Lack of effect of alcohol on pituitary-gonadal hormones in women

Alcohol intake and endogenous sex hormones in women: meta-analysis of cohort studies and Mendelian randomization

Background

The mechanisms underlying alcohol-induced breast carcinogenesis are not fully understood but may involve hormonal changes.

Methods

We investigated cross-sectional associations between self-reported alcohol intake and serum or plasma concentrations of oestradiol, oestrone, progesterone (in pre-menopausal women only), testosterone, androstenedione, DHEAS (dehydroepiandrosterone sulphate) and SHBG (sex hormone binding globulin) in 45 431 pre-menopausal and 173 476 post-menopausal women. We performed multivariable linear regression separately for UK Biobank, EPIC (European Prospective Investigation into Cancer and Nutrition) and EHBCCG (Endogenous Hormones and Breast Cancer Collaborative Group), and meta-analysed the results. For testosterone and SHBG, we also conducted two-sample Mendelian Randomization (MR) and colocalisation using the ADH1B (Alcohol Dehydrogenase 1B) variant (rs1229984).

Results

Alcohol intake was positively, though weakly, associated with all hormones (except progesterone in pre-menopausal women), with increments in concentrations per 10 g/day increment in alcohol intake ranging from 1.7% for luteal oestradiol to 6.6% for post-menopausal DHEAS. There was an inverse association of alcohol with SHBG in post-menopausal women but a small positive association in pre-menopausal women. MR identified positive associations of alcohol intake with total testosterone (difference per 10 g/day increment: 4.1%; 95% CI: 0.6%, 7.6%) and free testosterone (7.8%; 4.1%, 11.5%), and an inverse association with SHBG (-8.1%; -11.3%, -4.9%). Colocalisation suggested a shared causal locus at ADH1B between alcohol intake and higher free testosterone and lower SHBG (PP4: 0.81 and 0.97 respectively).

Conclusions

Alcohol intake was associated with small increases in sex hormone concentrations, including bioavailable fractions, which may contribute to its effect on breast cancer risk.

Sex and gender-related differences in alcohol use and its consequences: Contemporary knowledge and future research considerations

AIMS

To review the contemporary evidence reflecting male/female differences in alcohol use and its consequences along with the biological (sex-related) and psycho-socio-cultural (gender-related) factors associated with those differences.

METHODS

MEDLINE, PubMed, Web of Science, SCOPUS, PsycINFO, and CINAHL databases were searched for relevant publications, which were subsequently screened for the presence/absence of pre-specified criteria for high quality evidence.

RESULTS

Compared to men, more women are lifetime abstainers, drink less, and are less likely to engage in problem drinking, develop alcohol-related disorders or alcohol withdrawal symptoms. However, women drinking excessively develop more medical problems. Biological (sex-related) factors, including differences in alcohol pharmacokinetics as well as its effect on brain function and the levels of sex hormones may contribute to some of those differences. In addition, differences in alcohol effects on behavior may also be driven by psycho-socio-cultural (gender-related) factors. This is evident by variation in the magnitude of differences in alcohol use between countries, decreasing difference in the rates of alcohol consumption in recent generations and other findings. Evidence indicates that both sex and gender-related factors are interacting with alcohol use in complex manner, which differentially impacts the risk for development of the behavioral or medical problems and alcohol use disorders in men and women.

CONCLUSIONS

Discovery of the mechanisms underlying biological (sex-related) as well as psycho-socio-cultural (gender-related) differences in alcohol use and related disorders is needed for development of personalized recommendations for prevention and treatment of alcohol use disorders and related problems in men and women.

Subjective effects and changes in steroid hormone concentrations in humans following acute consumption of alcohol

BACKGROUND

GABAA receptors are an important site of action of endogenous neurosteroids and an important mediator of several behavioral effects of alcohol. This study examined the effects of alcohol on plasma steroid hormone concentrations on the hypothesis that the endocrine effects mediate some of the subjective effects of alcohol.

