Notes from the Consortium of Multiple Sclerosis Centers Annual Meeting in San Antonio, TX June 2-5, 2010
These observations are taken from my notes of educational offerings provided at this conference and may not represent the entire message the presenters intended to convey.
Cherie C. Binns RN BS MSCN
A Symposia entitled “Gender Specific Concerns in MS”,
Nancy L. Sicotte MD
Faculty at the David Geffen School of Medicine at UCLA
Los Angeles, California
AND
Barbara Geisser, MD
Faculty at UCLA
Los Angeles, California
In this symposia, strategies for tailoring therapies to gender specific needs were addressed. The primary sex hormones Estrogen and Testosterone have long been thought to “normalize” Multiple Sclerosis events in patients when given in dosing that promotes healthy hormone levels.
After years of noting that women in their third trimester of pregnancy who had Multiple Sclerosis did very well with few to no relapses and minimal disease impact, Researchers began to look at the pregnancy-specific estrogen we call Estridol. The only time this hormone is produced in the human body is during pregnancy and years of study of the pregnant population has confirmed that Estridol seems to have a neuroprotective effect in Multiple Sclerosis. Low dose supplementation at times other than pregnancy appears to replicate the benefits found in the pregnant patient. It is to be noted that this supplementation sustains what is considered to be “normal” third trimester levels of the hormone and does not exceed those levels. In trials to date, this hormone shows significant statistical benefit in reducing the rate and severity of MS relapses.
Correspondingly, testosterone levels in male MS subjects was explored. During times of disease progression and relapse many of the subjects produced lower than normal levels of this hormone and when supplemented to a higher “normal range” there was a significant impact shown which decreased frequency and severity of relapse in the male population.
Neither of these hormones is being tested in the Multiple Sclerosis patient over the age of 50 (fifty) as they both taper off by that age in the general population.
There was considerable discussion as to whether it was beneficial to place a woman on her Disease Modifying Therapy (DMT) immediately after the delivery of her child since statistically there is a 75-80% risk of relapse in the 3-6 months Postpartum thought to be due to a drop of pregnancy hormones. This group of women is being studied for Estridol supplementation but the addition of the hormone has potential to affect the newborn if s/he is breast feeding from a mother who is receiving supplementation.
In tracking hormone levels and relapse rates in women who chose to breast feed their newborn babies rather than bottle feed and go back on DMT therapy, the hormone Estridol did remain slightly elevated and the woman remained relapse free for up to six months of the study if breast feeding exclusively and not supplementing with formula or baby food.
If a woman who has Multiple Sclerosis and wishes to nurse her newborn makes a commitment to exclusive breast feeding with no food or formula supplementation for a period of six months, relapse rate is minimal to non-existent. This effect could be more long standing for those wishing to nurse their babies for longer periods but studies have not been done in this nursing population. The recommendation still remains that once a woman has weaned her child , she immediately resume DMT use unless she is already pregnant again or is trying to become pregnant.
None of the Disease Modifying Therapies is recommended for pregnant or nursing women.
For Men with Multiple Sclerosis who are attempting to father a child, testosterone levels may be lowered to not produce adequate number and motility of sperm while on a DMT. Some men have had success impregnating partners by coming off DMTs for a period of time and supplementing with low dose Testosterone and once the pregnancy is confirmed and deemed healthy, will return to DMT use.
There are currently clinical trials looking for men or women under the age of 50 who have Multiple Sclerosis and are interested in trying Testosterone or Estridol therapies to minimize frequency and severity of relapse in MS. For more information on trials in your area, go to www.clinicaltrials.gov and when on the home page type “Multiple Sclerosis” into the search area. Once there, further narrow your search with either the word “Estridol” or “Testosterone”.
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