DENT 3005: Introduction to Pharmacology¹

Hormonal drugs

Dr Thuy Linh Truong thuy.truong@uwa.edu.au

Acknowledgement of country²

The University of Western Australia acknowledges that its campus is situated on Noongar land, and that Noongar people remain the spiritual and cultural custodians of their land, and continue to practise their values, languages, beliefs and knowledge.

Artist: Dr Richard Barry Walley OAM

Learning Outcomes³

Learning objectives

Identify major endocrine gland the the hormones they produce
Basic understanding of steroid hormones
Broad understanding of the pituitary gland and the various hormones it produces and their function
Broad understanding of estrogen, progestogens and androgen drugs and their implications in the dental setting
Applied knowledge to clinical scenarios

World Health Organization⁴

Gender and Hormonal therapy

Gender refers to the characteristics of women, men, girls and boys that are socially constructed.
This includes norms, behaviours and roles associated with being a woman, man, girl or boy, as well as relationships with each other.
As a social construct, gender varies from society to society and can change over time.
As a healthcare professional, we need to be treating patients with justice regardless of gender.
Gender is not the same as Sex.

If unsure → Ask

Testosterone and Steroid Hormone Action⁵

Testosterone in males

Made by Leydig cells (testes)
Role: reproductive development, secondary sex traits, muscle/bone maintenance

Testosterone in females

Made by ovaries & adrenal glands
Role: libido, muscle strength, bone density, estrogen precursor

Diagram showing testosterone sources and its mechanism of action:

Left Side (Testosterone Sources):

Men:
- Adrenal glands
- Testicles
- Produces Testosterone (chemical structure shown)
Women:
- Adrenal glands
- Ovaries
- Produces Testosterone (chemical structure shown)

Right Side (Mechanism of Action - Steroid Hormone Action):

Steroid molecules (small blue hexagons/dots) diffuse across the Cell membrane.
Inside the cell cytoplasm, the steroid molecule binds to an intracellular receptor (red and blue complex with a cavity).
This binding causes a Conformational (allosteric) change in receptor structure (indicated by the receptor changing shape and color, shown by a green curve representing the conformational change).
The activated Steroid-Receptor complex then enters the Nuclear membrane.
Inside the nucleus, the complex acts as a Transcription factor, binding to the Steroid response element (SRE) on the DNA.
RNA polymerase binds to the promoter region (indicated by ATG and TAA).
Transcription occurs, leading to the formation of $3^{'}$ pre-mRNA.
The pre-mRNA undergoes Processing (splicing out introns, represented by A, B, C, D, E, F, G segments).
The mature mRNA is then Exported out of the nucleus.
In the cytoplasm, the mRNA undergoes Translation (AUG and UAA codons indicated), forming a New protein (polypeptide chain).
This Altered cell function is the final result of the steroid hormone action.

Legend/Key:

Steroid molecules
Conformational (allosteric) change in receptor structure

Steroid hormone mechanism⁶

Lipid-soluble → crosses cell membrane
Binds intracellular receptors (cytoplasm/nucleus)
Activates receptor → hormone-receptor binds DNA (HREs)
Regulates gene transcription → alters protein synthesis

Examples

Cortisol: stress, inflammation
Estrogen: reproduction, bones
Testosterone: muscle, bones, sex traits

An image illustrating the production of Testosterone in Men (Adrenal glands and Testicles) and Women (Adrenal glands and Ovaries), and a diagram of the steroid hormone mechanism of action within a cell, showing the hormone crossing the cell membrane, binding to an intracellular receptor, regulating gene transcription in the nucleus, and altering protein synthesis in the cytoplasm.

