<img width=960 alt="Title slide of a presentation with the University of Western Australia logo and the title DENT 3005: Introduction to Pharmacology Hormonal drugs. The speaker is Dr Thuy Linh Truong with email thuy.truong@uwa.edu.au." src="https://o.quizlet.com/Qk97yE0p56.P-Eoyn12Y5w.png"> </img>
DENT 3005:Introduction to
Pharmacology
**Hormonal drugs**
Dr Thuy Linh Truong
thuy.truong@uwa.edu.au
# **DENT 3005: Introduction to Pharmacology**
## **Hormonal drugs**
Dr Thuy Linh Truong
thuy.truong@uwa.edu.au
**Acknowledgement**
of country
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.
<img src='Walley OAM Aboriginal Art'> </img>
Artist: Dr Richard Barry Walley OAM
# **Acknowledgement of country**
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 Outcomes**
Learning objectives
1) Identify major endocrine gland the the hormones they produce
2) Basic understanding of steroid hormones
3) Broad understanding of the pituitary gland and the various hormones it produces and their function
4) Broad understanding of estrogen, progestogens and androgen drugs and their implications in the dental setting
5) Applied knowledge to clinical scenarios
<img ></img>
# **Learning Outcomes**
## **Learning objectives**
1) Identify major endocrine gland the the hormones they produce
2) Basic understanding of steroid hormones
3) Broad understanding of the pituitary gland and the various hormones it produces and their function
4) Broad understanding of estrogen, progestogens and androgen drugs and their implications in the dental setting
5) Applied knowledge to clinical scenarios
<img > World Health Organization logo with text </img>
**World Health Organization**
**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 $\rightarrow$ Ask
# **World Health Organization**
## **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 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
# **Testosterone and Steroid Hormone Action**
## **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 mechanism**
- Lipid-soluble $\rightarrow$ crosses cell membrane
- Binds intracellular receptors (cytoplasm/nucleus)
- Activates receptor $\rightarrow$ hormone-receptor binds DNA (HREs)
- Regulates gene transcription $\rightarrow$ 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.
## **Steroid hormone mechanism**
- 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 Gland**
* 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
<img alt="Diagram showing the pituitary gland and the hormones it releases affecting various target organs including the mammary glands, adipose tissue, bone and muscle, gonads, thyroid gland, and adrenal glands." />
# **The pituitary Gland**
- 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 hormones**
* 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
```mermaid
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
```
# **Brain and hormones**
- 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
```mermaid
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
```
**Estrogen**
* **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 |
# **Estrogen**
- **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 |
**Progestogen**
* 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 |
| :--- | :--- |
| **COCs** | Yaz, Femme, Zoley, Brenda, Madeline... many more |
| **Drospirenone** | |
| **Levonorgestrel** | |
| **Nomegestrol** | |
| **Norethisterone** | |
| **Many more+++** | |
| Etonogestrel | Implanon NXT |
| Medroxyprogesterone | Provera |
# **Progestogen**
- **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 |
**Androgens**
* 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
<table><thead><tr><th>**Generic name**</th><th>**Brand Name**</th></tr></thead><tbody><tr><td>Testosterone</td><td>Testogel</td></tr><tr><td>COCs cyproterone</td><td>Brenda, Carolyn, Diane, Estelle</td></tr><tr><td>Finasteride</td><td>Finpro</td></tr></tbody></table>
# **Androgens**
- 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 drugs**
**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
# **Hormonal drugs**
## **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 mambo**
- **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 1: the menopause mambo**
- **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!”
* Scenario
* Mrs Lip, a 32-year-old woman, presents for her routine dental exam
* Medical history: pregnant in her $2^{nd}$ 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?
<img href="Case_2_gum_tumor_image.png"/>
# **Case 2: “my gum has a tumor!”**
- **Scenario**
- Mrs Lip, a 32-year-old woman, presents for her routine dental exam
- Medical history: pregnant in her $2^{nd}$ 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?
**References**
* 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
![]()
A woman suffering from a cold surrounded by medication, and an image of several pill bottles.
# **References**
- 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
[[L11 HORMONAL DRUGS 2025.pdf#page=1|L11 HORMONAL DRUGS 2025, p.1]]
[[L11 HORMONAL DRUGS 2025.pdf#page=2|L11 HORMONAL DRUGS 2025, p.2]]
[[L11 HORMONAL DRUGS 2025.pdf#page=3|L11 HORMONAL DRUGS 2025, p.3]]
[[L11 HORMONAL DRUGS 2025.pdf#page=4|L11 HORMONAL DRUGS 2025, p.4]]
[[L11 HORMONAL DRUGS 2025.pdf#page=5|L11 HORMONAL DRUGS 2025, p.5]]
[[L11 HORMONAL DRUGS 2025.pdf#page=6|L11 HORMONAL DRUGS 2025, p.6]]
[[L11 HORMONAL DRUGS 2025.pdf#page=7|L11 HORMONAL DRUGS 2025, p.7]]
[[L11 HORMONAL DRUGS 2025.pdf#page=8|L11 HORMONAL DRUGS 2025, p.8]]
[[L11 HORMONAL DRUGS 2025.pdf#page=9|L11 HORMONAL DRUGS 2025, p.9]]
[[L11 HORMONAL DRUGS 2025.pdf#page=10|L11 HORMONAL DRUGS 2025, p.10]]
[[L11 HORMONAL DRUGS 2025.pdf#page=11|L11 HORMONAL DRUGS 2025, p.11]]
[[L11 HORMONAL DRUGS 2025.pdf#page=12|L11 HORMONAL DRUGS 2025, p.12]]
[[L11 HORMONAL DRUGS 2025.pdf#page=13|L11 HORMONAL DRUGS 2025, p.13]]
[[L11 HORMONAL DRUGS 2025.pdf#page=14|L11 HORMONAL DRUGS 2025, p.14]]
[[L11 HORMONAL DRUGS 2025.pdf#page=15|L11 HORMONAL DRUGS 2025, p.15]]