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Concussion Chronicles II: Hormones

Concussion Chronicles II: Hormones

Bruce Thomas, MD

As noted last month, traumatic brain injuries generates over 2.87 million emergency department visits a year and is a great cause of suffering for many people for months and sometimes years afterwards. Last month, we talked about a great option for treatment: neurofeedback.

We continue now mentioning other things that could help seed recovery starting with……..Hormones.

The hormone that has received the most attention is progesterone. Progesterone is known to be protective of the brain, to slow down brain cell death, protect glial cells and be anti-inflammatory (1). Trauma researchers know that premenopausal women with head injury have LESS of the inflammatory signals (cytokines) and less multi-organ failure and overwhelming infection (sepsis) than do age matched men (2). We know it helps in animal trials (3-6) and unlike other sex hormones, it is actually made in the brain (7). In the most famous trial, the ProTECT study (8), mortality after Traumatic Brain Injury (TBI) was cut in half for the progesterone group. Truth be told, subsequent trials did not always show such dramatic results (9), but further research has suggested that this could be because the dosing regimens were simply too low (10). TBI is a difficult thing to treat. The way I see it, progesterone should have a place at the table of brain injury treatment.

While not as famous as progesterone, estrogen has also been found to have brain protective effects (11-18). Because of its protective effect for Alzheimer’s (19), I often say, “Estrogen is brain.”

Interestingly, melatonin, the hormone famous for sleep, can help. I often acknowledge melatonin as the best antioxidant for the brain that I know of. Since oxidant stress is part of the mechanism of inflammation after brain injury, it is not surprising that it could help. Notably it’s higher right after a brain injury but lower a long time after TBI (20), as if the brain knows it needs it acutely after the trauma but later it gets depleted. Studies on melatonin for TBI have been favorable (20-21).

Finally, while not thought of by most as a hormone, Vitamin D actually is a hormone and has been speculated to be helpful in brain injuries (22).

One reason that brain injuries are so hard to treat is that there are many factors involved and it becomes an entire body problem. Sometimes for an optimal outcome, it is good to address it from all angles. Moreover, having the right hormone levels helps us do just that.

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  2. Frink M, Pape HC, van Griensven M, Krettek C, Chaudry IH, Hildebrand F. Influence of sex and age on MODS and cytokines after multiple injuries. Shock 2007;27:151–156.
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    in rats. J Neurotrauma 2005;22:106 –118.
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