Testosterone and Epilepsy: What You Should Know

Epilepsy is a complex neurological group of symptoms that affects millions of people around the world. While many factors can influence seizure activity, one that’s often overlooked—especially in men—is the role of hormones.

Much of the existing conversation around hormones and epilepsy centres on women, due to well-known links between seizure patterns and the menstrual cycle. But men, too, experience hormonal fluctuations that can have a significant impact on their epilepsy and overall wellbeing.

This article explores the relationship between male hormones—particularly testosterone—and epilepsy, and highlights what’s currently known from research and clinical observations.

Hormones and the Brain: The Basics

Hormones are chemical messengers that regulate a wide range of bodily functions, from metabolism and mood to reproduction and sleep. In the brain, they interact with neurotransmitters and neural circuits, meaning they can influence electrical activity—and by extension, seizures.

In men, testosterone is the primary sex hormone, but other hormones such as cortisol, oestrogen (present in small amounts), and Dehydroepiandrosterone (DHEA) also affect neurological health. Shifts in these hormones can impact how the brain functions, and for people with epilepsy, may affect seizure frequency and severity.

Testosterone and Seizure Activity

Research into the connection between testosterone and epilepsy is ongoing, but several key findings have emerged:

• Testosterone may have anti-seizure effects in some individuals. It appears to reduce neuronal excitability in certain areas of the brain.
  
• However, metabolites of testosterone, such as oestrogen-like compounds, may have the opposite effect and increase seizure susceptibility.
  
• Low testosterone levels have been linked to mood disorders, such as depression and anxiety, which are common among people with epilepsy and can contribute to worsening symptoms.
  

While the precise mechanisms are still being studied, it’s clear that testosterone levels—whether naturally occurring or influenced by medication or age—can affect seizure patterns and quality of life.

When Hormonal Changes Might Matter

There are several stages in life and health where hormones might have a noticeable impact on epilepsy in men:

1. Puberty

During adolescence, the surge in testosterone and other hormonal changes can lead to shifts in seizure type or frequency. Some young men may develop epilepsy for the first time during puberty, while others may experience changes in how their epilepsy presents.

2. Adulthood and Ageing

Testosterone levels tend to decline gradually with age, a process sometimes referred to as andropause. For some men with epilepsy, this decline may be linked to increased fatigue, mood changes, and alterations in seizure frequency or severity.

3. Medication Side Effects

Some anti-seizure medications (ASMs), especially enzyme-inducing drugs like phenytoin or carbamazepine, can interfere with hormone production or metabolism. This can result in lower testosterone levels and associated issues such as reduced libido, sexual dysfunction, or changes in body composition.

In some cases, switching medications or adjusting dosages may help minimise hormonal side effects—though any changes should always be made under medical supervision.

Signs of Hormonal Imbalance

Recognising the signs of a hormonal imbalance is important for managing epilepsy and overall health. These may include:

• Mood swings, irritability, or depression
  
• Low energy or chronic fatigue
  
• Reduced sex drive or erectile dysfunction
  
• Sleep problems
  
• Increased body fat or loss of muscle mass
  
• Unexplained changes in seizure patterns
  

If any of these symptoms are persistent or worsening, it’s worth discussing hormone testing with a GP or epilepsy specialist. Blood tests can help determine whether testosterone or other hormone levels are within a healthy range.

Hormones, Mental Health, and Quality of Life

It’s important to acknowledge the wider impact of hormonal imbalances—not just on seizures, but on mental health and emotional wellbeing. Men with epilepsy are at increased risk of depression and anxiety, and these conditions can be worsened by low testosterone or the psychological effects of chronic illness.

In some cases, testosterone replacement therapy (TRT) may be considered, especially if low levels are contributing to a significant decline in quality of life. However, TRT is not suitable for everyone and should be carefully assessed by a medical professional familiar with both epilepsy and endocrinology.

What You Can Do

If you or someone you know is living with epilepsy and experiencing symptoms that may be hormone-related, here are a few steps to consider:

• Keep track of symptoms such as fatigue, mood changes, or variations in seizure activity. Patterns may emerge that can help inform clinical decisions.
  
• Discuss concerns with your healthcare provider. Don’t hesitate to raise questions about how hormones could be affecting your epilepsy.
  
• Stay active and eat a balanced diet. Exercise and nutrition play a key role in maintaining hormonal balance and general health.
  
• Prioritise sleep and stress management. Both poor sleep and chronic stress can negatively impact hormones and increase seizure risk.
  

Final Thoughts

While the link between male hormones and epilepsy is still being explored, it’s becoming increasingly clear that hormones—particularly testosterone—can influence how epilepsy manifests and how well it’s managed.

Raising awareness of this connection can help ensure that epilepsy care is more comprehensive and individualised. Whether you’re living with epilepsy yourself, supporting a loved one, or working in healthcare, understanding the role of male hormones is an important step towards better outcomes and quality of life.