A comparative study of testosterone,sex hormonebinding globulin and free androgen index levels in men with epilepsy at Kenyatta National Hospital neurology clinic

Abstract

Background; Epilepsy, anti-epileptic drugs and the reproductive system have complex interactions.Reproductive endocrine disorders are more common among patients with epilepsy than in the general population. These disorders have been attributed to both epilepsy and the antiepileptic drugs. Use of anti-epileptic drugs especially the enzyme inducing drugs increases hepatic synthesis of Sex Hormone Binding Globulin in both men and women. The increase in Sex Hormone Binding Globulin level leads to increased binding of testosterone effectively reducing the fraction of biologically active testosterone available for tissue binding and action. This may have effects on sexual function and fertility of affected individuals. Broad objective; Toassess the effects of Anti-Epileptic drugs on male reproductive hormones in male patients attending neurology clinic at Kenyatta National Hospital. Study design: Cross sectional comparative survey. Study population: Sixty three (63) adult male epileptic patients attending neurology clinic at Kenyatta National Hospital. A comparative group of sixty three (63) healthy adult males accompanying patients to outpatient clinics. Study setting: This study was carried out at the neurology clinic.Participants in the comparative group were recruited from medical, surgical outpatient clinics, Accident and Emergency department of KNH. Methods:Patients and age matched comparative cases were consecutively sampled .A venous blood sample for determination of total testosterone levels and Sex Hormone Binding Globulins levels was drawn. Free androgen Index was calculated for all study cases and the comparative group. Results: The mean testosterone levels was found to be higher in the study group compared to the comparative group (22.1±8.2 nmol/l versus 15.3±8.2 nmol/, p=<0.001), this difference was statistically significant. The study group had higher mean levels of Sex Hormone binding Globulin compared to the comparative group, the difference achieving statistical significance(62.9±27nmol/l versus 44.6±26.7nmol/l,p=<0.001).The Free Androgen Index was comparable in the two groups with no statistically significant difference(38.4±14.4 versus 38.9±18.7,p=0.873). Conclusion: This study showed that men with epilepsy on Anti-epileptic drugs had higher concentrations of both Total Testosterone and Sex Hormone Binding Globulin than normal healthy aged matched men. However Free Androgen Index was not reduced in the male patients compared to the comparative group.