but I notice there's no psychoendocrinology fellowship, or anything of the kind
I should've addressed this in my first post.
Although knowledge of endocrinology is important in psychiatry, IMHO its not to the point where the demand will warrant the creation of a fellowship. E.g. if I got a depressed patient who is depressed because of hypothyroidism, the treatment is not complicated. You treat the hypothyroidism. Yes, I'm not an endocrinologist, I simply refer the patient to one or get a consult.
Another example: psychiatric DOs often can have somatic GI symptoms. E.g. some abdominal discomfort when a patient has anxiety. Does that warrant a Gastroenterology-Psychiatry fellowship? There's a lot of complexity with the connections with the CNS & ANS with the GI tract which have to do with this, and it would be a great field of study, but speaking practically, is there a market for it (financially & academically) to the point where a fellowship is wanted?
It would seem to me that one of the fields where endocrine really needs to be known well is with sexual & gender ID DOs. However I've noticed (at least from my limited training & experience) that this is more with developmental aspects of sexuality & gender identity that practical clinical endocrinology does not touch. E.g. endocrinologists detect thyroid problems, treat them etc. I haven't met one that delves into the theories of testosterone masculinization during in utero development and how it affects gender identity.
The only people I've seen that have really tackled this issue are research psychologists. I've taken several developmental endocrinological psychology classes in college and very little of it correlated with clinical psychiatry or endocrinology.
Why? I'm not certain, but I'd figure it has to do with sexual & gender identity DOs being a type of "closet" problem--its something that isn't as common as the other psyche DOs, and people with it often don't seek treatment for it---> causing little demand for clinical services for it.
Another problem is there is a strong lack of knowledge in this field because researchers cannot research on human fetuses for obvious reasons. So there are still many questions in this field that are unanswered and until they are answered--cannot lead to practical treatments.
I forgot the name of the person, but there was a famous case of a boy who lost his penis during a botched circumcision. The (erroneous) theory at the time was that male & female babies are virtually the same except for the differing genitalia. We now know that to not be true, and there have been studies showing that hormones affect the brain's development in-utero.
The poor baby was given a sex change surgery to a female at the suggestion of doctors based on the above theory--(a theory with pretty much no studies to back it up--it was just a theory). Well that poor kid turned out to feel she was a boy her entire life. She identified herself as a male.
This is truly a case where a psychiatrist with real endocrinological knowledge on the development of a fetus would have been crucial.
However such an expertise is so rare and in so little demand, and not within the realm of today's practical clinical training.
I've had hundreds of patients in my last 3 years. Only 2 of them had a gender ID DO and did not want treatment for it.
I guess its something like the field of Reproductive Psychiatry. Yes there is a need for it, yes hormones do affect emotions, but there's no fellowship for it.
There is also a theory that estrogen may be protective against schizophrenia, and this is evidenced by SCZ appearing later in females and the rare "late onset schizophrenia" which often starts in females > 40. The theory being that decreased estrogen may be contributing to worsening psychosis which was not apparent until premenopause.
So of course, I ask the question, "if this theory is around why don't psychiatrists offer HRT as a possible treatment against SCZ?"--and no one I asked could give me a good answer.
Sorry for the overly long post.
Bottom line: Endocrine is pillar of medicine that is crucial for psychiatry, but there doesn't appear to be enough of a demand for an endopsychiatric fellowship. I would still reccomend having a good knowledge of it because it and several other aspects of medicine will help you be a better psychiatrist in the long run.
IMHO--endo-psychiatry may yield some valuable contributions in the next few decades, such as offering treatments for sex offenders, sexual & gender ID DOs and there may be better knowledge on the effects of hormones on emotions.
I'm still surprised I've seen very little data on the adverse & beneficial effects of hormonal treatments on emotions. Several females I've known who go on birth control rave or hate specific OCP brands for the emotional effects it had on them.
