title: Contribution of sex hormones to gender differences in schizophrenia: A review.
abstract: Female patients with schizophrenia tend to have a more benign course and better outcomes than males. One proposed explanation is the differential influence of male and female sex hormones, including estrogen, progesterone, testosterone, and dehydroepiandrosterone (DHEA) and its sulfate (DHEAS). Such benefit may be mediated by their effects on neurotransmitters and neuroprotection. Besides altered estrogen and DHEA/DHEAS levels in female patients, data is equivocal on hormonal differences between patients and controls. However, several reports note a mostly negative correlation between estrogen levels and symptom severity in both genders, and a positive correlation between estrogen levels and neurocognition but mainly in females. Adjunctive estrogen appears to improve symptoms in both genders. Progesterone levels have inconsistent links to symptom severity in both genders, and correlate positively with neurocognition but only in males. Estrogen-progesterone combination shows preliminary benefits as augmentation for both symptoms and neurocognition in females. Testosterone levels correlate inversely with negative symptoms in males and have inconsistent associations with neurocognition in both genders. Testosterone augmentation reduced negative symptoms in male patients in a pilot investigation, but has not been evaluated for neurocognition in either gender. DHEA/DHEAS have mixed results for their association with, and clinical utility for, symptoms and neurocognition in both genders. Overall, data on the impact of sex hormones on clinical course or as treatment for schizophrenia is limited, but estrogen has most evidence for positive influence and clinical benefit. The possibly greater tolerability and broader impact of these hormones versus existing medications support further exploration of their use.
authors: Institute of Medical Science, Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario, Canada M5S 1A8; The Centre for Addiction and Mental Health, 100 Stokes St., Toronto, Ontario, Canada M6J 1H4; Department of Psychiatry, Faculty of Medicine, University of Toronto, 250 College St., Toronto, Ontario, Canada M5T 1R8.
authors: Tricia L
authors: TL
authors: da Silva
authors: Institute of Medical Science, Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario, Canada M5S 1A8; The Centre for Addiction and Mental Health, 100 Stokes St., Toronto, Ontario, Canada M6J 1H4; Department of Psychiatry, Faculty of Medicine, University of Toronto, 250 College St., Toronto, Ontario, Canada M5T 1R8. Electronic address: arun.ravindran@camh.ca.
authors: Arun V
authors: AV
authors: Ravindran
mesh_terms: D004967:Estrogens / Q000378:metabolism / Q000494:pharmacology; D005260:Female; D012739:Gonadal Steroid Hormones / Q000378:metabolism / Q000494:pharmacology; D006801:Humans; D008297:Male; D000066829:Neuroprotection / Q000502:physiology*; D065840:Protective Factors; D011569:Psychiatric Status Rating Scales; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy / Q000378:metabolism; D012737:Sex Factors; D009435:Synaptic Transmission / Q000502:physiology
chemical_list: D004967:Estrogens; D012739:Gonadal Steroid Hormones
keywords: Dehydroepiandrosterone and its sulfate; Estrogen and progesterone; Gender differences; Schizophrenia; Testosterone