Sex Hormones as Biomarkers for Eating Disorder Risk With Tom Hildebrandt, PsyD

In an exclusive interview with Psychiatric Times, Tom Hildebrandt, PsyD, shares information about his recent research on sex hormones and the development of eating disorders, such as bulimia nervosa and binge eating disorder. He notes that in examining the amygdala and arousal circuits, there are clear differences in prefrontal cortex’s ability to prevent disinhibition; inability to disinhibit eating cues, he says, is one of the potential causes in developing these types of eating disorders.

He also mentions a finding of large aromatase differences between healthy individuals and individuals who develop bulimia nervosa. With these new results, it is likely that “this process is not governed necessarily just by presence of hormones themselves but actually the metabolism and how these metabolic differences can lead to very specific regional differences in the brain.”

Development of disorders like bulimia nervosa and binge eating disorder appears to be related to reduced aromatase availability causing reduced estrogen exposure in arousal circuitry which manages eating cues.¹ These biological connections may be able to serve as biomarkers for risk of eating disorders. Aromatase availability can be affected by heritable genetic differences and by environment during development.²

Hildebrandt recommends clinicians make cautious and thoughtful choices around hormonal birth control for women who may be at risk of bulimia nervosa and binge eating disorder. For male patients, he recognizes the need for developing testing strategies to see estrogen deprivation in the brain. In terms of treatment, estrogen levels can be increased by increasing their precursor, testosterone, and he recommends keeping a close watch to prevent onset during adolescent development. Areas of research that may benefit treatment include studying sex hormones as a therapeutic target, and looking into potential developmental windows where prevention can be prioritized.

Dr Hildebrandt is a clinician and researcher with Mount Sinai, specializing in adolescents and adults with weight disorders along with neuroendocrine and hormonal contributions to eating and substance use disorders. He is also a professor of psychiatry and of AI and human health.

References

1. Klump KL, Racine SE, Hildebrandt B, et al. Ovarian hormone influences on dysregulated eating: a comparison of associations in women with versus without binge episodes. Clin Psychol Sci. 2014;2(4):545-559.

2. Saure E, Sipila PN, Surcel HM, et al. Maternal sex-hormone exposure and the risk of eating disorders in daughters. Psych Res. 2024;342:116170.