogenism (extra male like hormones) such as acne and hirsutism (extra male like hair growth). This is the most common endocrine disorder in young females. Blood tests which may be elevated in this condition are testosterone and DHEAS. The underlying cause of this disorder is thought to be insulin resistance (poor response of body tissues to insulin). 

Amenorrhea 

Amenorrhea is the absence of a menstrual period in a woman of reproductive age. It may be either primary (woman never developed menstrual periods) or secondary (absence of menstrual periods in a woman who was previously menstruating). 

Outside of the reproductive years there is absence of menses during childhood and after menopause. Physiological states of amenorrhea are seen during pregnancy and lactation. 

Pathophysiology 

Normally, the hypothalamus generates pulses of gonadotropin-releasing hormone (GnRH). GnRH stimulates the pituitary to produce gonadotropins (follicle-stimulating hormone and luteinizing hormone), which are released into the bloodstream. Gonadotropins stimulate the ovaries to produce estrogen (mainly estradiol), androgens (mainly testosterone), and progesterone. These hormones cause the following:

• FSH stimulates developing tissues oocytes around the to convert testosterone to estradiol. 

• Estrogen stimulates the endometrium, causing it to proliferate.
• LH, when it surges during the menstrual cycle, promotes maturation of the dominant oocyte, release of the oocyte, and formation of the corpus luteum, which produces progesterone.
• Progesterone changes the endometriu- mium into a secretory structure and prepares it for egg implantation. If pregnancy does not occur, estrogen
and progesterone production decreases, and the endometrium breaks down and is sloughed during menses. Menstruation occurs 14 days after ovulation in typical cycles.

Treatment 

Treatment of primary and secondary amenorrhea is determined by the precise cause. Treatment goals can be to relieve symptoms of hormonal imbalance, establish menstruation, prevent complica-tions, and to achieve fertility. 

Medical Treatment: Some causes of amenorrhea can be managed by drug therapy. 

Dopamine agonists: In most treatment with dopamine medications restores normalendocrine function and ovulation. e.g. Bromocriptine, or Pergolide are effective in treating hyperprolactinemia. 

Hormone replacement therapy: An estrogen and a progestin can be used for women in whom estrogen deficiency remains because ovarian function cannot be restored. 

Metformin: May used in women with polycystic ovary syndrome to induce ovulation. In premature ovarian failure, hormone therapy may be recommended both to avoid the unpleasant symptoms of estrogen depletion as well as prevent complications of low estrogen level such as osteoporosis. 

Amenorrhea Surgery: Amenorrhea caused by pituitary and hypothalamic tumors or structural blockage may require surgery and, in some cases, radiation therapy. 

Disorders of Sex Hormones in Males 

Hypogonadism 

Hypogonadism refers to the decreased production of testosterone. This can result from the pituitary gland not stimulating the testicles to make testosterone or the failure of the testicles to produce adequate testosterone. When testosterone levels are low, men can experience decreased libido (sex drive), erectile dysfunction, decreased energy, decreased muscle mass and thinning of the bones. Testicle size may also decrease and sperm count decrease. Blood testing is done to diagnose hypogonadism and to determine the cause. MRI (magnetic resonance imaging) of the pituitary or testicular biopsy may be needed in some cases. Testosterone when low can be replaced by injection, patches or topical gels. 

Gynecomastia 

The increase in breast tissue in a man is referred to as gynecomastia. This can occur during puberty and resolve on its own. Gynecomastia can also be due to medications, hypogonadism, thyroid disease, malnutrition, testicular cancers, adrenal cancers, liver disease or kidney disease. 

Erectile Dysfunction (ED) 

Erectile dysfunction (ED) is the inability to attain or sustain an erection firm enough to have satisfactory sexual intercourse. It is also called as impotence. It is not unusual for this to happen to a man on occasion, but frequent ED can be a sign of a bigger medical problem that needs attention. 

Causes 

ED can result from medical, physical or psychological factors. ED may be caused by a combination of factors that could also include medicine, alcohol or drugs. Intermittent ED is common. Many men experience occasional ED. It is generally caused by stress, exhaustion, or similar causes. Occasional ED should not be a cause of concern. 

Frequent ED may be a sign of damage to the cardiovascular or nervous systems. It is also be a sign of serious emotional or relationship difficulties. 

Pathophysiology 

From the mechanisms of a normal erection, erectile dysfunction may develop due to hormonal deficiency, disorders of the neural system, lack of adequate penile blood supply or psychological problems. 

Restriction of blood flow can arise from impaired endothelial function due to the usual causes associated with coronary artery disease, but can also be caused by prolonged exposure to bright light. 

Symptoms 

Erectile dysfunction symptoms may include persistent: 

• Trouble in getting an erection.
• Trouble in keeping enough erection to have intercourse or only be able 

to have brief erections. • Reduced sexual desire.