Sex Hormones

1
Chapter 36

• Sex Hormones

2
Reproductive System

• Controlled by endocrine glands
• Hypothalamus and anterior pituitary
• Females ovaries, fallopian tubes, uterus, and
  vagina
• Males testes, penis, seminal vesicles, prostate
  gland, and bulbourethral glands

3
Reproductive System

• At puberty, hormone secretion increases
  (gonadotropins)
• Causes stimulation of gonads
• Gonads then start secreting hormones

4
Sex Hormones

• Endocrine glands control development and
  function of the human reproductive system
• Female ovaries, fallopian tubes, uterus, and
  vagina
• Male testes, penis, seminal vesicles, prostate
  gland, and bulbourethral glands

5
Female

• Ovaries
• Stimulated by follicle-stimulating hormone (FSH)
  and luteinizing hormone
• Synthesize and secrete estrogen and progesterone

6
Estrogen and Progesterone

• Regulate the development and maintenance of the
  female reproductive system
• Secondary sex characteristics
• Cycling of FSH and estrogen influences the female
  menstrual cycle

7
Female Sex Hormones

• Ovarian follicle stimulated by FSH
• Estrogen secreted
• Estrogen rises
• Mid menstrual cycle FSH is suppressed
• As estrogen peaks, LH is released
• Stimulates development of corpus luteum
• Progesterone and estrogen prepares uterus for
  conception and also has effects on metabolic
  processes

8
Estrogen

• Helps develop and maintain reproductive maturity
  in females
• Influences the retention of fluid, growth of
  tissue, and the shaping of the skeleton
• Estrone, estradiol, and estriol

9
Estrogen

• Oral natural estrogens are inactivated by the
  liver can be given parenterally
• Chemical derivatives and synthetic estrogens can
  be given orally
• DES no longer given because of birth defects

10
Estrogen

• Mechanism not clear
• Some tissues are more responsive to estrogen
• Have specific estrogen receptors that produce
  effects

11
Estrogen

• Can be given orally, parenterally, transdermal,
  and vaginally
• Estrogen based cancers can be made worse by
  administration of estrogen
• Female children of women who received DES are
  more at risk for adenocarcinoma of the vagina and
  cervix and infertility

12
Adverse Effects of Estrogen

• Nausea
• Vomiting
• Breast swelling
• Fluid retention
• Weight gain
• Thromboembolic disease

• High blood pressure
• Breast cancer
• Uterine cancer
• Cervical cancer

13
Evista and Fosamax

• Given for the prevention of osteoporosis
• Strengthens the bones
• Not as effective as estrogens on bone mineral
  density but does not have the risks of estrogen
• Not associated with GI upset

14
Progesterone

• Secreted last 2 weeks of the menstrual cycle
• Uterine lining begins secretory phase
• Greatest amount in the week after ovulation

15
Progesterone

• Secreted by the corpus luteum
• Uterine lining changes
• If fertilization does not take place, corpus
  luteum shrinks and progesterone levels drop

16
Progesterone

• If fertilization, corpus luteum produces
  progesterone until placenta takes over
• Maintenance and integrity of placenta, embryo
• During pregnancy, progesterone is essential

17
Progesterone

• Oral progesterone is inactivated by the liver
• Chemical modification can protect it
• Used to treat
• - uterine bleeding
• - amenorrhea
• - dysmenorrhea
• - premenstrual tension
• - endometriosis
• - infertility
• - threatened miscarriage
• - toxemia of pregnancy
• - contraception

18
Adverse Effects and Cautions

• Menstrual irregularities
• Jaundice
• Thrombotic disease
• Nausea
• Fever
• Weight gain

19
Adverse effects and cautions

• Headache
• Dizziness
• Diminished sex drive
• Use with caution in patients with cardiac
  disorders, asthma, epilepsy, migraines, and the
  first four months of pregnancy

20
Oral Contraceptives

• Femalesprevent conception
• Combination of estrogens and progestins
  (progesterone)
• Close to 100 effective if properly used
• Monophasic fixed dose throughout cycle

21
Oral contraceptives

• Biphasic estrogen constant, progestin varies
• Triphasic estrogen and progestin vary
  throughout cycle mimics normal hormonal changes
  

22
Oral Contraceptives

• Estrogen suppresses release of FSH
• Viable ovum is not released from ovary
• Progestin suppresses LH

23
Oral Contraceptives

• Alters cervical mucus, reduces motility of
  fallopian tubes, and alters endometrial lining
• Impairs transport of sperm and ova
• Impairs ability of fertilized ovum to implant

24
Oral Contraceptives

• Inhibits conception without preventing
  menstruation
• Wide variety of products
• Wide variety of adverse effects
• Now more low dose options with fewer side effects

25
Oral contraceptives

• Serious side effect is thromboembolism
• Risk increased in women over 35 and smokers
• Some medications decrease effectiveness
• Minipill only progestin

