Hormonal aspects of schizophrenias: An overview

Although the lifetime risk and prevalence of schizophrenia are comparable for men and women, gender differences occur in various aspects of the disease, including age of onset, pathophysiology, symptoms, course, and response to treatment. These gender differences strongly suggest a key role played by gonadal hormones and their interactions with neurotransmitters. They may also suggest a key role for future applications of specific estrogens for improved treatment of schizophrenics. 'Atypical' antipsychotics definitely improved the benefit/risk ratio of treatment of schizophrenic patients. However, they shift the reasons for noncompliance from extrapyramidal symptoms to hormonally related adverse effects, mostly weight gain and impaired sexual functions (which occur in men and women, but cause noncompliance mostly in men). Diabetes, dyslipidemia, and decreased bone mineral density, as well as some other adverse effects are more 'silent' but their long-term effects are detrimental. 'Hormone-friendlier' interventions might be needed.