Concussions and the Effect on Hormone Levels in Men and Women
We regularly hear after a patient has had a concussion that their doctors tell them to just “deal with it.” In Doctors' defense, often times nothing appears to be wrong with the CT Scans or lab work. There is no explanation for the headaches or fatigue. They can’t explain the emotional outbursts, why a person with these symptoms don’t feel like themselves or why they are so tired. It seems invisible and they can’t explain it.
Typical care after a concussion:
There is much confusion surrounding concussions but there IS an explanation, it IS a visible injury if the right imaging is ordered.
Today, let's talk about concussions and hormone dysregulation.
There is a common link between concussions and low testosterone. Surprised?
To begin, we need to understand normal testosterone development:
It all starts with the hypothalamus. In turn, the hypothalamus talks to your pituitary and your pituitary makes hormones that go throughout your body and produce the hormones that we are most familiar with. For instance, the pituitary secretes FSH and LH. Those hormones go to the gonads (in men) to produce the dominant hormone, testosterone.
In a study published researchers explored the connection between NFL players, their testosterone levels, and the incidences of erectile dysfunction.1
3,506 pro-football players filled out questionnaires post concussion and they found that “Concussion symptoms at the time of injury among former football players were associated with current participant-reported low testosterone levels and ED indicators. These findings suggest that men with a history of head injury may benefit from discussions with their health care clinicians regarding testosterone deficiency and sexual dysfunction.”
On one hand, there are doctors that believe that raising testosterone levels in their patient will help anything and everything and that it is a magic bullet that will cure all of their ails. While healthy hormones are necessary to fight depression, and good hormones are necessary to prevent cognitive declines, just hormone supplementation will not address the root cause. The root cause is found in the brain.
But in this study, it is evident in these documented head injuries and immediately after, that these professional football players noticed a significant increase in symptoms of low-testosterone. Keep in mind that these NFL players are considered by many to be the top physical specimens of athletes in our country. This is the highest-running testosterone group that is out there. However, after head injuries, it has now been documented that testosterone goes down.
Later in the article, they state, “We identified a highly robust, monotonically increasing association between self-reported concussion symptoms at the time of football injury and self-reported low testosterone levels and ED indicators. Even participants with relatively few concussion symptoms (i.e., those in the second quartile) had significantly elevated odds of reporting low testosterone levels compared with men in the lowest quartile.”
It is so interesting that even in minor head injuries resulting with fewer symptoms, you can see that the symptoms they experience are due to low testosterone.
In another study about concussions, researchers studied our military veterans who served in Iraq or Afghanistan. The first group of veterans had been through blast related injuries while deployed in the Middle East. The second group were military veterans who served in similar areas but had not experienced any blast injuries.2
They found, “Studies of traumatic brain injury from all causes have found evidence of chronic hypopituitarism, defined by deficient production of one or more pituitary hormones at least 1 year after injury, in 25-50% of cases.”
This means that when the hypothalamus talks to the pituitary, the pituitary is not making the correct amount of hormones that would then go to the gonads and produce testosterone. There are insufficient amounts of testosterone being made. Also, the pituitary produces human growth hormone. When HGH is low in an adult, they are prone to symptoms of PTSD.
This knowledge is huge for our concussion patients. As we have discussed in prior newsletters and videos, brain injuries promote leaky gut, can cause POTS, fatigue, etc. The realities of suffering a concussion are vast, varied, and need to be taken seriously, but there IS help for the post concussion patient.
In addition, according to this study, 25-50% of brain injury sufferers also have hormonal dysfunction in which the brain is not sending the right signals out to the target endo-organs.
Your symptoms are legitimate and you need to find a doctor that knows what is going on.
You can see from the figure above how when the pituitary is misfiring, it can cause problems in several different areas physiologically.
“Eleven of 26, or 42% of participants with blast concussions were found to have abnormal hormone levels in one or more pituitary axes, a prevalence similar to that found in other forms of TBI.”
So basically, this is reiterating what was found in the article above. 42% of the blast injured in this study are walking around with at least one pituitary hormone imbalance.
