As Herzog et al10 noted: "The results confirm some long-held views regarding men with epilepsy." Most of what is being studied currently either replicates old studies or expands into examination of the effects of specific drugs, most of which is predictable based on the pharmacokinetic profiles of the AEDs. The implication is that hormonal changes are related to enzyme induction by AEDs that induced SHBG synthesis, resulting in higher levels of bound testosterone, and lower biologically-active (unbound) testosterone. However, this cycle usually resolves to a steady-state with normal levels of the free compound. However, epilepsy patients may have hypergonadotropic hypogonadism if their hypothalamic-pituitary-gonadal axis is feedback mechanism impaired. The evidence from a variety of studies for a cause of these problems is conflicting. Is it all related to enzyme-inducing AEDs or partly related to the effect of seizures on the hypothalamus and pituitary? A preponderance of the hormone studies on men (and women) were performed in Finland. Are there genetics differences among populations with epilepsy that could affect hormone balance?
Studies of the effects of AEDs on male hormonal function are few, and focused largely on the older, enzyme-inducing drugs. The current attention given to women's issues now is being matched by attention to men's issues. We need to know whether the newer AEDs affect the hypothalamic-pituitary-testicular axis, and what effects this might have on male sexual function. The implications are not limited to libido and potency, but should delve into male fertility, live birth rate, and teratogenic effects when men take AEDs.
Reviewed and revised September 2004 by Steven C. Schachter, MD and Orrin Devinsky MD, epilepsy.com Editorial Board.
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