The pituitary Gland⁷

A tiny gland at the base of the brain: small but mighty!!!
A major endocrine gland!
- Produces a wide variety or hormones that travels to regulate other glands & organs in the body
Anterior lobe: GH, ACTH, TSH, FSH, LH
Posterior lobe: ADH, oxytocin

Brain and hormones⁸

Hypothalamus releases GnRH
GnRH signals pituitary to release FSH and LH

FSH

Stimulates egg growth
Promotes estrogen production
Prepares for ovulation

LH

LH surge triggers ovulation

Hormonal contraceptives

Combined pill
- Estrogen inhibits FSH and LH
- Progestogen inhibits LH and thickens cervical mucus
Progestin-only pill
- Thickens cervical mucus
- Alters endometrium to prevent implantation

No pregnancy

Corpus luteum degenerates
Estrogen and progesterone levels drop
Endometrial lining sheds, leading to menstruation

flowchart TD
    A[Hypothalamus] -->|GnRH| B(GnRH)
    B -->|Activates(+)| C[Anterior pituitary]
    C -->|FSH| D{FSH}
    C -->|LH| E{LH}
    D -->|Activates(+)| F[Ovary]
    E -->|Activates(+)| F
    F -->|Maturation| G{Oestrogens}
    F -->|Ovulation| G
    F -->|Corpus Luteum (CL)| H{Progesterone}
    G -->|Inhibits(-)| C
    H -->|Inhibits(-)| C
    G -->|Inhibits(-)| A
    H -->|Inhibits(-)| A

    subgraph Hormonal contraceptives
        J[Combined pill]
        K[Progestin-only pill]
        J --> L[Estrogen inhibits FSH and LH]
        J --> M[Progestogen inhibits LH and thickens cervical mucus]
        K --> N[Thickens cervical mucus]
        K --> O[Alters endometrium to prevent implantation]
    end

    subgraph No pregnancy
        P[Corpus luteum degenerates]
        P --> Q[Estrogen and progesterone levels drop]
        Q --> R[Endometrial lining sheds, leading to menstruation]
    end

Estrogen⁹

Replacement therapy
- Menopause – Flushing, vaginal dryness, Preserve bone mass
- Tablets, patches are most commonly used
Contraception
- Combination: ethinylestradiol, oestradiol
Antiestrogen
- Oestrogen-sensitive breast cancer (Tamoxifen)
- Induce ovulation (Clomiphene) in treating infertility

Generic name	Brand Name
COCs	Yaz, Femme,
Ethinyloestradiol	Zoley, Brenda,
Oestradiol	Madeline…
Mestranol	many more

Progestogen¹⁰

Contraception e.g. Norethisterone, Levonorgestrel
- Combined with Oestrogen
- Progesterone only [Oral, Injection, Implant, Intrauterine] e.g. Medroxyprogesterone, Etonogesterol
Endometriosis
Antiprogestogens
- Medical termination of pregnancy (Mifepristone)

Generic name	Brand Name
Drospirenone
Levonorgestrel
Nomegestrol
Norethisterone
Many more+++
Etonogestrel	Implanon NXT
Medroxyprogesterone	Provera

Androgens¹¹

Aka anabolic steroids
Bind & activate androgen receptors
Hormone replacement
- Male hypogonadism
Anti-androgens e.g. Flutamide, Cyproterone
- Indication: tx of prostatic cancer, COCs
5α-Reductase inhibitors e.g. finasteride
- Indication: benign prostatic hyperplasia

Generic name	Brand Name
Testosterone	Testogel
COCs cyproterone	Brenda, Carolyn, Diane, Estelle
Finasteride	Finpro

Hormonal drugs¹²

Dental implications

Hormonal based medications can exacerbate gingival overgrowth
ADR: dry mouth, taste disturbances
Oral contraceptive
- Potential risk factor for dry socket after dental extraction

Case 1: the menopause mambo¹³

Scenario
- Mrs. Canine, a 54-year-old woman, presents for her routine dental exam.
- Medical history: started HRT for menopause
- Medication history: estrogen patches
- Clinical findings: gingival inflammation, despite excellent plaque control
- Patient also reports recent dry mouth
Discussion Points
- How might hormonal replacement therapy influence salivary flow and increase xerostomia risk in postmenopausal patients?
- Why is it important to recognize inflammation in patients with good plaque control, especially those on HRT?
- What preventative or supportive strategies can we offer patients experiencing hormone-related oral dryness?