METHODS

Thirty-two healthy subjects (17 men) with no history of a substance use disorder participated in this human laboratory study. All subjects consumed three standard drinks of grain alcohol. Subjective measures and blood samples for steroid concentrations were collected at baseline and 40 min after alcohol consumption.

RESULTS

Alcohol increased self-reported stimulation, alcohol liking, and desire for more alcohol. Alcohol also increased pregnenolone (PREG) and dehydroepiandrosterone (DHEA) concentrations, while it decreased progesterone (PROG) and allopregnanolone (ALLO) concentrations, as well as ALLO/PREG and PROG/PREG ratios. In men, the change in PREG concentration was significantly correlated with alcohol liking, while the alcohol-induced change in ALLO concentration correlated significantly with both alcohol liking and desire for more alcohol.

DISCUSSION

These findings provide preliminary support for the hypothesis that endogenous neurosteroids mediate some of the subjective effects of alcohol. Efforts to replicate these findings should aim to specify more clearly the nature and time course of the effects.

Moderate doses of ethanol fail to increase plasma levels of neurosteroid 3alpha-hydroxy-5alpha-pregnan-20-one-like immunoreactivity in healthy men and women

RATIONALE

The endogenous GABAergic neuroactive steroid 3alpha-hydroxy-5alpha-pregnan-20-one (3alpha,5alpha-THP, allopregnanolone) has been proposed to contribute to ethanol actions. Humans synthesize 3alpha,5alpha-THP, but its role in response to systemic administration of ethanol is unclear.

OBJECTIVE

The present study aims to determine the effect of a moderate dose of ethanol on progesterone and 3alpha,5alpha-THP concentrations in plasma samples of healthy male and female subjects and to determine if these levels are related to the subjective effects of ethanol. Females were tested in both the follicular and luteal phases of the menstrual cycle.

METHODS

Healthy men (N=9) and women (N=12) aged 21-35 participated in the study. Men participated in two sessions on which they received ethanol (0.8 g/kg) or placebo. Women participated in four sessions on which they received ethanol (0.7 g/kg) or placebo during the follicular and luteal phases of their cycle. Subjective states and mood were measured by standardized self-report questionnaires and a measure of psychomotor performance. Steroid levels (progesterone, 3alpha,5alpha-THP, estradiol, and cortisol) were measured in plasma samples by radioimmunoassay.

RESULTS

Ethanol significantly increased plasma levels of progesterone, but not 3alpha,5alpha-THP-like immunoreactivity, in women in the luteal phase. Ethanol had no effect on progesterone or 3alpha,5alpha-THP-like immunoreactivity levels in women in the follicular phase or in men, and it did not increase cortisol in men or women. Ethanol also did not affect estradiol in men or women.

CONCLUSIONS

3alpha,5alpha-THP-like immunoreactivity levels in human plasma are not increased following moderate ethanol consumption, suggesting that circulating levels of progesterone or its tetrahydro-reduced metabolites do not play a major role in ethanol action. However, the possibility remains that ethanol increases endogenous brain production of GABAergic neurosteroids without affecting plasma levels. Moreover, humans synthesize 5beta-reduced GABAergic steroids, and levels of these steroids may be altered in plasma or brain.

Reinstatement of serum pregnanolone isomers and progesterone during alcohol detoxification therapy in premenopausal women

BACKGROUND

Alcohol abuse is associated with menstrual irregularities related to the inhibition of progesterone secretion involved in regulation of the menstrual cycle. Reduced progesterone metabolites, including pregnanolone isomers (PIs), are efficient neuromodulators. The authors attempted to evaluate whether levels of PIs reflect impairment in progesterone biosynthesis in premenopausal women treated for alcohol addiction and whether alcohol detoxification therapy contributes to the restoration of their reproductive functions and psychosomatic stability by influencing steroid biosynthesis.

