John W. Addington is a minister, a medical researcher and a patient rights paralegal. As a freelance writer he regularly publishes on the topics of Chronic Fatigue Syndrome and Fibromyalgia.
While some CFS and FM patients note having sexual problems this is not a primary symptom of either of these conditions. Nevertheless, reproductive issues have been implicated. Indeed, research has found irregularities in the production of sex hormones in persons with these disorders.
Various chains of hormone reactions begin in the brain's hypothalamus and pituitary glands but end up effecting different organs within the body. One of these chains of hormonal reactions, called the Hypothalamus Pituitary Adrenal (HPA) axis, interacts with the adrenal gland and has been studied extensively in conjunction with CFS and FM. A number of alterations have been found in the HPA axis that result in abnormally low amounts of cortisol. These alternations include abnormal amounts of the hypothalamus and pituitary hormones which stimulate cortisol production and suppressed adrenal response to such hormones. (For more details see also: Treatment for Chronic Fatigue Syndrome Hormonal Imbalance)
Another chain, called the Hypothalamus Pituitary Gonad (HPG) axis, has interplay with the body's production of sex-related hormones and reproductive cycles and has been researched to a lesser degree. As outlined below, some studies have revealed deviations in levels of sex hormones in those with CFS and FM. Research in this area is far from conclusive, however. One recent joint U.S./U.K. study for instance found no difference between sex hormones levels in women with or without fibromyalgia or chronic fatigue syndrome. The difference in timing during the women's reproductive cycle when hormone levels were tested has been given as a possible explanation in the varying results.
Because the HPA and HPG axes originate in the same part of the brain, it is understandable how closely related they are. If the chain of events in one axis becomes altered, this can cause the other chain to also lose balance resulting in abnormal levels of the associated hormones. Similarly both of these axes have a delicate interplay with the immune system. Immune problems can negatively impact these two hormonal chains and vice versa.
Sex Hormone Treatment Generally
Much more research needs to be done before the complexities of sex hormone alterations in CFS and FM are understood. When it comes to treatment, it is good to bear in mind that such alterations are thought to be secondary to the likely root of these ailments. Further, because studies of CFS and FM patients to date have had mixed results, it is essential that an individual have his or her hormone levels specifically evaluated before considering any treatment. If it is determined that your hormone levels are altered, then remedies aimed at normalizing them may be beneficial.
Caution when receiving this kind of care is essential. Replacing diminished sex hormones is a form of steroid treatment and can have unwanted side effects. Thus when undergoing sex hormone replacement therapy it is always best to be under the care of an experienced physician. Using natural, as opposed to synthetic, hormones can greatly decrease the risks involved. Some natural progesterone and estrogen products can be obtained over the counter whereas both synthetic and natural testosterone require a prescription.
In a lab, natural hormones can be produced from a yam extract called diosgenin. On the other hand there is little evidence that the body itself can convert this, or other yam products advertised, into hormones. Other over-the-counter products including pregnenolone and DHEA supplements can be converted by the body into various sex hormones. Additionally the body can convert these into adrenal hormones which have found to be deficient in CFS and FM.
Estrogen refers to any of several female sex hormones that stimulate the appearance of sexual characteristics in girls at puberty. Although estrogen is produced primarily in the ovaries, the adrenal glands supply a portion as well. Estrogen is produced in men also but in much smaller amounts. These hormones control the growth of the lining of the uterus during the menstrual cycle, are necessary for egg maturation and release, and cause changes in the breasts during pregnancy. Estrogen has many non-reproductive benefits as well. It helps the skin to be smooth and moist, maintains the body's thermostat, regulates metabolism and helps bone formation.
