It can happen without warning: you slip in the shower and hit your head, a car swerves and hits you, a small stroke occurs and suddenly you can't speak, your mobility is limited, and your world shrinks.
These are real-life examples of the often intractable effects of traumatic brain injury or TBI. And thanks to the groundbreaking work of Dr. Mark L. Gordon and a handful of forward-looking physicians, there's new hope for the 1.7 million Americans afflicted with this condition.
Using cutting-edge hormone replacement techniques, Gordon and his colleagues are helping to change the way we think about traumatic brain injuries, their symptoms - and how to treat them effectively. In his clinical practice, Dr. Gordon is developing new protocols that may revolutionize the devastating impact of traumatic brain injuries. One of the biggest patient populations in need of urgent care are the soldiers returning from the battlefields of Iraq and Afghanistan. Our story begins with them.
Starting with Soldiers
Traumatic brain injury (TBI) is often referred to as the "signature wound" of both the Iraq and Afghanistan wars. Traumatic brain injury occurs when a sudden trauma to the head disrupts brain function. In both these wars, however, even close proximity to the force of an explosion can be just as devastating. Most of the reported traumatic brain injury among Operation Enduring Freedom and Operation Iraqi Freedom veterans has been traced to improvised explosive devices, or IEDs.
"Traumatic brain injury can be caused by a direct impact, or by acceleration alone," explains Dr. Mark L. Gordon, interventional endocrinologist and traumatic brain injury treatment specialist at Millennium Health Centers in Los Angeles. "Brain trauma also causes secondary injury, which takes place in the minutes and days following the injury," he adds. "These processes include alterations in cerebral blood flow and increased pressure within the skull, contributing substantially to damage from the initial injury."
Gordon says traumatic brain injury can cause a host of physical, cognitive, emotional, and behavioral effects, some of which can be difficult to detect. Symptoms can appear immediately or weeks to years following the injury. "Insidious traumatic brain injury can be difficult to detect," Gordon says. "Localized damage to the frontal and occipital lobes occurs when the brain collides with the skull. Increasingly, we are discovering that traumatic brain injury is also a causative factor for accelerated hormonal deficiencies." These deficiencies, says Gordon, can cause a host of psychological, physiological, and physical manifestations, including depression, outbursts of anger, anxiety, mood swings, memory loss, inability to concentrate, learning disabilities, sleep deprivation, increased risk for heart attacks, strokes, high blood pressure, diabetes, loss of libido, menstrual irregularities, premature menopause, obesity, loss of lean body mass, muscular weakness, and a number of other medically documented conditions.
What's more, Gordon points out that veterans suffering from these forms of psychological damage due to traumatic brain injury are frequently misdiagnosed and have their injury erroneously downgraded to post-traumatic stress disorder (PTSD). Moreover, especially in mild traumatic brain injury cases, symptoms at the initial time of injury may go unrecognized or unnoticed, but patients will still develop hormone deficiencies. Unfortunately, the government is slow to accept the link between traumatic brain injury and hormonal deficiencies.
Dr. Gordon's Epiphany
By sheer serendipity, many years ago Dr. Gordon provided care for a young man with a history of numerous sports-related head injuries, whose parents were themselves patients at the clinic. The young man's symptoms long outlasted the immediate effects of his acute injury and included loss of concentration, memory, mental energy, focus, and physical well-being, often accompanied by loss of lean muscle mass and an increase in body fat.
The parents, familiar with the effects of hormonal imbalances, naturally assumed that their son's problems might reflect an endocrine problem of his own. And indeed, many of his symptoms resembled those of adult patients with so-called hypopituitarism, or loss of pituitary gland function. The pituitary gland is located at the base of the brain and is sometimes called the "master" gland of the endocrine system, because it controls the functions of the other hormone- secreting glands.
Gordon, who is nothing if not intellectually curious, hit the books. What he found was startling and life-changing, for himself as a clinician, for his young patient, and now for scores of additional victims of traumatic brain injury.
Symptoms of Traumatic Brain Injury Mimic Pituitary Dysfunction
Dr. Gordon found a wealth of published literature suggesting that traumatic brain injury causes pituitary dysfunction, confirming his initial hunch.1 Although the figures vary between studies, at least 50% (and up to 76%) of traumatic brain injury victims show some loss of pituitary hormone function immediately after the brain injury.2-4 In general, the more severe the original brain injury, the more profound the hormonal deficits, although hormone deficiency or insufficiency (levels in the low "normal" range) are seen even in patients with mild traumatic brain injury.5-9
And while about 58% of patients recover their normal pituitary function within one year of their head injury, a shocking 52% develop new pituitary hormone deficiencies after one year. 10,11
Those deficits include reductions in many different pituitary hormones, including those that regulate the thyroid gland, the adrenal glands (that produce cortisol, DHEA, and other vital hormones), the gonads (where estrogen and testosterone are produced), and growth hormone.3,4,12,13
The severity of the hormone deficiencies correlates strongly with the kinds of symptoms Dr. Gordon was seeing in his patient. For example, patients with growth hormone deficiency or insufficiency had significantly worse disability rating scores, greater rates of depression, worse quality of life, lower energy, greater fatigue, and poorer emotional well-being, compared to brain injury patients with normal hormonal levels.14,15
Dr. Gordon's hunch was borne out: patients with traumatic brain injury often have pituitary hormone deficiencies or insufficiencies, especially in growth hormone. And those defects are closely associated with the persistent neurological, psychological, and emotional deficits that are so tragically common in survivors of traumatic brain injury. And where are you most likely to find a high concentration of survivors of traumatic brain injury? The United States military.
The Combat Connection
"When you have 360,000-plus GIs coming back from war with traumatic brain injury, it gets expensive," he says. "Especially when you have to start addressing hormone deficiencies."
In 2006, the army's surgeon general established the Traumatic Brain Injury Task Force to establish a clear picture of the processes and research involved with helping traumatic brain injury–affected service members transition to civilian life. The task force was designed to assess how the army addressed aspects of traumatic brain injury care, and made recommendations for improvement. But Gordon believes the bottom line is that a task force can do little if the military doesn't want to pay for treatment.
Gordon explains that conventional medical dosage for testosterone is at 200-300 milligrams per week, which he has shown is far too high! "For example, a typical 25-35 year old male naturally generates 4-10 milligrams per day, or 60 milligrams per week. Using supraphysiological dosages of testosterone (as military doctors are doing) can have significant side-effects if not monitored closely. We can achieve similar benefits at one-quarter the dose without the risk factors."
While Gordon admits that interventional endocrinology may not be for everyone, patients like soldiers will eagerly seek it out when traditional doctors have hit a wall and are unable to fix ongoing issues. Recently, he spoke with a military veteran in North Carolina who described the sheer difficulty of getting anything done through the military. "Part of the reason," Gordon explains, "is because the military and doctors see testosterone as a ‘bodybuilder drug,' rather than a natural substance produced in our bodies. It makes no sense why they can readily accept insulin use for diabetes, but not testosterone. They are both natural hormones, flowing naturally through our bodies."