METHODS

Serum allopregnanolone (3alpha-hydroxy-5alpha-pregnan-20-one; P3alpha5alpha), pregnanolone (P3alpha5beta), isopregnanolone (P3beta5alpha), epipregnanolone (P3beta5beta), progesterone, pregnanolone sulfate (PregS), pregnanolone, and estradiol were measured in 20 women during therapy (at start, three days, 14 days, one month, and four months) by gas chromatography-mass spectrometry or radioimmunoassay. The results were evaluated by a linear mixed model for longitudinal data, with stage of the treatment and subject as categorical factors, phase of the menstrual cycle as a time-varying covariate, and age of the subject as a covariate and by regression in individual stages of the menstrual cycle.

RESULTS

During detoxification treatment, progesterone increased in the luteal phase. P3alpha5alpha, P3beta5alpha, and P3beta5beta rose in both phases of the menstrual cycle.

DISCUSSION

Given the similar mechanism in the effects of alcohol and steroids in activating gamma-aminobutyric acid A receptors, the restoration of progesterone and PIs during therapy could be explained by an adaptation to increasing requests for gamma-aminobutyric acid A-receptor activating substances owing to the cessation of alcohol intake or by the regeneration of progesterone formation. In conclusion, the reinstatement of progesterone, P3alpha5alpha, and P3beta5beta serum levels demonstrates the favorable effect of detoxification therapy on both reproductive functions and the psychosomatic stability of premenopausal women treated for alcohol addiction.

Acute effect of alcohol on estradiol, estrone, progesterone, prolactin, cortisol, and luteinizing hormone in premenopausal women

BACKGROUND

Heavy alcohol consumption is associated with menstrual irregularities, including anovulation, luteal-phase dysfunction, recurrent amenorrhea, and early menopause. In addition, moderate to heavy alcohol intake has been found to increase the risk of spontaneous abortions and breast cancer. These adverse effects could at least in part originate from alcohol-mediated changes in hormone levels.

METHODS

The acute effect of alcohol on the hormone balance in women using oral contraceptives (OC+) and also in nonusers (OC-), was evaluated in 30 OC- and 31 OC+ subjects, representing the whole period of the menstrual cycle. It was also evaluated in 40 OC- and 47 OC+ subjects during the midcycle phase and in 10 OC+ subjects with unknown cycle phase.

RESULTS

We found that among subjects who used oral contraceptives, estradiol levels increased and progesterone levels decreased after intake of alcohol (0.5 g/kg). No dose effect (0.34-1.02 g/kg) on progesterone was observed in a substudy on 10 OC+ subjects. With regard to estrone levels, no effect was observed, although a significant increase was found in the estradiol-to-estrone ratio. Among subjects not using oral contraceptives, progesterone levels decreased after intake of alcohol (0.5 g/kg). No effect was found in estradiol, estrone, or the estradiol-to-estrone ratio during midcycle in this study group. A transient elevating effect of alcohol (0.5 g/kg) on prolactin levels was observed in both study groups. We found that alcohol (0.5 g/kg) had no significant effect on luteinizing hormone (LH) levels among subjects not using oral contraceptives, and observed a decline among subjects using oral contraceptives at midcycle.

CONCLUSIONS

We suggest that the estradiol and progesterone effects are related to decreased steroid catabolism, resulting from the alcohol-mediated increase in the hepatic NADH-to-NAD ratio. The transient effect on prolactin levels may reflect acute changes in opioid and dopamine levels in the hypothalamus. The present findings regarding female sex steroids may be of relevance in the association between moderate to heavy alcohol consumption and the development of breast cancer.