And remember, they are also finding that symptoms of PTSD correlate with human growth hormone (HGH) levels that come from the pituitary. If HGH levels go down, you are more prone to have PTSD symptoms.
When it comes to the female population, there is less research that focuses on women after a traumatic brain injury, because women tend to be less prone to difficulties after a TBI.
But the incidences of women dealing with the aftermath of a mild or not-so-mild traumatic brain injury exist. Thus the studies, thankfully exist. In a study looking at female's hormones coming from the pituitary after a concussion, researchers found that a head injury reduces a woman’s ability to produce estrogen.3 Although interestingly, if they are on birth control, cortisol levels will actually be higher.
“This current study provides initial evidence that women with predominantly mild TBI, vs. with moderate to severe TBI, may also have significant hormonal changes in response to the injury these TBI effect increase as severity of the injury increases.”
As we discussed in other newsletters and video broadcasts, commonly in men after a TBI, cortisol will drop and adrenaline will go up leading to broken down gut health and then a variety of many negative consequences.
In women, however, the gonadal hormone goes down (estrogen) but cortisol will go up. In the study, they are saying that even in mild TBI, in female concussion patients there are hormone disturbances.
There has been a question as to why women tend to do better after a traumatic brain injury than their male counterparts. Researchers are finding that estrogen and progesterone have a neuroprotective effect on the brain. This comes from some robust data. With 218,000 patients it was “found female gender to be associated with improved survival rates...” after the age of 46.
In a study with animals, it was found “estrogen acted as a neuroprotectant through multiple mechanisms including antioxidant, increased cerebral blood flow, anti-inflammatory activity, induced prosurvival gene, and glutamate-induced excitotoxicity protection.”4
It is even being discussed that maybe in the future, we will treat men post TBI with estrogen and progesterone.
Very interesting data, but nonetheless, male or female, if you are dealing with symptoms of post concussion syndrome, another important thing to note is that your hormones should also be checked.
The body is very inter-related. Every individual needs an individualized whole-body approach to chronic problems, because it is not one thing that is wrong, it is multiple things. This is why we check pituitary hormones in every post-concussion syndrome/multiple traumatic brain injury patient. It is very important and these hormones play such a major role in the body's workings and role in recovery.
Note the symptoms we listed above. If you are experiencing any symptoms of hormone imbalance, please reach out to your doctor.
Functional Neurology emphasizes rehabbing certain parts of the brain that have been damaged by using neuroplasticity based exercises. These exercises activate certain areas of the brain through sensory stimulations, eye exercises, complex motor stimulations in an attempt to rehab those damaged areas. We also consider the underlying biochemical factors which are disturbing neurophysiology which may play a part in vitamin deficiencies, hormone dysregulation, and inflammation.
If you are ready to begin your path to healing or have any questions, contact us at (775) 507-2000 or email firstname.lastname@example.org
1. Grashow, Rachel, et al. “Association of Concussion Symptoms With Testosterone Levels and Erectile Dysfunction.” JAMA Neurology, JAMA Network, 26 Aug. 2019, jamanetwork.com/journals/jamaneurology/fullarticle/2748920.
2. Wilkinson, Charles W., et al. High Prevalence of Chronic Pituitary and Target-Organ Hormone Abnormalities after Blast-Related Mild Traumatic Brain Injury. 7 Feb. 2012, pubmed.ncbi.nlm.nih.gov/22347210/.
3. Niemeier, Janet P., et al. “A Repeated Measures Pilot Comparison of Trajectories of Fluctuating Endogenous Hormones in Young Women with Traumatic Brain Injury, Healthy Controls.” Behavioural Neurology, Hindawi, 12 Feb. 2019, www.hindawi.com/journals/bn/2019/7694503/.
4. Berry, Cherisse, et al. “The Effect of Gender on Patients with Moderate to Severe Head Injuries.” The Journal of Trauma, U.S. National Library of Medicine, Nov. 2009, pubmed.ncbi.nlm.nih.gov/19901653/.
This Article by Gemma Ward based on information shared by Dr. Gates here and here.