Hormone Therapies As Treatment For Dysautonomia (in Men)

[erik]

Since hormonal influences are often so interactive with dysautonomias and such (well, everything really , and a decent number of female patients get improvement with hormonal BCP or other hormone therapies, I figured I'd float the question in the context of men?

Does such an approach exist? ...in theory?

(I offer this as both a serious and humorous question. Both styles of response are most welcome)

[firewatcher]

Erik,

I vote for the heating approach! Or the cooling approach...mmmmmh....ice or hot coals......heh, heh, heh......WAIT, I was never married to you! Sorry!

Seriously, men have hormones too, and they fluctuate, but not to the extent that women do. You also have all the other hormones that we have, just not in the same levels. Have you had your testosterone levels checked? With so many of us, the HPA/HPO axis is out of whack, it stands to reason that it would be for you too. I don't think supplemental estrogen is your answer since the male brain does not respond to estrogen like the female brain does (psychologically and chemically.) You just aren't wired for it. I think that eventually they will find that there is an exquisite balance of hormones and neurochemicals that exacerbate the autonomic response and will be able to even out the rough spots, but for now that is science fiction. Perhaps an alien abduction from the top of Mt. Kilauea would be a better shot!

[juliegee]

Erik-

Too funny. I think hormone replacement helped me to be more like YOU. A steady supply of estrogen and progesterone closely mimics your MUCH more steady state of hormones. Since I started my HRT, I have felt so much better.

When I was in perimenopause, those w-i-l-d-l-y flucuating hormones made me feel awful. MY AUTONOMIC & MCAD SYMPTOMS WERE AT THEIR WORST.

Unless your hormones are crazily unsteady for some unknown reason- I doubt this is the approach for you. Sorry

The patches are a drag anyways. That gummy glue is a bear to remove- baby oil, etc. You're not missing much

Julie

[erik]

...WAIT, I was never married to you!

True, if you had been married to me I imagine you'd opt for the "Implanon" option even if it is more expensive! I can only think of unpleasant options in that regard.

I did pass a "Low-T" test at one point in the past (without even studying)... but things can change and it is almost fraudulent to consider "moment in time serum sample" of anything hormonal to have much meaning. Yet that's medicine and it's 10,000 times better than nothing and much to be thankful for. I do look forward to the science fiction days when a little chip-on-chip like device can help digest some of these complex things. A couple folks are researching artificial baroreflex devices... that's at least a start for some sci-fi autonomic stuff!

Mack's Mom, in terms of "those w-i-l-d-l-y flucuating hormones" I did have an odd thing for a few days when I first started fludro. I felt horrible & volatile for a while... but it was "literally the exact same" horrible state that I felt during many of my teen years (also after head injury, which might tie in). It was like a "return to youth" for a bit (a negative one, but youthful still). Was similar with a panic-attack-like phase after a round of hydrocortisone. Was awake... yet also messed up of course. Made me hopeful that something could be corrected. Of course, since it's dysautonomia rather than overt Addison's or other constant shortage or excess... nothing tests out of whack and no simple fix. Just band-aid stuff. "Keep you from fainting", "Keep heart from exploding", "Blunt some feelings of one sort or another".

Aww... it is probably just my PCOS acting up again and I'm singing the dysautonomia blues.

[firewatcher]

Erik,

I don't think that hormones are really the answer for any of us. Estrogen and Testosterone are neuromediators for men and women, but as I am sure you know, they do not act the same way in each sex. I think with whatever autonomic issues we have, there is a direct assault on the HPA/HPO axis and the whole endocrine enchilada. Since there is really no way to isolate the effects of one hormone on all systems, we can't tell what each one does in addition to what "we think" it does (i.e. melatonin.) For many of the ladies, the fluctuations wreak real havok on the system, for reasons not completely understood and by evening things out, it makes autonomic balance a little easier to achieve. Alas, I know of no mad scientists working on biologic autonomic chips, and I'm not sure I'd trust one at this point. I am surprised that NASA hasn't recruited a few of us to study how to manage long-range spaceflight, since we are perfect human models of extended anti-gravity exposure!

Acta Paediatr. 2010 Mar 1. [Epub ahead of print]

Hormonal alterations in adolescent chronic fatigue syndrome.

Wyller VB, Evang JA, Godang K, Solhjell KK, Bollerslev J.

.Division of Paediatrics, Oslo University Hospital, Oslo, Norway.