26
Other Contraceptives

• Norplant
• Depo-Provera
• Morning after pill
• Ovcon
• Yasmin
• Seasonale
• Transdermal patch
• Vaginal ring

27
Oral Contraceptives

• Adverse effects
• Nausea
• Acne
• Edema
• Headache
• Breast swelling
• Weight gain
• Fatigue
• Depression

28
Nursing Considerations

• Educate about and monitor side effects
• Periodic blood pressure checks, assessment for
  thrombophlebitis for women on prolonged estrogen
  therapy
• Provide education about use

29
Ovulation Stimulants

• For those who do not ovulate but desire pregnancy
• Could be part of in vitro fertilization
• Pituitary and ovarian function must exist
• Clomiphene citrate
• HCG
• Menotropins
• Urofollitropin

30
Nursing Considerations

• Provide emotional support
• Clomid usually confined to three courses of
  therapy
• Watch for symptoms of ovarian enlargement or
  hyperstimulation syndrome in patients on
  menotropins or HCG immediate hospitalization

31
Male Androgens

• Synthesized and secreted by the interstitial
  cells of the testes
• Controlled by FSH (Follicle Stimulating Hormone)
  and ICSH (Interstitial Cells Stimulating Hormone)
• Testosterone
• After puberty, testosterone levels rise quickly

32
Male Androgens

• Testosterone (contd)
• Secondary sex characteristics, penis, prostate,
  seminal vesicles, and vas deferens
• Initiates spermatogenesis

33
Male Androgens

• (testosterone contd)
• Enhances function of the penis, prostate, seminal
  vesicles, and the vas deferens
• Declines after age 40

34
Male Sex Hormones

• Increased formation of muscle tissue
• Enhanced ability to retain dietary protein
  nitrogen
• Natural testosterone is inactivated by the liver
  when given orally
• Synthetic testosterone can be given orally most
  commonly used
• Treatment of hypogonadism

35
Testosterone

• Adverse effects
• In young boys
• Premature epiphyseal closure
• Impaired bone growth
• Estrogen and androgen combinations
• Used to treat
• Postpartum breast engorgement
• Menopause vasomotor symptoms

36
Impotence

• Erectile dysfunction (ED)
• Affects up to 30 million men
• Consistent inability to obtain and maintain an
  erection

37
Impotence

• Differentiated from other problems associated
  with impotence (lack of sexual desire, problems
  with ejaculation, and difficulties with orgasm)
• Occurs at any age more common over 50
• Has many causes

38
Male Impotence

• Treatable condition
• Becoming more acceptable to talk about
• Treatment contraindicated for patients taking
  nitrates for chest pain or beta-blockers for
  hypertension dangerous drop in blood pressure
  can occur

39
Agents for Treatment of Impotence

• Sildenafil citrate (Viagra)
• Enhances the effect of nitric oxide, a chemical
  that causes smooth muscle relaxation in the penis
• Requires sexual stimulation
• Take 1-2 hours before sexual activity

40
Agents for treatment of impotence

• Adverse effects
• Chest pain, sudden cardiac death, asthma, and
  sloughing of the skin
• Levitra
• Similar to Viagra
• More effective for patients with diabetes

41
Agents for Treatment of Impotence

• Cialis
• Not affected by food
• Longer duration of action
• Same adverse effects as Viagra and Levitra as
  well as myalgia and back pain
• Alvilmil
• Dietary supplement
• Some effectiveness
• Lack of scientific data

42
Nursing Considerations

• Encourage discussion of feelings
• Obtain history to find out possible causes for ED
• Teach about agents used
• Teach patients to seek emergency care if erection
  lasts longer than 4 hours

43
Anabolic Agents

• Androgenic steroid hormones
• Anabolic steroids
• Synthetic testosterone
• Derived from or closely related to testosterone
• Promotes muscle growth
• Promotes weight gain in underweight individuals
• Misuse by athletes

44
Anabolic agents

• Significant risk of serious side effects
• Risk for cardiac death at a young age

45
Anabolic agents

• Serious adverse effects
• Liver toxicity, testicular hypofunction, elevated
  cholesterol, hepatic cancer, erectile
  dysfunction, and myocardial infarction

46
Anabolic agents

• (contd)
• Treatment of senile and postmenopausal
  osteoporosis
• Reversal of catabolic states associated with use
  of anti-inflammatory corticosteroids

47
Androgen Hormone Inhibitors

• Decreases size of prostate in men with benign
  prostatic hypertrophy (BPH)
• BHP can lead to difficulties with urination and
  urinary retention and infection
• Avodart
• Proscar

48
Finasteride (Proscar)

• Androgen hormone inhibitor
• Treatment of benign prostatic hyperplasia (BPH)

49
Nursing Considerations

• Assess urinary tract symptoms
• Baseline PSA should be evaluated before starting
  treatment to rule out prostate cancer
• Women should not handle pills

50
Nursing Considerations

• Barrier protection should be used if woman is
  pregnant
• Drugs presence in semen can harm male fetus
• Patients should not donate blood until 6 months
  after stopping therapy