Relation to CFS/FM:
In studies done both in the U.S. and Germany, women with fibromyalgia had abnormally low levels of estrogen. Other studies have shown higher incident of female reproductive cycle irregularities in FM or CFS. Some researchers have attributed this to low ovarian function resulting from improper functioning of hypothalamus, which is the master hormone-regulating gland. The stress of chronic pain could alter the production of estrogen but abnormal levels of sex hormones could just as easily cause symptoms such as pain. Likewise estrogen levels can effect immune function and vice versa. Interestingly, aside from loss of libido, estrogen deficiency is known to cause fatigue, brain fog, disordered sleep and reduced amounts of serotonin.
Estrogen replacement therapy can consist of tablets, patches, or vaginal creams rings or gels. Natural biestrogen or triestrogen is the form preferred by some. Doctors recommend that women who have not had a hysterectomy also take progesterone (natural forms are available). A protocol recommended by Dr. Teitelbaum is 2.5 to 5 milligrams of triesterone daily throughout the month supplemented by either 200 milligrams of progesterone for the first 10 days of the month, or 100 milligrams every day. An added benefit to estrogen replacement therapy is protection from osteoporosis. Women who have been diagnosed with breast cancer, or whose sisters or mothers have breast cancer should not take estrogen, particularly Premarin, a synthetic estrogen. An experienced physician can help their patients weigh the risks versus benefits of this therapy.
Progesterone can also boost estrogen levels. Products such as Female Balance, containing wild yam, essential fatty acids, vitamin B-6 and dong quai are felt by some to reduce symptoms of diminished estrogen and help balance hormone levels.
FOLLICLE STIMULATING HORMOME (FSH)
FSH is produced in the pituitary although proper levels are controlled by the hypothalamus. In females this hormone stimulates the formation of eggs in the ovaries whereas in men FSH stimulates the formation of sperm in the testes. High levels of sperm or testosterone levels in men, or estrogen and progesterone in women will trigger the hypothalamus to reduce FSH production.
Relation to CFS/FM:
In studies done both in the U.S. and Germany, women with fibromyalgia were found to have excessive levels of FSH with associated abnormally low levels of estrogen.
Treatment directly addressing estrogen deficiencies will naturally have the ancillary benefit of reduced FSH secretion.
Oxytocin is a pituitary produced hormone which stimulates the uterus to contract during labor. This hormones also causes contraction of the smooth muscles in the intestines and blood vessels. Additionally oxytocin facilitates release of milk from the breasts during nursing. Oxytocin is also a neurotransmitter and is thought to be important in the day to day performance of the hypothalamus.
While oxytocin levels in CFS or FM sufferers have not been found to be abnormal, evidence from several doctors indicates oxytocin therapy has been beneficial to their CFS patients. 10 I.U. per day are recommended particularly for CFS patients who are pale or have cold extremities.
Function: Progesterone, secreted by the ovaries, prepares the uterus lining for implantation of the fertilized egg, helps maintain pregnancy and stimulates breast development. Progesterone also has a beneficial effect on the central nervous system and immune function. Particularly progesterone is essential for a specific neurotransmitter, GABA, that enables proper sleep.
Relation to CFS/FM:
The delicate balance between estrogen and progesterone required for proper reproductive functioning has been found to be altered in CFS and FM patients. A study of estrogen and progesterone's relationship to the immune system in CFS patients found an apparent over-sensitivity to progesterone that may lead to an improper inflammation response. It is theorized that this alteration coupled with elevated levels of prolactin may turn what would be in most women a short-term abnormal response into chronic immune activation.
A progesterone deficiency could be addressed with either natural or synthetic progesterone replacement therapy, sometimes in the form of creams. But progesterone deficiency, also called estrogen dominance, is not normally the problem with CFS and FM unless there is a concurrent PMS condition. Rather, since the progesterone/estrogen imbalance in CFS and FM is primarily caused by deficient estrogen, estrogen replacement may be more appropriate. That having been said, depending on the particulars of each case, progesterone is often prescribed by doctors to accompany and balance estrogen replacement therapy. Prometrium, a natural form of progesterone available by tablet, is recommended by some. Natural progesterone is also available over-the-counter as a cream
An added benefit of progesterone is that it can be used by the body to produce other sex hormones including estrogen and testosterone. Additionally our bodies can naturally convert progesterone into adrenal hormones include often found to be low in CFS patients. Further, this substance can correct symptoms of an underactive thyroid including chronic fatigue and muscle aches and weakness. Thus some advocate the use progesterone for men, as well as women.
