Hormonal contraceptive use in relation to basal and reactive testosterone, DHEAS, and cortisol

A burgeoning area of research has begun to uncover a wide range of potential neurological and psychological correlates of hormonal contraceptive (HC) use. Yet there remains a limited understanding of the underlying mechanisms for how HC use alters aspects of neurobiology and related behavioral outcomes. Uncovering these processes has the potential for new discovery in the field of behavioral neuroendocrinology, particularly in the complex interplay between steroid hormone subclasses. Although prior research has often focused on the effects of HC use on progestogen and estrogen disruption, basal and reactive androgens and cortisol may also be significantly impacted by HC use and serve critical functions throughout the brain and body. We discuss important background information on the synthesis and function of three steroid hormones – testosterone, dehydroepiandrosterone-sulfate (DHEAS), and cortisol, review prior research showing how HC use is related to circulating (basal) and reactive levels, and provide sample data on salivary levels from our own research. The combined evidence shows that HC use, specifically of the OC pill, is associated with significantly reduced total, free, and salivary androgens, increased total cortisol in blood but not saliva, and a blunted salivary cortisol response to social stressors. Limited evidence provides initial indication that the specific estrogen and progestin compounds in HC formulas may differentially impact steroid hormone levels. Finally, we discuss the mechanisms by which HCs alter steroid hormone levels, the potential implications of these effects on brain and behavior outcomes, and considerations for future research.