El-Khayat et al9 compared 130 boys (ages 8-18) who were taking AEDs with age-matched controls. They found delayed sexual development with lower testicular volume and penile length, delayed pubic hair staging. Boys taking AEDs also had increased total testosterone, lower free testosterone, higher estradiol, and reduced ratios of testosterone to luteinizing hormone. Differences were more pronounced among boys taking multiple AEDS. These differences were unrelated to duration of epilepsy or seizure control, suggesting a drug effect, although they did not evaluate differences among AEDs.

A related report by Mikkonen et al12 described 70 boys taking AEDs (ages 7-21 years) compared to age-matched controls. They found testicular volumes and testosterone levels in the normal range for the boys with epilepsy. Boys taking valproate (N=25) had five-fold higher androstenedione levels, but the clinical implications of this effect are unknown. Sex hormone binding globulin (SHBG) levels were increased while dehydroepiandrosterone (DHEAS) levels decreased in boys taking CBZ (N=28), probably because of enzyme induction. Herzog et al (2004) compared men taking AEDs (ages 30-42 years) who had frequent seizures with a control group. They also found lower testosterone, estradiol and luteinizing hormone levels, as well as reduced sexual desire and performance, among men taking enzyme-inducing AEDs.

Authored By: 
Joyce Cramer
Reviewed By: 
Steven C. Schachter MD
Orrin Devinsky MD
Wednesday, September 1, 2004