Abstract Aim: The chronic fatigue syndrome is associated with alterations in the hypothalamus-pituitary-adrenal axis and cardiovascular autonomic nervous activity, suggesting a central dysregulation. This study explored differences among adolescent chronic fatigue syndrome patients and healthy controls regarding antidiuretic hormone, the renin-angiotensin-aldosterone-system, sex hormones and cardiac peptides. Methods: We included a consecutive sample of 67 adolescents aged 12-18 years with chronic fatigue syndrome diagnosed according to a thorough and standardized set of investigations, and a volunteer sample of 55 healthy control subjects of equal gender and age distribution. Hormones were assayed with standard laboratory methods. Results: Among patients, plasma antidiuretic hormone was significantly decreased and serum osmolality and plasma renin activity were significantly increased (p </= 0.001). Serum concentration of aldosterone, cortisol, NT-proBNP and sex hormones were not significantly different in the two groups. Conclusion: Chronic fatigue syndrome in adolescents is associated with alterations in hormonal systems controlling osmolality and blood volume, possibly supporting a theory of central dysregulation.

PMID: 20199497

Semin Reprod Med. 2009 Jul;27(4):338-45. Epub 2009 Jun 15.

Autonomic regulation of blood pressure in menopause.

Vongpatanasin W.

Department of Internal Medicine, Hypertension Division, University of Texas Southwestern Medical Center, Dallas, TX 75390-8586, USA. wanpen.vongpatanasin@utsouthwestern.edu

A large body of evidence indicates a major influence of sex hormones, particularly estrogen, on autonomic regulation of blood pressure (BP). The sympathetic nervous system is now widely recognized as a major regulator of BP homeostasis and contributor to pathogenesis of hypertension in humans. Menopause is accompanied by an accelerated age-related rise in sympathetic nerve activity (SNA). Mechanisms underlying sympathetic activation in menopause are unknown but may be related to impaired central modulation of baroreflex function or direct inhibitory influence of estrogen on SNA. Menopause is also accompanied by enhanced alpha-adrenergic peripheral vasoconstriction both at rest and during exercise. In ovariectomized rats, reduced nitric oxide release from the skeletal muscle caused by estrogen deficiency contributes to augmented sympathetic vasoconstriction during muscle contraction. The alteration in central autonomic regulation coupled with enhanced vascular adrenergic sensitivity may be responsible for elevation in resting BP and exaggerated pressor responses to exercise and mental stress in postmenopausal women.

PMID: 19530068

[erik]

True. There are some docs that do "physiological doses" of various things... meaning simply supplying an exogenous (and usually a steady) supply of something. They just aim for normal (or "top of normal") range. Mostly heard of that for thyroid. Also heard of super low dose cortisol in some experiments for CFS (and low enough doses are thought to avoid adrenal fatigue). That's similar to certain "hormone therapy" for ladies. I'm not talking about replacing known deficits (since in most dysautonomia cases there aren't any obvious ones), nor augmenting to supra-normal values (except like with fludro that can be a possibility)... but just the simple notion of "going exogenous" with a few things, rather than trusting the dysregulated endogenous production & feedback.

That can be my book title: "Going Exogenistic: A Dysautonomic American Life".... how I faced medical oppression as a male minority in a female dominated disease, and triumphed.

Even if I don't end up having Low-T, overt Addison's, hypopituitarism, hypothyroid, et. al. (like most with dysautonomia that "test normal" for most everything)... a modest trickle of some hormones might do something, good or bad. The testicular shrinkage from exogenous testosterone would be a bummer, but then that leaves less to hurt during the heating/cooling treatment process! I'm not too worried about growing excess breast tissue... a reduction surgery can handle that. But my deepest fear is that I might develop "feelings" and all that "sensitivity" junk. That could be the worst potential side effect and blow to my manhood. Now that I think of it, this is all a bit too risky.

[scarfgirl]

I have sometimes pondered-in a mostly silly manner I should warn- that since women are so much more likely to develop POTS than men, that perhaps a sex change, or at least hormone therapy would be in order for me. Maybe if I were a dude it would go away . Not only would I be able to return to work, but I'd probably get paid what I was worth for once!

[iheartcats]

I am back on BCP for more 'steady hormone infusions' - I'll let you know in a week.

My new OB/GYN said the generic of Seasonique is doing well with many patients and it is cheap.

[miranda]

Interesting stuff . My blood test came back saying I have a lack of hormones due to early menopause and I am only 41. Could this be making me ill ?

[Chaos]

True. There are some docs that do "physiological doses" of various things... meaning simply supplying an exogenous (and usually a steady) supply of something. They just aim for normal (or "top of normal") range. Mostly heard of that for thyroid. Also heard of super low dose cortisol in some experiments for CFS (and low enough doses are thought to avoid adrenal fatigue). That's similar to certain "hormone therapy" for ladies. I'm not talking about replacing known deficits (since in most dysautonomia cases there aren't any obvious ones), nor augmenting to supra-normal values (except like with fludro that can be a possibility)... but just the simple notion of "going exogenous" with a few things, rather than trusting the dysregulated endogenous production & feedback.

