The Relationship Between Sex Hormones and Eating Disorders Like Bulimia Nervosa and Binge Eating

Tom Hildebrandt, PsyD, discusses the relationship of sex hormones to eating disorders like bulimia nervosa and binge eating disorder. Hildebrandt studies how gonadal hormones, like androgen and estrogen, can affect the brain and create increased likelihood of disinhibition of response to food cues.¹ He notes that in both binge eating disorder and bulimia nervosa, “the symptom of binge eating is conserved across both diagnoses,” and conceptualizes the inability to inhibit eating cues in both. Concerning sex differences in these disorders, Hildebrandt notes researchers have found a larger difference between men and women in bulimia nervosa, along with a larger range of comorbid diagnoses that deal with impulse control.² Data has also shown that sex differences are present in adolescence, with different risks for girls and boys as they develop. One of Hildebrandt’s core research questions asks what role androgen and estrogen play in the brain of individuals at risk for developing bulimia nervosa and binge eating disorder.

The element of heritability also plays a role in calculating risk of developing these disorders. Before puberty, heritability risks seem stable, but shift going into adolescence where androgens may become increasingly risk inducing for individuals born as females. Hildebrandt points out the potential for “aromatase differences in men and women who develop this problem to begin with, such that their brains are being exposed to less estrogen, and is that risk even more exacerbated...among those born as boys.” Hormones also have a metabolic pattern governed by enzymatic processes which aromatase governs, and this plays a role in localized regulation of sex hormones, also known as sex hormone metabolism.

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. Hildebrandt T, Alfano L, Tricamo M, et al. Conceptualizing the role of estrogens and serotonin in the development and maintenance of bulimia nervosa. Clin Psychol Rev. 2010;30(6):655-668.

2. Zhao Z, Gobrogge K. Neurodevelopmental model explaining associations between sex hormones, personality, and eating pathology. Brain Sci. 2023;13(6):859.