Contraindication Question

[Lynne]

~michelle~ and I have been reading about Hormone Replacement Therapy and we were reading about contraindications, we would like to know what "Androgen Sensitive Epilepsy" is.   ~michelle~ has epilepsy which can be cause by stress, too much excitement, too much sadness so she has to watch what she does.  ~michelle~ has trouble swallowing pills so she chews all her pills that she has to take for epilepsy, injections aren't a problem to her. 

Thank you.


Lynne

[LynnER]

I havnt had any luck finding anything out on this subject myself as of yet... but I will keep on looking and see what turns up...  Honestly Id never heard of Androgen Sensitive Epilepsy untill now but *shrugs*  (mainly posting here so Ican find the thread again     )

[BrandiOK]

  I suppose the major question initially is ~Michelle~ using AED's (Anti-Epilepsy Drugs).  I only found one reference to "androgen sensitive epilepsy" and it was a dead link. Perhaps the term isn't used anymore or simply not documented well however I did find that AED's can create some unsual issues with both testosterone and estradiol.

 

AED effects on testosterone

Androgens are important in regulating potency and libido.112 Testosterone is the most important androgen. Its serum concentration-specifically the concentration of its free, bioactive form-is affected by PHT, CBZ, VPA, OXC, and the barbiturates.108-111
Serum testosterone exists in three forms:

    * free testosterone (FT, 2% to 3% of total)
    * albumin-bound testosterone (55%)
    * sex hormone-binding globulin (SHBG)-bound (43% to 45%)

The SHBG-bound fraction is not biologically active, but the albumin-bound and free fractions are. Reduction in free but not total testosterone is associated with diminished libido107,108 and potency. Testosterone increases potency and libido, whereas estradiol lowers it. Although estradiol constitutes only 1% of male gonadal steroids, it exerts almost 50% of the negative feedback on male LH secretion.110 Hepatic enzyme-inducing AEDs lower the amount of free or biologically active testosterone available to stimulate sexual function; at the same time they increase the serum level of estradiol, which actively inhibits it.   http://professionals.epilepsy.com/page/hormones_antiepmen.html

 

Elevating serum estradiol: Although incompletely researched, it has been suggested that AEDs induce the production in the liver of the enzyme aromatase. This enzyme converts testosterone to estradiol (the final common path of all natural estradiol production). Induction of aromatase production leads to an elevated serum level of estradiol.116 By shunting free testosterone (FT) to estradiol, serum FT is further reduced. Thus, the ratio of FT to estradiol (FT/E2) is lower in men with epilepsy and hyposexuality than in sexually normal epilepsy patients or in normal controls.117 Estradiol may impair testosterone secretion in two ways:

    * by suppressing male luteinizing hormone (LH) secretion, leading to hypogonadotropic hypogonadism
    * by producing premature aging of the hypothalamic arcuate nucleus, causing hypothalamic hypogonadism

Estradiol also stimulates SHBG synthesis, whereas testosterone inhibits it. Thus, AED-induced elevation of estradiol could have a downward-spiraling effect of decreased testosterone and testosterone/E2 ratio, stimulating SHBG synthesis, resulting in further depression of bioactive testosterone over time.   http://professionals.epilepsy.com/page/hormones_antiepmen.html

  So....in a nutshell....the use of AED's can effectively change the testosterone in the body into estradiol.  So when AED's and HRT are to be combined the potential for unstable hormone levels exists.  What would be considered "normal" estrogen dosages for a TS patient may be much to high if the patient is using AED's.  This is certainly something that ~Michelle~ needs to discuss with an endocrinologist before considering ANY kind of HRT. 

Modified: Links included

 

[Melissa]

Hi, I did a google search on the terms "androgen" and "epilepsy" and came up with a couple site that may be relevant.  They look like they are similar to what Brandi found, but she didn't specify her sources.

http://www.ingentaconnect.com/content/bsc/epi/2004/00000045/00000007/art00008
http://professionals.epilepsy.com/page/hormones_endomen.html

Melissa

[Lynne]

Thank you so much for the informations you left here for us to look into.

LynnER I found the thread here on this board that Steph put up and its called "Hormone Replacement Therapy (HRT)."

Once again thanks, LynnER, BrandiOK and Melissa for replying..*s*