Multiple sclerosis (MS) is a complex autoimmune disease that affects the central nervous system, leading to symptoms such as muscle weakness, balance problems, and vision difficulties. Research into the relationship between MS and hormone therapy has been growing, as hormones appear to influence the immune system and neurological function, which are central to MS pathology.
One key area of investigation is the role of **sex hormones**—such as estrogen, testosterone, and progesterone—in MS. These hormones fluctuate naturally in the body and have been found to affect immune responses. For example, women are more likely to develop MS than men, and the disease often shows changes in activity during pregnancy and menopause, times when hormone levels shift significantly. This suggests hormones may modulate disease activity.
Studies have explored how hormone therapy might impact MS symptoms and progression. **Estrogen**, in particular, has been studied because it has anti-inflammatory properties and can promote neuroprotection. Some research indicates that higher estrogen levels may reduce MS relapses and inflammation. This is supported by observations that MS symptoms often improve during pregnancy, when estrogen levels are elevated. Conversely, the drop in estrogen after childbirth or during menopause can coincide with worsening symptoms.
**Testosterone** has also been examined, especially in men with MS or women with low testosterone levels. Testosterone may have protective effects on nerve cells and modulate immune responses, potentially slowing disease progression. Some studies suggest that testosterone therapy could be beneficial, but more research is needed to confirm safety and efficacy.
Another hormone-related factor is **sex hormone-binding globulin (SHBG)**, a protein that regulates the availability of sex hormones in the body. Elevated SHBG levels have been linked to increased risk of MS, indicating that hormone regulation complexity plays a role in disease risk and progression.
Regarding **menopausal hormone therapy (MHT)**, which replaces hormones lost during menopause, there is interest in how it affects women with MS. Menopause can worsen MS symptoms due to declining estrogen and progesterone. MHT might help alleviate these symptoms and improve quality of life by restoring hormone levels. However, the type of hormone therapy and timing are important, as different formulations may have varying effects on cognition and disease activity.
Research also highlights the importance of considering **gender and sexual health** in MS care. Hormone therapies used for gender-affirming purposes in transgender individuals with MS are an emerging area of study, but data are limited. Sexual dysfunction is common in MS and can be influenced by hormone levels, so hormone therapy might play a role in managing these issues.
Beyond sex hormones, other hormone systems are being investigated. For example, gut hormones like GLP-1 have been linked to brain inflammation in related neurological autoimmune disorders, suggesting that hormone pathways outside the reproductive system might also influence MS or similar diseases.
Clinicians and researchers are actively studying how to optimize hormone therapy for MS patients, especially women during pregnancy, postpartum, and menopause. This includes understanding the safety of disease-modifying therapies alongside hormone treatments and addressing mental health risks associated with hormonal changes.
In summary, hormone therapy in MS is a promising but complex field. Sex hormones influence immune function and neurological health, and hormone therapies may help manage symptoms and modify disease course. However, individual factors such as age, sex, disease stage, and hormone type must be carefully considered. Ongoing research aims to clarify these relationships and develop tailored hormone-based treatments to improve outcomes for people living with MS.
