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Hormonal consequences of epilepsy and its treatment in men

Sivaraaman, Kartik; Mintzer, Scott

Current Opinion in Endocrinology, Diabetes and Obesity: June 2011 - Volume 18 - Issue 3 - p 204–209
doi: 10.1097/MED.0b013e328345e533
Androgens: Edited by David Handelsman

Purpose of review Epilepsy and anticonvulsant medications may substantially alter endocrine homeostasis, including the male reproductive hormonal system.

Recent findings Seizures in medial temporal lobe structures, through their connectivity to the hypothalamus, alter the secretion of gonadotropins. Levels of circulating bioavailable testosterone are affected by changes in the level of binding proteins, which in turn may be affected by seizure medications. The use of older generation medications that induce the cytochrome P450 system is associated with an increase in sex hormone-binding globulin and lower bioactive testosterone. Sexual dysfunction, including decreased libido and decreased potency, and infertility, is seen commonly in men with epilepsy. However, its relation to sex hormone levels remains unclear. Comorbid depression and anxiety may be important confounding factors. Testosterone and sexual function appear not to be affected by the newer generation (noninducing) anticonvulsants.

Summary Epilepsy and its drug treatments are associated with alterations in hormonal and sexual function in men. Further study is needed to clarify the precise mechanisms behind these alterations, as some of the data conflict. More attention should be paid to this issue in male patients with seizures; when appropriate, treatment for psychiatric comorbidity and switches in anticonvulsant therapy may be worth consideration.

Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA

Correspondence to Scott Mintzer, 900 Walnut Street, Suite 200, Philadelphia, PA 19107, USA Tel: +1 215 955 1222; fax: +1 215 955 0606; e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.