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One of the unexpected side effects of hormone replacement therapy can be a new sense of self. This can be good or bad. And many of us experience hormone fluctuations because of a common but seldom recognized brain condition.

At the age of 83, widower Carlo decided it was time to get back on the dating scene. Having faithfully cared for his wife of 57 years as she suffered and later died of Alzheimer's disease, he wanted to find a woman with whom he could share his remaining years. But he wasn't too sure how he would perform in the boudoir.

Carlo persuaded his son, a physician, to put him on testosterone replacement therapy. And sure enough, when Carlo met Ima, whom he immediately recognized as the 86-year-old woman of his dreams, he felt like he was in his 20's again. Activities in the bedroom went just fine. But he also found out he still had a temper. In fact, he was angry almost all the time. He thought about sex all the time. And other people seemed a lot more stupid than usual. This observation made him even angrier.

Fortunately, Carlo's son the doctor recognized the problem right away just by talking with his father. Carlo was on too much testosterone. At a lower dosage, Carlo was still a tiger in the bedroom, but he stopped being a bear everywhere else.

Our Hormones Tell Us Who We Are

Of course, fluctuating testosterone levels aren't the only hormonal condition that can have a profound effect on emotions. Most of us know at least one woman who has some degree of premenstrual dysphoric disorder, the variation of premenstrual syndrome (PMS) that causes not just bloating, muscle aches, and breast tenderness, but also tension, anxiety, feelings of worthlessness, feelings of persecution, irritability, anger, crying, binge eating, and generally feeling out of control. This condition, which can occur 6 to 8 days a month around a woman's period, can give a woman an entirely different self-identity, until her levels of estrogen, progesterone, and testosterone stabilize.

Profound psychological changes are not just linked to the well-known hormones estrogen, testosterone, and progesterone. The stress hormone cortisol, which is essential to life, also changes how "attached" we feel to the rest of the world. When our stress hormone levels go up, we feel less attached. When they go down, we feel that we are more a part of the communities around us.

The hormone oxytocin has the opposite effect. A woman's body normally produces enormous amounts of oxytocin right after the birth of a child. This hormone of love causes the new mother to bond with her child.

Men, however, are susceptible to oxytocin, too. When depressed men are given oxytocin, they stop the behaviors that cut off social contact. They become more interactive with others, and the social interaction helps them find a way out of their depression.

Hormones and the Pituitary Gland

It's normal, of course, for hormone levels to go up and down. It's normal for people to show variations in mood. About 25% of the population, however, has some degree of damage to the brain's pituitary gland. The pituitary is the gland that tells the rest of the body when and how to make the hormones that power our self-identity.

Continue reading after recommendations

  • Fernandez-Balsells MM, Murad MH, Barwise A, et al. Natural history of nonfunctioning pituitary adenomas and incidentalomas: a systematic review and metaanalysis. J Clin Endocrinol Metab. Apr 2011. 96(4):905-12.
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