Abstract
The case described by Dhillon and colleagues [1]
underlines the importance of noting signi? cant clinical
events in single case studies as well as providing very
important information about the impact of gonadal
hormone administration on the central nervous system.
In this case, the transgender patient had nine years of
administration of testosterone 250 mg intramuscular
injection (IMI) three weekly. It was only when the patient
had declining levels of circulating estradiol due to perimenopausal changes at age 47, that he developed a psychotic illness which required treatment with 30 mg
olanzapine. The assumption is that the neuroprotection
provided by higher levels of estradiol when the patient
was younger decreased over time and then the continued
administration of testosterone precipitated psychosis.
Oestrogens provide neuroprotection via many complex
physiological mechanisms including both genomic and
? 2011 The Royal Australian and New Zealand College of Psychiatrists
non-genomic mechanisms. Oestrogen has direct effects
on the serotonin, dopamine, and cholinergic and other
neurotransmitter systems. Also, oestrogen in? uences
axonal sprouting and has other neurocircuitry impact.
Hence, with loss of estradiol in the menopause, the CNS
effect is marked in a number of areas. In this case, the
addition of testosterone would have the opposite effects
in the CNS.
The role of the hormones of the hypothalamopituitary-gonadal axis in the development or protection
against the onset of psychosis are grossly underestimated
and poorly understood. Far more research into this area is
needed since the potential use of estradiol, as a treatment
is now feasible, as we have shown in our clinical trials.
The lesson learned from this case is that without the
tempering effect of oestrogen, testosterone can be a psychosis-inducing hormone. Tongue in cheek; is this a metaphor for the roles that women and men play in society?
Original language | English |
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Pages (from-to) | 604 - 604 |
Number of pages | 1 |
Journal | Australian & New Zealand Journal of Psychiatry |
Volume | 45 |
Issue number | 7 |
DOIs | |
Publication status | Published - 2011 |