Our son Chris committed suicide in August 2008 at the age of
31 and it came as a complete shock. There had been no overt signs that
something was wrong.
We discovered after his death that he had never managed to
consummate his four-year relationship with his girlfriend, who had left him
five years previously. Perhaps unsurprisingly he had never revealed his sexual
problems to us.
We wondered if there could be a connection with a serious
head injury he'd suffered when falling out of a
tree as a seven year old and that was when we found a whole mass of eye-opening research,
available to anyone who googles the words "head injury" and
"pituitary" (201,000 hits when I looked just now).
Chris was in a coma for five days and apparently recovered
fully. He appeared to transition through puberty properly, although his hair
growth appeared somewhat sparse. He attended Birmingham University for four years, and although depression prevented him from getting his Engineering degree, he found a responsible job afterwards with Rover and then BMW. His future seemed bright and he was apparently happy in his relationship.
I believe now that Chris's suicide a few years later was a tragedy that could have been avoided if the GPs and psychiatric professionals that he consulted for depression had been more aware and had probed more deeply into his relationship difficulties. It has long been accepted in academic circles that head injuries can cause hormone problems. Chris never sought medical advice about his "little man's" inability to perform, and nor did his girlfriend who feared it might be her fault. It is questionable whether treatment for the root problem would have been forthcoming, even if they had.
Sadly the NHS still does not properly deal with hormone
problems in men. This obviously means other people,
particularly the young, are at risk of remaining untreated and susceptible to
the awful physical and emotional issues that affected Chris.
In 2000/2001 according to NICE, the UK's medical guiding
body for doctors 112,978 people suffered head
injury requiring hospital treatment. Around 75% of those patients were male.
Since the 1980s, studies have come out showing that there is
a high risk that the Pituitary Gland, the small vital "master
gland" in the brain can be damaged by head injury.
Growth hormone is the most frequently affected, and the gonadotrophins, LH and FSH, which trigger the production of
the sex hormones, come next on the list.
Between 10% and 17% of moderate to severe traumatic brain
injury survivors will suffer deficiency in these hormones and their libido
and fertility will be damaged. Other hormones that can be affected are adrenocorticotrophic (ACTH) which governs the response to stress, TSH which stimulates the Thyroid gland, and Prolactin which enables women to breastfeed but has no obvious function in men (though inappropriately high levels can interfere with sexual performance).
If the more protected posterior part of the gland is damaged, anti-diuretic hormone (ADH) may be affected.
The possible symptoms are many. They include failure to
grow in children, muscle loss in adults, the sexual and fertility problems mentioned
before, depression, uncontrollable weight gain, diabetes insipidus, fatigue and
inability to control body temperature. I understand genetic problems can also
cause Hypopituitarism, but the fact is only the most
obvious cases get attention. The remainder appear sentenced to an unexplained miserable
Although the risk of pituitary damage is higher in survivors
of moderate to severe traumatic brain injury, mild injury can cause it too.
Another complication is the damage may not reveal itself immediately. Symptoms
can appear many decades after injury apparently without explanation. It is
likely however that the symptoms have been a long time developing as the mind and body slowly succumb to knock on effects created by the damaged gland.
I believe if the head injury patient's Pituitary
related hormones were checked as a matter of course periodically, such problems could be nipped in the bud, thus preventing serious latent problems and
outcomes including the most tragic, suicide.
What is alarming is that many doctors either don't
know, or else consider the condition too rare to take into account. This may be attributable to the long
standing conflict between the UK's medical hierarchy and experts in the
field surrounding the importance of male sex hormones. Numerous UK experts work
outside the NHS, damned by their Endocrinology colleagues who set arbitrary
treatment levels far below the levels when symptoms are present.
When we first began to raise the alarm, we only discovered
two hospitals (Southampton General and Salford Royal) that took the risk
Popular websites like NHSDirect did not mention it, nor did
the Head Injury guideline produced by NICE.
It is likely that even now, if you've had a head
injury in the past and tell your GP you have symptoms that suggest pituitary
damage, he will know nothing of the connection, and you will have to persist if
you want him to refer you to an Endocrinologist.
It is advisable to go armed with Schneider's
systematic review of the research, which covers 19 studies and over 1,000
patients and finds an incidence of 27.5% of pituitary dysfunction after any
traumatic brain injury, and 47% after subarachnoid haemorrhage .
The tests men and women should ask for are LH, FSH, PrL,
IGF-1, cortisol, ACTH, TSH and Serum Testosterone and Oestradiol (an Estrogen derivative).
It should be noted that a little Testosterone in women is important as is a small amount of Oestrogen in men.
More information and other stories can be found on our website established in Chris's memory Here
There is also an article in The Guardian which tells the full story and an interview with Women's Hour, (needs Real Player),
using the pseudonym Caroline Churchill.
If this information has helped you to get diagnosed we
really appreciate it if you would tell us your story firstname.lastname@example.org as it
might help other people.
1. High risk of hypogonadism after traumatic brain injury: implications, Agha A, Thompson CJ, Pituitary 2005
2. Hypothalamopituitary dysfunction following traumatic brain injury and aneurismal subarachnoid hemorrhage: a systematic review, Schneider HJ et al,JAMA 2007 Pubmed abstract.
This hardened soul, normally impervious to the real suffering Hypogonadal people endure, because he has been there, shed tears in the preparation of this web page.
I do so not because of a young life tragically lost, but the consequence of a loving mother racked by the feeling she could have prevented it. She couldn't of course because the system weighs heavily against diagnosing and treating anything but the most severe male hormone problems. May she find peace.
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