Function: Prolactin is secreted by the pituitary gland primarily during sleep. In women prolactin levels surge at the end of pregnancy to help induce and sustain milk production. Men make less prolactin and its function for them is not clear although it is believed that prolactin may aid the immune system.
Relation to CFS/FM:
In a study reported this year from Illinois the production of prolactin during sleep was found to be significantly lower in a women with fibromyalgia in comparison to those without. This may be caused by sleep cycle alterations or over-sensitivity to dopamine, which has an inhibiting effect on prolactin and can increase nighttime wakefulness. In other words it may be that by some yet to be understood process dopamine may be overstimulating fibromyalgia patients at night and restraining the natural nighttime production of prolactin.
On the other hand, some patients with CFS have mildly elevated prolactin levels or exaggerated response to prolactin stimulation. Doctors theorize this could be due to a lack of proper responsiveness to dopamine or a secondary consequence of prolonged inactivity or disturbed sleep cycles. Elevated prolactin can also result from hypothyroidism, a condition sometimes found in CFS or FM.
Excessive prolactin levels can be addressed by drugs such as bromocriptine or cabergolin which act like dopamine by inhibiting prolactin secretion. Because a small pilot study in lupus patients found bromocriptine relieved many symptoms common to FM, a study was done using this medication for CFS and FM patients. The results of this study conducted by Dr. Robert McMurray from the University of Mississippi, in Jackson have yet to be published. However, those who funded the study explain that a portion of the patients responded well. More patients might have benefited if the drug not been given at nighttime, since bromocriptine, like dopamine, can interfere with sleep. Regardless addressing other sex hormone abnormalities that high prolactin levels can cause, like reduced estrogen secretions, may be more effective.
Testosterone is primarily produced by the testes with a portion also coming from the adrenals. Testosterone is responsible for stimulating the development of male sex organs, sexual characteristics, and sperm. The hormone also aids in the growth and muscular development of men and supports skin and bones. Women produce about 80% less testosterone but both men and women depend on it for libido.
Relation to CFS/FM:
Results have been mixed from the few studies done on testosterone levels in CFS and FM. For instance a 1992 report found elevated levels in women with FM as did a 1995 report on CFS in women, whereas a 1999 article reported low levels in premenopausal women with FM. Although no studies could be found in men with either CFS or FM, doctors often report finding low testosterone levels in men with these ailments. Dr. Teitelbaum relates that 70% of his male patients and many of his female patients have this problem. This might be explained by low adrenal, not testes, production of testosterone since underactive adrenals have been widely observed in CFS. Additionally, the evidence of high occurrence of this problem in men could possibly be related to the fact that men can go through male menopause when testosterone secretions diminish. This can result in fatigue, diminished physical strength and stamina, poor libido, insomnia, anxiety and depression.
Dr. Teitlebaum recommends shots of 100-125 mg Delatestryl (synthetic Testosterone) every 7-10 days coupled with daily application of testosterone cream after 8 weeks for his male patients who have tested low in testosterone. He prefers this to testosterone patches or tablets. A new testosterone gel might also be beneficial. Since women require less, Dr. Teitlebaum recommends natural micronized testosterone tablets. Obviously this requires being under the care of an experienced physician, as there are a number of potential side effects, some dangerous, that should be closely monitored from this steroidal treatment. Daily applications of the cream or gel alone could minimize side effects for men by avoiding the more potent surges of testosterone shots received at greater invervals. Some doctors recommend natural testosterone, available by prescription. The over-the-counter supplements pregnenolone and DHEA, which are precursors of testosterone among other hormones, may also be useful.
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