Sex Steroid Hormones

Question 1

How are sex steroids transported?

Answer 1

Bound to sex hormone binding globulin (SHBG), except progesterone, and albumin
SHBG is unregulated by oestrogen

Question 2

Where is progesterone metabolised?

Answer 2

Liver

Almost all progesterone is metabolised in one passage through the liver

Question 3

Where are sex steroids stored?

Answer 3

Fatty tissues

Storage increases the half life of oestrogen

Question 4

How are sex steroids excreted?

Answer 4

Glucronides in faeces

Sulphates in urine

Question 5

Name some sex steroid hormones

Answer 5

Oestrogen
Progesterone
Androgens (synthesised from cholesterol)

Question 6

Name some sex steroid inhibitors and antagonists

Answer 6

Clomiphene
Finosteride
RU486

Question 7

Mixed sex steroid hormone antagonist/agonist MoA and effects

Answer 7

Selective oestrogen/progesterone receptor modulators
Oestrogenic effects on lipids and coagulation
Decreased osteoporosis
Decrease risk of invasive breast cancer in post menopausal women

Question 8

What are the actions of oestrogen?

Answer 8

Anabolic
Increased sodium and water
Increased HDL, decreased LDL
Decreased bone reabsorption 
Increased blood coagulability

Question 9

What are the side effects of oestrogen?

Answer 9

Breast tenderness
Nausea
Thromboembolism
Endometrial/breast hyperplasia
Ovarian metaplasia

Question 10

What are the effects of progesterone?

Answer 10

Anabolic
Increased water
Increased bone density
Mood changes
Maintains pregnancy

Question 11

What are the side effects of progesterone?

Answer 11

Increased weight
Acne
Nausea
Irritability
Depression
PMS
Decreased concentration

Question 12

What are the actions of testosterone?

Answer 12

Secondary male sexual characteristics
Anabolic
Voice changes

Question 13

What are the side effects of testosterone?

Answer 13

Acne
Increased aggression
Increased LDL
Increased atherosclerosis

Question 14

What are the different types of COCP?

Answer 14

Monophasic - fixed oestrogen and progesterone
Biphasic - fixed oestrogen and increasing progesterone
Triphasic - fixed/variable oestrogen and increasing progesterone

Question 15

How long is a cycle of the COCP?

Answer 15

21 days + 7 days off

Question 16

What metabolises COCP?

Answer 16

Cytochrome P450 in the liver

Efficacy is decreased by enzyme inducers (phenytoin, rifampicin)

Question 17

How can the COCP be taken?

Answer 17

Orally
Skin patch
Implants
Nasal
Vaginal

Question 18

What is the MoA of the COCP?

Answer 18

Decreased LH and FSH -> no ovulation

Viscous cervical mucus

Question 19

What are the side effects of the COCP?

Answer 19

Thromboembolism
Increased BP
Decreased glucose tolerance

Question 20

What is the effect of soya protein?

Answer 20

Decreases the half life of oestrogen (decreases the storage ability)
Beneficial in post-menopausal women as it replaces natural oestrogens

Question 21

When is the progesterone only pill started?

Answer 21

Follicular phase

Question 22

What is the MoA of the progesterone only pill?

Answer 22

Thickens cervical mucus

It is a slow release agonist which replicates natural hormones

Question 23

How are progesterone receptors modulated?

Answer 23

Expression of progesterone receptors are dependent on oestrogen action