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Androgens and Their Role in Bulimia Nervosa and Eating Disorder Not Otherwise Specified of Purging Type (EDNOS-P)

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Eating Disorders

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Abstract

The sex steroid hormones, estrogen, progesterone, and androgens, play an essential role in the pathophysiology of bulimia nervosa (BN). The importance of androgens has also been recognized recently. However, the research on androgens’ role in bulimic disease, and its psychopathology and comorbidity, is scarce.

Androgens exert direct action on the CNS but also in conjunction with estrogens, and progesterone.

APABulimic women of normal body weight have disturbances in the hypothalamic-pituitary-thyroidal axis and are at increased risk of developing physiologic and endocrine disturbances, including menstrual irregularities. Polycystic ovarian syndrome (PCOS), with features of biochemical hyperandrogenism, menstrual disturbances, and polycystic ovarian morphology, can be seen in women with BN. Antiandrogenic oral contraceptives appear to reduce bulimic symptoms, meal-related appetite, and bulimic behavior. Maybe BN is a hormonal rather than primarily a psychiatric illness in some cases.

In a recent study, it has been found that women with BN and the subgroup of Eating Disorder Not Otherwise Specified of Purging type (EDNOS-P) had different origin of androgens, despite similar androgen levels. A direct ovarian testosterone (T) secretion was found in women with EDNOS-P, and peripheral conversion of circulating androstenedione (A2), and dehydroepiandrosterone sulfate (DHEAS) in women with BN.

These findings can perhaps be interpreted as a transition between EDNOS-P to BN and vice versa; the results may also indicate endocrine and psychoendocrine differences between the two groups of bulimic women.

These implications of sex steroid hormones’ involvement in the pathophysiology of BN are yet to be understood.

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Abbreviations

A2:

Androstenedione

A4:

4-Androstene-3,17-dione

BN:

Bulimia nervosa

COC:

Combined oral contraceptive

DHEA:

Dehydroepiandrosterone

DHEAS:

Dehydroepiandrosterone sulfate

DHT:

Dihydrotestosterone

DSM:

Diagnostic and Statistical Manual of Mental Disorders

E2:

17-ß-Estradiol

EDNOS:

Eating Disorder Not Otherwise Specified

EDNOS-P:

Eating Disorder Not Otherwise Specified of Purging subtype

FDA:

Food and Drug Administration in the United States

FHA:

Functional hypothalamic amenorrhea

FSH:

Follicle-stimulating hormone

GABA:

γ-Aminobutyric acid

GnRH:

Gonadotropin-releasing hormone

HDL:

High-density lipoproteins

HPA:

Hypothalamic-pituitary-adrenal axis

HPG:

Hypothalamic-pituitary-gonadal axis

LDL:

Low-density lipoprotein

LH:

Luteinizing hormone

PCOS:

Polycystic ovarian syndrome

PMS:

Premenstrual syndrome

T:

Testosterone

VLDL:

Very-low-density lipoproteins

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  1. Department of Women’s, and Children’s Health, Karolinska Institutet, Stockholm, Sweden

    Sabine Naessén

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  1. Department of Biomedical Sciences, University of Westminster, London, UK

    Vinood Patel

  2. Dept Nutrition & Dietetics, King's College London, London, UK

    Victor Preedy

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Naessén, S. (2022). Androgens and Their Role in Bulimia Nervosa and Eating Disorder Not Otherwise Specified of Purging Type (EDNOS-P). In: Patel, V., Preedy, V. (eds) Eating Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-67929-3_42-1

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  • DOI: https://doi.org/10.1007/978-3-030-67929-3_42-1

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