Estrogen, alcohol and breast cancer risk

Estrogen replacement has been used for many years to reverse the hypoestrogenic symptoms of menopause and prevent osteoporosis. Studies have found that estrogen replacement also decreases cardiovascular risk. In addition, social use of alcohol has been found to decrease cardiovascular risk. Therefore, both estrogen replacement therapy and alcohol use have been proposed to have cardiovascular benefits, and are often used in combination. Epidemiologic evidence indicates that estrogen replacement therapy after menopause increases breast cancer risk. Regular alcohol consumption is also associated with increase in risk. However, interactions between the two are poorly understood. In addition, if alcohol alters circulating estrogen levels in estrogen users, this may have implications in terms of altering the risks:benefit ratio of estrogen replacement in an undesirable direction. For example, there are data suggesting that the use of both alcohol and estrogen may increase breast cancer risk more than the use of either one alone. Data support both acute and chronic effects of alcohol in raising circulating estrogen levels in premenopausal women on no hormonal medications. In postmenopausal women studies focusing on acute effects of alcohol on estrogen metabolism indicate that alcohol has a much more pronounced effect in women using estrogen replacement than in those who do not. Studies evaluating chronic effects of alcohol ingestion on circulating estrogens in postmenopausal women are needed.

High doses of alcohol increase urinary testosterone-to-epitestosterone ratio in females

The effect of alcohol (1.2 and 2.0 g/kg) on the urinary testosterone-to-epitestosterone (T/E) ratio was studied by two experiments each conducted with four healthy females and males. The intake of 2.0 g/kg of ethanol within 5 h in the evening significantly increased plasma testosterone concentration and ratio of T/E in urine collected next morning in females. The results suggest that alcohol increases the T/E ratio more in females than in males. The effect of high doses of alcohol on urinary T/E ratio must be kept in mind when doping tests are performed during training periods.

Pituitary-gonadal hormones and adrenal androgens in non-cirrhotic female alcoholics after cessation of alcohol intake

To investigate the sex-hormone profiles associated with chronic alcoholism in women we examined 16 non-cirrhotic alcohol abusers (aged 18-46 years). They were admitted for the treatment of alcoholism (duration of 2-16 yrs) to a social hospital for 6 weeks. Their mean daily alcohol consumption was 170 g. Blood samples for serum LH, FSH, prolactin (PRL), oestrone (E1), oestradiol (E2), progesterone (P), 17-alpha-hydroxyprogesterone (17-OHP), androstenedione (A) and dehydroepiandrosterone (DHEA) were drawn three times a week during the hospital stay. Similar blood samples were taken from 10 control women during one menstrual cycle. The cycles were anovulatory in two patients and in none of controls. Serum LH and FSH levels were similar in alcoholic and control women but serum concentrations of PRL were increased 2-4-fold in alcoholic women. In the patients serum, concentrations of E1 and E2 tended to be lower during the follicular and midcycle phases, as did those of P and 17-OHP during the luteal phase. Compared with the controls, serum levels of A were increased 2-3-fold in the patients. A parallel difference between the two groups was seen in serum DHEA concentrations. We conclude that until liver injury, even heavy alcohol drinking has only minor effects on the secretion of gonadotrophins and ovarian steroids. Hypersecretion of PRL and adrenal androgens may well be an initiating mechanism for sexual dysfunction of female alcoholics.

