Hormone Replacement Therapy for NED (symptoms of TBI and PTSD)

PTSD and TBI have physical symptoms that can be evaluated and treated if we ask our care teams about the newly emerging treatments that can help manage some of the symptoms.  Most of the time, the VA will guide a service member or veteran to CBT (Cognitive Behavior Therapy) or PET (Prolonged Exposure Therapy) as their first standard of care.  Yet, if you look at many of the symptoms of TBI and PTSD, these conditions may have resulted in reduced levels of important hormones.  These invisible injuries have a “neuro-endocrine” component; hence the psychological elements, but also the physical one.  Considering hormone replacement therapy is a complementary therapy option.

Physical injury to the brain with these (often) precipitous drop in hormonal levels, may contribute to many psychological and physical symptoms such as anger outbursts, depression, anxiety, mood swings, memory loss, concentration issues, learning disabilities and sleep deprivation. Many vets also experience high blood pressure, diabetes, loss of sexual drive, obesity, muscle weakness, and in women, menstrual changes. 

Hormones are powerful in our bodies, and may strongly impact quality of life for the veteran and their families.  It’s never fast enough for us, but studies are ongoing with hormone therapy to address the specific areas of reduced hormone production.  These hormonal deficits cover hormones regulating the thyroid, pituitary and adrenal glands, growth hormone, and the sex hormones, estrogen and testosterone. 

Researchers at the VA Puget Sound and the University of Washington found that up to 42% of veterans with blast injuries could suffer from low levels of pituitary hormones, causing some of the most troubling and lingering effects of mild TBI, such as fatigue, insomnia, lessened cognition, memory loss, sexual problems, depression, concentration and mood disturbances.  The primary investigating physician on the study said this:  “If PTSD does not resolve, it’s very possibly due to hormonal deficiencies”.

How many of you have heard the term “NED”?  DCoE for Psychological and Brain Health recommends screening for NED, or Neuro-Endocrine-Dysfunction in veterans with a history of TBI and symptoms lasting longer than 3 months, or which present within 3 years of injury. One example is with low levels of testosterone.  In the past, testosterone was delivered via injections, which caused spikes in blood levels, translating to the comments made by caregivers in two categories:  “too much sex drive, low energy, mood change” or “too little sex drive, aggressive, mood change”.  Newer administration is through pellet delivery (small as grains of rice) through a shallow incision in the buttocks or elsewhere for roughly 3-4 months in women and 5-6 months in men.  This delivers the bio-identical hormone in a steady fashion to the body; a blood test can determine if the levels have been optimized for each of the hormones (thyroid, adrenal gland, pituitary and gonads).  Sometimes, hormones are administered through oral supplements to complement the therapy an individual will require. 

This isn’t only about sex drive; it’s about quality of life with energy, mood, concentration, focus, and the potential to feel more like before deployment.  Note: this may be used as a complementary or alternative therapy, and no single therapy works for 100% for all taking it.  Research hormone therapy as a possibility with your primary care physician, since studies are showing real promise for improved quality of life.  More information is available through an Internet search or at the www.USMedicine.com website and search for “hormone replacement”. 

Linda Kreter & the 

VeteranCaregiver Team