Sex Hormones and Appetite in Women: A Focus on Bulimia Nervosa

Abstract

Sex hormones play an important role in the regulation of appetite and energy metabolism. Estrogen is known to inhibit feeding, whereas progesterone and testosterone may stimulate appetite. There is increasing knowledge about the role of sex hormones in disturbed eating behavior. Bulimia nervosa is frequently associated with sex hormone disturbances, which may be secondary or primary to abnormal eating. Menstrual disorders and low estradiol levels are common although most bulimic women are of normal weight. Furthermore, polymorphisms in the estrogen receptor b gene have been associated with bulimic behavior. Increased androgens and clinical features of hyperandrogenism like acne, hirsutism, and polycystic ovary syndrome (PCO) are also frequent among bulimics. High testosterone levels in women have been associated with a greater craving for sweets, impaired impulse control, irritability, and depression. It has therefore been suggested that androgens may promote bulimic behavior. In support of this hypothesis, antiandrogenic treatment has been demonstrated to improve bulimic behavior. Oral contraceptives (OCs) with antiandrogenic properties reduce symptoms in bulimic patients in relation to decreased testosterone levels. The findings support that androgens could play a significant role in bulimic behavior. Antiandrogenic treatment may therefore develop into a new therapeutic approach in women with bulimia nervosa, especially in those bulimics with hyperandrogenic symptoms.