Alcohol effects on LH and FSH in ovariectomized female monkeys

The acute effects of alcohol (2.5, 3.0, 3.5 g/kg) and sucrose control solution on basal levels of luteinizing hormone (LH) and follicle stimulating hormone (FSH) were compared in recently and chronically ovariectomized female rhesus monkeys. Integrated plasma samples were collected at 20 min intervals for 3 hr before and 6 hr after nasogastric intubation of alcohol or isocaloric sucrose control solution. Baseline levels of LH and FSH were significantly higher in recently than in chronically ovariectomized females (p less than 0.001). Baseline LH pulse frequency was also significantly higher (p less than 0.001) in the recently ovariectomized group than in the chronically ovariectomized group (0.704 +/- 0.03 vs. 0.379 +/- 0.10 pulses/hr). FSH pulse frequency was equivalent in both groups (0.444 +/- 0.06 to 0.360 +/- 0.06 pulses/hr). After 2.5 g/kg of alcohol, peak blood alcohol levels were 243 to 256 mg/dl and LH decreased significantly (p less than 0.01) in both groups. After 3.0 g/kg alcohol, peak blood alcohol levels were 237 to 289 mg/dl, and basal LH levels (p less than 0.05) and LH pulse frequency (p less than 0.05) decreased significantly only in the recently ovariectomized group. After 3.5 g/kg of alcohol, peak blood alcohol levels exceeded 320 mg/dl, and LH did not change significantly in either group. Administration of 3.5 g/kg alcohol was associated with increased LH pulse amplitude in some individuals. Since lower alcohol doses (2.5 and 3.0 g/kg) and sucrose control administration were followed by a significant decline in LH (p less than 0.05-0.01) and the highest alcohol dose (3.5 g/kg) was not, these data suggest the possible influence of nonspecific "stress" on modulation of LH secretory activity. FSH did not change after sucrose administration in recently ovariectomized monkeys, but was significantly suppressed after 2.5 and 3.5 g/kg alcohol (p less than 0.05). In the chronically ovariectomized monkeys, FSH decreased significantly after administration of sucrose and all alcohol doses. LH suppression was not consistently associated with changes in FSH in either group--a finding consonant with the hypothesis that LH and FSH may be controlled by different hypothalamic regulatory factors.

Effect of alcohol and glucose infusion on pituitary-gonadal hormones in normal females

During 1 h, median 976 mmol ethanol in 5.5% glucose was administered i.v. to six healthy female volunteers (aged 26-37 years) in the luteal phase of the menstrual cycle. The median maximal blood ethanol concentration was median 33.5 mmol/l and serum ethanol concentrations of 2 mmol/l were reached after 8 h. Four of the women participated in a control experiment with infusion of an equal volume of glucose 5.5%. Venous blood samples were drawn 5 times during the 24-h follow up period. Serum concentrations of sex steroids and pituitary hormones decreased in both ethanol and control experiments and the results did not differ significantly. The lowest hormone concentrations were observed 1-5 h after the start of infusion. Oestradiol, oestrone and oestrone-sulphate concentrations decreased 24-46% compared to basal values. 5 alpha-dihydro-testosterone levels decreased 23-31%, androstenedione and dehydroepiandrosterone-sulphate levels decreased 6-48%, while testosterone levels did not change significantly. Prolactin concentrations were reduced by 41-51% of basal values and luteinizing hormone concentrations by 37-68% Follicle stimulating hormone levels did not change significantly. Stress factors or haemodilution are not likely explanations of the observed changes in hormone concentrations. A circadian rhythm could not explain changes in hormones of non-adrenal origin.

Acute alcohol effects on plasma estradiol levels in women

Acute administration of alcohol (0.695 g/kg) to healthy adult women resulted in peak blood alcohol levels between 70 and 75 mg/dl within 50-60 min after initiation of drinking. Alcohol induced a significant increase (means = 18 pg/ml) in plasma estradiol levels (P less than 0.01). In contrast, after placebo ingestion, plasma estradiol levels did not change significantly. After alcohol intake, plasma estradiol levels reached peak values at 25 min following initiation of drinking when blood alcohol levels averaged 34 mg/ml. It is postulated that the alcohol-induced increase in plasma estradiol is due to changes in hepatic redox states associated with the catabolism of ethanol.

International Commission for Protection against Environmental Mutagens and Carcinogens. ICPEMC Working Paper No. 15/7. Reproductive consequences of alcohol abuse: males and females compared and contrasted

The adverse effects of ethyl alcohol on the hypothalamic pituitary gonadal axes of men and women are discussed with particular attention being given to effects of alcohol upon reproduction. Data obtained from acute and chronic alcohol exposure studies are presented. The putative pathophysiologic mechanisms responsible for disturbed reproductive performances in alcohol abusing individuals are discussed where sufficient data are available.