That can be my book title: "Going Exogenistic: A Dysautonomic American Life".... how I faced medical oppression as a male minority in a female dominated disease, and triumphed.

Even if I don't end up having Low-T, overt Addison's, hypopituitarism, hypothyroid, et. al. (like most with dysautonomia that "test normal" for most everything)... a modest trickle of some hormones might do something, good or bad. The testicular shrinkage from exogenous testosterone would be a bummer, but then that leaves less to hurt during the heating/cooling treatment process! I'm not too worried about growing excess breast tissue... a reduction surgery can handle that. But my deepest fear is that I might develop "feelings" and all that "sensitivity" junk. That could be the worst potential side effect and blow to my manhood. Now that I think of it, this is all a bit too risky.

Eric-

You are too funny! Let us know when you get that book published. Hope it won't hurt your newly found "feelings" if I just check it out of the library instead of buying it.

I dated a guy back in the 80's who swore there were studies proving that men had PMS too. Maybe you're on to something! (Of course that relationship didn't go far. I was bad enough with PMS. There wasn't room for the both of us in that situation. ; )

Interesting reading all these posts. I've been blaming hormones for years for all my weird symptoms. (Now I'm thinking they were all part of the dysautonomia and possibly MCAD). Started HRT after my hysterectomy 2 years ago and have felt much more "stable" in many ways although ironically the rapid HR and tremor etc. actually appeared in a much more troublesome way right around the time I started the HRT. Have played with the HRT levels and stopped altogether for awhile but that didn't change my POTS type symptoms but have always wondered about the timing of the symptom onsets.

Thanks to all of you for giving me more paths to wander in my research.

[erik]

Research points toward a strong hormonal component to SSAD (Sports Season Affective Disorder). I've seen it strike some guys very hard. Unfortunate regression to prior developmental stages and habits, such as yardwork or chores, has been known to occur (but is thankfully quite rare). Irritability and withdrawal into excessive PS2/XBox use or compulsive automobile tinkering is common. Others swing to an outward extreme, a manic flurry of dating to fill the empty void inside... temporarily losing grasp of their strong innate monogamistic base.

If lucky, "bright light therapy" can offer some relief... so long as the bright light is shining on the latest Sports Illustrated Swimsuit Edition. For treatment resistant cases though, co-administration of a malt liquor may be required (40oz q.i.d + ad. lib.) is standard. Some folks swear by intense amnesiatic sedation via rapid J?germeister lavage, so long as a little temporary psychosis is tolerable (or desired).

I've had a number of friends that found it necessary to resort to all of these techniques on a regular basis, simply to regain normalcy in their life. It can rob a man of his essence. Tragic indeed. But cycles & seasons are a fact of life and we must all cope in our own manner.

[Chaos]

Research points toward a strong hormonal component to SSAD (Sports Season Affective Disorder). I've seen it strike some guys very hard. Unfortunate regression to prior developmental stages and habits, such as yardwork or chores, has been known to occur (but is thankfully quite rare). Irritability and withdrawal into excessive PS2/XBox use or compulsive automobile tinkering is common. Others swing to an outward extreme, a manic flurry of dating to fill the empty void inside... temporarily losing grasp of their strong innate monogamistic base.

If lucky, "bright light therapy" can offer some relief... so long as the bright light is shining on the latest Sports Illustrated Swimsuit Edition. For treatment resistant cases though, co-administration of a malt liquor may be required (40oz q.i.d + ad. lib.) is standard. Some folks swear by intense amnesiatic sedation via rapid J?germeister lavage, so long as a little temporary psychosis is tolerable (or desired).

I've had a number of friends that found it necessary to resort to all of these techniques on a regular basis, simply to regain normalcy in their life. It can rob a man of his essence. Tragic indeed. But cycles & seasons are a fact of life and we must all cope in our own manner.

All I can say is your brain fog must be getting a lot better with those new meds. You're certainly on a roll here! Are you like my husband where if I laugh it just encourages more outrageous spouting???

[erik]

Yeah. I only have the classic fog or memory trouble on rare occasion. Usually I have a different style, brain drains out and tires every 10 or 15 minutes repeatedly if I'm doing something "real" and I have to micro-nap or just give up. Plus the classic "inattention". Caffeine works for "doing stuff", but "learning" or "contemplating" is another matter and usually just doesn't work.