Early hormonal changes during valproate or carbamazepine treatment - A 3-month study

Background: Long-term treatment with valproate (VPA) or carbamazepine (CBZ) may induce reproductive endocrine disorders in patients with epilepsy. Met hods: Serum concentrations of reproductive hormones were studied in 17 wome n and 22 men with recently diagnosed epilepsy before they started either VP A or CBZ medication, and 1 and 3 months later. Results: No weight gain or c linical signs of hormonal disorders were observed during the follow-up. The mean serum levels of testosterone, luteinizing hormone, follicle-stimulati ng hormone, and sex hormone-binding globulin (SHBG) increased, and dehydroe piandrosterone sulfate (DHEAS) decreased, in women starting VPA. Serum test osterone levels increased in half of the women on VPA. Serum concentrations of progesterone and dehydroepiandrosterone increased, and gonadotropins de creased, in men on VPA during the follow-up. Serum SHBG levels increased an d DHEAS decreased during the first months of CBZ treatment in both sexes. I n addition, the free-androgen index decreased in men after starting CBZ. Co nclusions: Hormonal changes occur after only 1 month's use of VPA or CBZ. V PA-treatment seems to be associated with increased serum androgen levels, b ut the profile of hormonal changes appears to be different in women than in men. The use of CBZ, in turn, was associated with increased SHBG concentra tions and thus with diminished sex steroid function in both sexes. The wome n with increased serum testosterone levels in the early phase of V-PA medic ation may be at increased risk for VPA-related endocrine disorders later du ring treatment.