LH pulsatility following acute ethanol ingestion in men

Alcohol abuse leads to impotence, infertility and feminisation. Patients with chronic alcoholism have impaired hypothalamic-pituitary function, but the effect of acute alcohol intake on hypothalamic function is unclear. The present study investigated the effect of ethanol ingestion on the pulsatile release of LH. Eight healthy male volunteers, aged 24-36 years, were investigated on a control day and a study day. Blood was sampled every 15 min for 8 h. On the study day ethanol was ingested, 1.5 ml/kg as an initial dose with supplements to maintain mean levels at 110-140 mg%. LH was measured on each sample by specific radioimmunoassay. Testosterone was measured at 0, 90 and 360 min. Data were analysed for pulsatile release by visual inspection, iterative computerized analysis and for longer period secretion by spectral analysis. Pulsatile release of LH was shown for all subjects on both days. Ethanol increased median LH levels (4.8 vs 5.55), but not by a significant amount. LH pulse amplitude was increased by ethanol ingestion, 3.7 vs 5.4 IU/l; P less than 0.05. Spectral analysis demonstrated a release of LH with a wavelength of 240 min which was unchanged by ethanol administration. Testosterone levels were unchanged.

Alcohol effects on plasma luteinizing hormone levels in menopausal women

Plasma luteinizing hormone (LH) levels were determined in five healthy post-menopausal adult females prior to, during, and following a period of acute alcohol intoxication. LH levels were also determined in the same women following acute administration of a nonalcoholic beverage which had identical isocaloric value of alcohol. Plasma samples were collected at 30-minute intervals from an indwelling intravenous catheter from 120 minutes prior to alcohol or isocaloric beverage administration to 300 minutes following beverage intake. All women became moderately intoxicated after acute alcohol administration and developed peak blood alcohol levels of 94 mg per dl between 60 to 90 minutes following alcohol intake. LH levels determined before administration of alcohol or isocaloric beverage were not significantly different and were within the range of normal values for healthy, post-menopausal women. No significant differences were found between LH levels following alcohol administration when compared with LH values after isocaloric beverage. These data indicate that acute alcohol intake which produces blood alcohol levels slightly below usual legal limits of intoxication does not suppress LH in post-menopausal females. Since post-menopausal females do not have significant estradiol feedback control of LH secretory activity, and since LH secretory activity in post-menopausal women (in contrast to pre-menopausal females) is more sensitive to the inhibitory actions of drugs which may affect adrenergic and dopaminergic pathways in brain, the findings obtained in this study do not support an acute alcohol effect upon hypothalamic-pituitary modulation of gonadotrophin release in humans.

The effects of alcohol on the endocrine system

Male hypogonadism is the best documented endocrine effect of chronic alcoholism. A reversible clinical syndrome resembling Cushing's syndrome has also recently been described in some chronic alcoholics. The pituitary-thyroid axis is relatively resistant to the effects of ethanol, although mild abnormalities in various thyroid tests are frequently noted in the presence of alcoholic liver disease.

Pharmacosexology: the effects of drugs on sexual function a review

The literature on the sexual side effects of drugs and chemicals has been reviewed. There are many substances which alter the human sociosexual response cycle either negatively, positively or both. Many of the drugs used therapeutically have been reported to have adverse effects on sexuality, and this must be taken into account when these drugs are used clinically. Many substances which are used for recreational purposes (or sometimes abused) also have profound effects on sexual response. Many of these substances are used in such a way that they can correct underlying sexual problems. Treatment of a drug abuser may well prove unsuccessful without consideration of preexistent sociosexual problems and concerns. From the dawn of recorded history, many substances have been used for the purpose of sexual enhancement. Some of these have known success and their reputations have been passed down through the millenia. The chapter has not yet been closed on aphrodisiacs, even though none have survived the rigors of scientific scrutiny. As long as humans place value on optimal sexual functioning, there will be a demand for sex-enhancing drugs. In order for the scientific and medical community to successfully meet these challenges, more effective and relevant study designs will have to be utilized in order to separate fact from fancy. The study of pharmacosexology is in its infancy, and in order for it to grow and contribute to the world body of knowledge, more researchers and clinicians must be trained in both pharmacology and sexology.