Disease- and treatment-related effects on the pituitary–gonadal functional axis: a study in men with epilepsy

The consideration of the patient’s gender has become an established practice in the choice of antiepileptic drugs (AEDs) for the treatment of epilepsy. This study was undertaken to confirm that temporal lobe epilepsy and the use of hepatic enzyme-inducing AEDs, have a negative effect on sex hormones in men. We calculated the testosterone (T)/luteinizing hormone (LH) ratio to reflect the effects of epilepsy or its treatment on the most important androgen and its pituitary control hormone. Of 324 men with focal epilepsy identified (untreated or on AED monotherapy), 201 were eligible for inclusion (mean age 37.5 years¸ mean duration of epilepsy 14.7 years). A total of 105 men served as healthy controls (mean age 33.9 years). Patients with temporal lobe epilepsy were more likely to show abnormal T/LH ratios than patients with extratemporal epilepsy ( p < 0.01). Patients receiving AEDs with marked hepatic enzyme-inducing effects were more likely to have low T/LH ratios than patients taking nonenzyme-inducing AEDs or healthy controls ( p < 0.01). Focus localization and AED choice affect male sex hormones. Findings raise some concerns about the effect of enzyme-inducing AEDs on sexual endocrine functions.