title: Hormonal consequences of epilepsy and its treatment in men.
abstract: OBJECTIVE
  Epilepsy and anticonvulsant medications may substantially alter endocrine homeostasis, including the male reproductive hormonal system.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: Kartik
authors.initials: K
authors.lastname: Sivaraaman
authors.forename: Scott
authors.initials: S
authors.lastname: Mintzer
mesh_terms: D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D004827:Epilepsy / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007989:Libido / Q000502:physiology; D008297:Male; D012738:Sex Hormone-Binding Globulin / Q000378:metabolism; D012735:Sexual Dysfunction, Physiological / Q000209:etiology; D013739:Testosterone / Q000378:metabolism*
chemical_list: D000927:Anticonvulsants; D012738:Sex Hormone-Binding Globulin; D013739:Testosterone