Alcohol Use Disorder: Why Men and Women Respond Differently

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Men and women with alcohol problems may benefit from different therapies, according to a recent study that uncovers hormonal and physiological aspects that affect alcohol dependence (also known as Alcohol Use Disorder).

Scientists are aware that men and women are at distinct risk for alcohol abuse and related issues, and that men and women may require different approaches to alcohol treatment. Uncertainty exists regarding the biological processes underlying those variations.

‘Did you know that men with #Alcohol_Use_Disorder (AUD) who have #depression and #cravings often have lower levels of #testosterone and other hormones? In contrast, women with higher testosterone and #sex hormone-binding globulin levels are more likely to #relapse within the first three months of treatment. ’

Gender-Specific Pathways in Alcohol Dependence

For both men and women, specific combinations of hormonal and molecular indicators have been linked to variations in Alcohol Use Disorder (AUD) and related difficulties, as confirmed by this large-scale investigation().

According to lead researcher Victor Karpyak, "it may mean that sex-specific treatments can be customized to improve responses for men and women with alcohol problems.

As part of a research project researching the alcohol dependence medication acamprosate, the researchers looked at hormonal and protein markers of 268 men and 132 women with Alcohol Use Disorder.

They correlated these markers with psychological markers, such as depressed mood, anxiety, craving,alcohol consumption and treatment outcomes during the first 3 months of treatment.

Biochemical Markers of Alcohol Use Disorder

At the beginning of the trial - before anyone had taken any medication - the researchers tested men and women for several sex-specific blood markers, including sex hormones (testosterone, estrogens, progesterone) as well as proteins known to impact their reproduction (such as follicle stimulating hormone, and luteinizing hormone) or bioavailability of these hormones in the blood (albumin and sex hormone-binding globulin).

They found that at the beginning of the trial men with Alcohol Use Disorder, symptoms of depression, and higher cravings for alcohol, also had lower levels of the hormones testosterone, estrone, and estradiol, as well as the protein sex hormone binding globulin. No such associations were found in women with AUD.

Professor Karpyak said, "We found that there were different associations in men and women. For example, women who had higher levels of testosterone, sex hormone binding globulin, and albumin were also more likely to relapse during the first three months of treatment compared to women with lower levels of those biochemical markers. No such relationships were found in men.

Need for Gender-Sensitive Approaches in Alcohol Use Disorder Care

These hormones and proteins are known to influence behaviour, and indeed we see an association between different levels of these compounds and different behavioural aspects of an alcohol use disorder, although we can't for sure say that one directly causes another.

What it does mean is that if you are treating a man and a woman for alcoholism, you are dealing with different biochemical and psychological starting points. This implies that what works for a man may not work for a woman, and vice versa.

This is the first study large enough to be able to confirm that particular combinations of sex hormones and related proteins may be part of the biological differences in how alcoholism manifests itself in men and women. We need more research to understand what this means for disease progression and its treatment.

Given that many of those differences are related to sex hormones, we particularly want to see how the dramatic hormonal change women experience during the menstrual cycle and at menopause may affect the biochemistry of alcoholism, and guide treatment efforts.

Dr. Erika Comasco, Associate Professor in Molecular Psychiatry at Uppsala University in Sweden, stated that the research represents an important step forward toward achieving gender equity in medicine. The findings provide an important first insight into the relationship between sex hormones and alcohol use disorder treatment.

While sex differences in the way the disorder manifests itself are known, these results suggest that sex hormones may modulate treatment response, potentially supporting sex-specific pharmacological intervention.

However, hormone fluctuations related to the menstrual cycle are also potential modulators of alcohol misuse, warranting further investigation into their role in treatment and relapse outcomes for female patients.

Reference:

1. Gender Differences in the Psychosocial Determinants Underlying the Onset and Maintenance of Alcohol Use Disorder - (https:www.frontiersin.org/journals/neuroscience/articles/10.3389/fnins.2022.808776/full)

Source: Eurekalert