Case 2: “my gum has a tumor!”¹⁴

Scenario
- Mrs Lip, a 32-year-old woman, presents for her routine dental exam
- Medical history: pregnant in her $2^{n d}$ trimester, borderline gestational diabetes
- Medication history: Elevit
- Presenting concern: “I have a lump around my canine”
Discussion Points
- How does pregnancy affect gingival health?
- Why is periodontal monitoring critical in diabetic patients?
- What role does patient education play in managing oral health during pregnancy?

References¹⁵

Ritter JM, Flower RJ, Henderson G, Loke YK, MacEwan D, Robinson E, editors. Rang & Dale’s pharmacology. 10th ed. Edinburgh: Elsevier; 2023
Shigehara K, Izumi K, Kadono Y, Mizokami A. Testosterone and bone health in men: a narrative review. J Clin Med. 2021;10(3):530. doi:10.3390/jcm10030530
Australian Medicines Handbook Online [Internet]. Adelaide (AU): Australian Medicines Handbook Pty Ltd;2000. Obstetrics and Gynaecological; [updated 2025; cited 2025]. Available from: UWA Onesearch
Pharmaceutical Society of Australia. Australian Pharmaceutical Formulary and Handbook: A Guide to Best Practice. 25th ed. Canberra: Pharmaceutical Society of Australia; 2021
Ali K. Clinical dental pharmacology. 1st ed. Oxford: Wiley-Blackwell; 2023
Bullock S, Manias E. Fundamentals of pharmacology. 8th ed. Frenchs Forest, NSW: Pearson Australia; 2017
MIMS Australia. eMIMSelite: Consumer medicine information, specific clinical monograph [Internet]. Sydney: MIMS Australia; [updated 2025; cited 2025 Apr 17]. Available from: UWA Onesearch

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Explorer

L11 HORMONAL DRUGS 2025_formatted_text

DENT 3005: Introduction to Pharmacology¹

Hormonal drugs

Acknowledgement of country²

Learning Outcomes³

Learning objectives

World Health Organization⁴

Gender and Hormonal therapy

Testosterone and Steroid Hormone Action⁵

Testosterone in males

Testosterone in females

Diagram showing testosterone sources and its mechanism of action:

Left Side (Testosterone Sources):

Right Side (Mechanism of Action - Steroid Hormone Action):

Legend/Key:

Steroid hormone mechanism⁶

Examples

The pituitary Gland⁷

Brain and hormones⁸

FSH

LH

Hormonal contraceptives

No pregnancy

Estrogen⁹

Progestogen¹⁰

Androgens¹¹

Hormonal drugs¹²

Dental implications

Case 1: the menopause mambo¹³

Case 2: “my gum has a tumor!”¹⁴

References¹⁵

Graph View

Table of Contents

Quartz 4

Explorer

L11 HORMONAL DRUGS 2025_formatted_text

DENT 3005: Introduction to Pharmacology1

Hormonal drugs

Acknowledgement of country2

Learning Outcomes3

Learning objectives

World Health Organization4

Gender and Hormonal therapy

Testosterone and Steroid Hormone Action5

Testosterone in males

Testosterone in females

Diagram showing testosterone sources and its mechanism of action:

Left Side (Testosterone Sources):

Right Side (Mechanism of Action - Steroid Hormone Action):

Legend/Key:

Steroid hormone mechanism6

Examples

The pituitary Gland7

Brain and hormones8

FSH

LH

Hormonal contraceptives

No pregnancy

Estrogen9

Progestogen10

Androgens11

Hormonal drugs12

Dental implications

Case 1: the menopause mambo13

Case 2: “my gum has a tumor!”14

References15

Footnotes

Graph View

Table of Contents

DENT 3005: Introduction to Pharmacology¹

Acknowledgement of country²

Learning Outcomes³

World Health Organization⁴

Testosterone and Steroid Hormone Action⁵

Steroid hormone mechanism⁶

The pituitary Gland⁷

Brain and hormones⁸

Estrogen⁹

Progestogen¹⁰

Androgens¹¹

Hormonal drugs¹²

Case 1: the menopause mambo¹³

Case 2: “my gum has a tumor!”¹⁴

References¹⁵