Behaviorally induced reproductive compromise in women and men

Behaviors that activate the hypothalamic-pituitary-adrenal (HPA) axis or sup press the hypothalamic-pituitary thyroidal (HPT) axis can disrupt the hypothalamic-pituitary-gonadal (HPG) axis in women and men. Individuals with functional hypothalamic hypogonadism typically display a combination of behaviors that serve as psychogenic stressors and metabolic challenges. Complete recovery of gonadal function depends upon restoration of the HPA and HPT axes. Hormone replacement strategies have limited benefit, because they do not achieve this objective and they mask deficits that accrue from altered HPA and HPT function. Although fertility can be restored with exogenous administration of gonadotropins or pulsatile gonadotropin-releasing hormone (GnRH), fertility management alone will not permit the HPA and HPT axes to recover. Thus, for complete recovery to ensue, biopsychosocial interventions that address the individual's unique set of psychogenic factors and metabolic challenges must be devised.