Hormonal Havoc: Imbalance after Injury with Dr. Tamara Wexler, Neuroendocrinologist


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By Mariah Morgan & Eryn Martin, Mariah Morgan, and Eryn Martin. Discovered by Player FM and our community — copyright is owned by the publisher, not Player FM, and audio is streamed directly from their servers. Hit the Subscribe button to track updates in Player FM, or paste the feed URL into other podcast apps.

Surprise! Our brains control our bodies! While it’s common knowledge that our brains control thoughts, movements, and perception; did you ever think about it controlling your hormones? Hormonal imbalance may sound abstract but could be behind many persistent and chronic brain injury symptoms. Fatigue, brain fog, mood changes, not feeling like yourself, menstrual irregularities, changes in libido, and weight gain, among many others could be signs of hormone imbalance related to your brain injury. While hormone dysfunction may not be your answer; if it is, it is easily treatable and totally worth getting checked. Gain awareness and knowledge from our talk today with Dr. Tamara Wexler neuroendocrinologist.

Topics covered:

  • Neuroendocrinology
  • A specific set of hormones overseen by parts in your brain
  • Includes: thyroid hormones, sex hormones (testosterone, estrogen, prolacin), growth hormones, and stress hormones
  • Systems in the brain involved are the pituitary gland and hypothalamus--they affect end organs like the adrenal glands, ovaries, testes, the liver, and the thyroid
  • The end organ glands are in a feedback loop with the brain
  • The hormones carry the messages between the brain and the end organs
  • Awareness of hormone insufficiency post brain injury
  • There is under awareness of hormonal issues in brain injury
  • It is under diagnosed and under treated
  • You need testing to determine if there is pituitary deficiency. You can replace the deficient hormone and remove the symptoms associated with its insufficiency
  • Pituitary insufficiency is most researched in post concussion/TBI. There is some information about acquired brain injuries and hormonal deficiencies but the literature isn’t as broad
  • Common symptoms associated with hormonal insufficiency are vague and non-specific. Not all of these symptoms are caused by hormonal changes but without looking you do not know if they are. There is a higher rate of pituitary insufficiency after injury but it doesn’t mean every symptom is due to it. Treatment may not lead to a complete return to pre-injury self.
  • Fatigue
  • Mental fog
  • Not feeling like yourself
  • Changed menses and fertility
  • weight changes
  • exercise intolerance
  • Body composition changes
  • Slowed thinking
  • Poor tolerance of things you used to be able to handle
  • Mood changes
  • School performance
  • Behavior
  • Growth
  • If you don’t look for insufficiency, you can’t tell if it exists
  • How do you test?
  • Menstrual irregularities, absence of menses, or changes in libido that persist more than 3 months after a concussion can reflect a brain related hormonal change (pituitary damage)
  • If you are having regular periods without being on oral contraceptives you don’t need to be tested
  • Estradiol and FSH: if ovary insufficiency or menopause are causing the symptoms, the estrogen will be low and FSH will be high. The pituitary sends FSH to signal the ovaries. FSH is high if the ovaries are the problem
  • If the pituitary gland/brain is the problem the FSH will be normal or low. It is trying to mount a response but it can’t
  • You have to look at multiple hormones as they rely on each other to understand the cause of the problem (brain vs end organ)
  • Thyroid testing: TSH and Free T4 need to be measured together after brain injury to determine if there is a brain or organ problem
  • Testosterone deficiency in men post brain injury: needs two morning blood tests timed appropriately to catch insufficiencies
  • Hormone testing is done by a blood test timed appropriately with your cycles. If you are looking to see if something is low you need to test it when you expect it to be high.
  • Provocative testing is when you stimulate your body to mount a hormonal response and then test it
  • There are 4 systems monitored by the pituitary gland: stress hormone system, thyroid hormone system, sex hormone system, and the growth hormone system
  • There is a domino effect if any one of the systems monitored by the pituitary is affected
  • Thyroid hormone system. Symptoms indicating imbalances:
  • Metabolism
  • Mood
  • Thinking
  • Temperature sensation
  • Poorer school performance
  • Behavior
  • Growth
  • Menstrual changes
  • Weight gain
  • Sluggish
  • Skin and hair changes
  • All of these changes can also come from something else
  • Thyroid insufficiency because of pituitary damage is less common after brain injury than problems in the other systems
  • Sex hormone system (refer to the above notes for menstrual and reproductive irregularities)
  • Symptoms from testosterone insufficiency:
  • Changes to libido
  • Erectile dysfunction
  • Decrease in frequency of spontaneous erections
  • Changes in bone strength
  • Changes in muscle strength
  • Changes in red blood cells
  • In one study, researchers looked at people with brain injury and sexual side effects, irregular periods in women and sexual changes in men. There were higher rates of hypogonadism (decreased estrogen and testosterone due to the pituitary) but also higher rates of other pituitary issues. The symptoms may not be as specific to just one system as we thought.
  • Stress Hormone System
  • Cortisol supports our body and its blood pressure during times of stress.
  • Need to look for adrenal insufficiency acutely after injury (ACTH and cortisol system)--if you miss this issue it can be fatal. It is easily replaced
  • Among pituitary deficiencies, the most common are sex hormone or growth hormone defficiency
  • They all have to be tested because they have to be replaced in a specific order
  • First replace any stress hormone issues with cortisol, then replace thyroid, then sex hormone, then growth hormones. You can’t diagnose growth hormone insufficiencies without first treating sex hormone issues
  • Growth hormone system
  • It affects linear growth: in kids look for changes in growth patterns (a drop or change from their norm)
  • Symptoms of insufficiency:
  • Cognitive and mood effects
  • Cognitive slowing
  • Brain fog
  • Bone strength, more fragile bones
  • Body composition: harder time gaining muscle and will see more fat around the middle
  • Exercise intolerance and low energy
  • Fatigue
  • Cardiovascular health: too much hormone is bad and too little is bad
  • Blood glucose effects
  • When do you know when to screen for pituitary damage post brain injury?
  • If the symptoms are persistent and consistent beyond three months to a degree that is disturbing you, get hormonal screening
  • Symptoms can show up later (3, 6, 12 months and beyond) after TBI
  • You can’t tell if it is a pituitary problem without looking.
  • If symptoms are getting worse or new symptoms are showing up over time, it is worth getting rechecked
  • Finding help with hormones
  • Bring up with your provider that you have heard that there are increased rates of pituitary insufficiency after brain injury and ask how you can get that checked out
  • Some providers that may be able to help: a provider that knows you well (your PCP or NP), rehabilitation medicine physician or physiatrists, neurologists, neuroendocrinologists
  • Not brushing off symptoms
  • It is worth raising your questions even if you are unsure if it is related
  • Your “usual” may be ramped up. You may be in ‘fight or flight.’ It could be hormonal but it may not. It is always worth looking
  • It is worth going down different avenues until you find the reason for your symptom. Even if hormones isn’t the answer it is worth looking at and checking off the list
  • Acute hormone deficiencies do not predict later problems. There is a much higher rate of acute issues at time of injury. This doesn’t correlate with having or not having long-term issues.

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