This chapter examines the origins and legacy of sexology – the scientific study of sexuality – in the modern world. First consolidated into a coherent programme in the late nineteenth century, sexology has its roots in the re-organization of knowledge about nature in the frameworks of taxonomy, evolutionism, and race. A pervasive preoccupation with heredity gave rise to powerful eugenics movements around the world. The interest in controlling variability and unlocking the secrets of the soul generated parallel developments in biomedicine, especially psychoanalysis and endocrinology. Sex experts worldwide converged in diagnosing cultural signs of homosexuality for the purpose of national modernization. As the centre of gravity in sexual science began to shift from Europe to North America, researchers gave growing support to the sex/gender distinction and redefined the meanings of normality. In the waning days of hereditarian theories, the rise of cultural anthropology coupled with a renewed scientific investment of colonial powers to reverse hierarchical templates of sexual practices and norms emanating from the metropoles. A public health crisis (HIV/AIDS), social movements (gender and sexual minority rights), and the systematization of research protocols (bioethics) shaped a comeback of biological sexology in the closing decades of the twentieth century.

• Thyrotoxicosis is a clinical state of hyperdynamic metabolism as a result of excessive circulating thyroid hormone. The most notable causes of thyrotoxicosis are Graves’ disease, Hashimoto thyroiditis, subacute (De Quervain) thyroiditis and thyroid-stimulating hormone (TSH)/thyroid hormone–secreting tumors. Excessive circulating thyroid hormone can have critical effects on many organ systems.

Cognitive impairment or dementia is increasing in prevalence worldwide and may be an unrecognised and early complication of a number of endocrine conditions, including diabetes mellitus and thyroid disease. In addition, these conditions may be predisposing factors towards developing dementia. In this chapter, we will discuss these issues with reference to diabetes in particular, being the endocrine disorder with the strongest association with cognitive impairment. Identifying cognitive impairments among people with endocrine disorders is important, as is identifying endocrine conditions in people living with dementia, as this may require adjustment of therapeutic targets and of treatment. There are particular challenges in certain clinical groups, including depressive pseudodementia, behavioural and psychological symptoms of dementia, frailty and mild cognitive impairment. Targets for glycaemic control may need to be relaxed in this group of patients, and this is supported by international best practice guidelines.

Depression is a common mental illness that is receiving increasing clinical, academic and even political attention. The World Health Organization (WHO) stated in its report of 2004 that depression is one of the most significant health challenges of the twenty-first century in terms of its effect on disability and loss of function, and it ranked depression as the third leading cause of burden of disease worldwide, as measured by disease-adjusted life-years. It is the leading cause of disease burden in the Americas, and is projected to be the leading cause of disease burden worldwide by 2030. In addition to being an important condition in its own right, it is increasingly being recognised as a condition that, when comorbid with physical illness, has a significant effect on recovery and even mortality. Comorbid mental disorders with endocrine conditions may present challenges both for the patient and for their healthcare providers. The evidence for effective joint interventions is at an early stage, and individuals with psychiatric disorders often experience inequalities in accessing routine physical healthcare.

The assessment and treatment of paraphilias and sex offenders are highly complex. The limited evidence base for treatment extends to both psychological and talking therapy interventions, as well as biological and medication-based interventions. Biological interventions and medical management of sexual offending are particularly challenging areas. Evidence is at the emerging stage only in this area, and Cochrane reviews have advised that further research is required. Nonetheless, given the serious outcomes of potential risks to the patient, such as prolonged stays in secure settings, and to the public in the event of recidivism, medication can be considered in the highest-risk groups. Such treatment regimens require careful assessment, consideration and ongoing management. Consent and motivation for treatment in the individual patient are key to the success or failure of an intervention with such anti-libidinal medications, as the patient will need to voluntarily comply with this treatment in the community in the medium or long term. Patients who find their intrusive sexual thoughts ego-dystonic are probably the most suitable candidates for consideration for such treatment. It is therefore appropriate that such treatments are offered to the highest-risk offenders only.

Over 650 million people live with obesity worldwide, and almost all countries are affected by what is considered a global obesity pandemic. It is one of the factors that contribute to excess premature mortality in patients with severe mental illness, who die 15–20 years younger than the general population. Both obesity and mental health disorders are highly prevalent and frequently occur in the same individual. While weight loss is typically associated with improvements in psychological functioning, a certain proportion of patients will develop new psychological issues or experience a relapse of pre-existing conditions. Further work is needed to clarify the underlying biological mechanisms explaining the relationship between obesity and mental health. In the interim, people with obesity should receive care in a multidisciplinary setting with access to mental healthcare integrated with their obesity care.

Modern developments in research and in the development of services have demonstrated the need for the better integration of mental and physical healthcare in various areas of medicine, including endocrinology. Years of research into the aetiology of depression and other mental disorders have demonstrated the importance of the stress response and the hypothalamic–pituitary axis in the aetiology of many common mental disorders. Where collaborative care or integrated care systems or interventions have been implemented, they have shown improved outcomes across the domains. There is a need for more naturalistic research in the management of complex comorbidities.

Suicide is a leading cause of death in many Western countries. Suicidal ideation and behaviours can be symptoms of depression, but they are also seen in people with other mental health problems, such as bipolar affective disorder, psychosis, substance abuse disorders and adjustment disorders. They are also seen in people who present with psychological distress rather than any diagnosable mental disorder. The consequences of suicidal acts may be especially serious in people with diabetes given the accessibility of lethal means on the one hand, but also the heightened risk of developing complications in cases of severe self-neglect due to a more passive death wish on the other. In Chapter 2, we discussed the relationship between depression and endocrine disorders. Although depression is associated with suicidal ideations and behaviours, it will be these symptoms rather than a diagnosis of mood disorder that are the focus of this chapter.

Given the high rates of diabetes being comorbid with many mental health conditions, it is no surprise that diabetes is very common in mental health facilities and settings. When the mortality gap in severe mental illness is considered, along with the fact that cardiovascular diseases (including diabetes as a cardiovascular risk factor) contribute greatly to this mortality gap, the importance of acting to reduce the impact of suboptimally managed diabetes in these settings is clear. Specific measures may be required to ensure that patients in these settings receive the usual standard of care. Factors such as acuity of illness, lack of insight into both mental and physical health problems and practical difficulties in attending appointments may mitigate against optimised diabetes management. This chapter considers specific challenges particular to various settings, and we will consider some measures that may help to ameliorate or fully overcome these barriers to optimised care. We will consider specific measures in various types of residential units and other settings (including inpatient settings), and we will explore different initiatives that have been used to overcome these challenges and close the mortality gap

People who are transgender and gender non-conforming (TGNC) include people whose experienced gender is different from their assigned sex at birth, and they have specific healthcare needs. As the number of people identifying as TGNC is increasing internationally, it is important that endocrinologists, psychiatrists and indeed all health professionals have a good understanding of the issues related to the physical and mental healthcare of transgender people. People who identify as TGNC experience a disproportionate amount of violence, discrimination and stigma, and these factors contribute to poorer outcomes. There is also a high rate of comorbidity in young people who are TGNC, including mood disorders, eating disorders, suicidal ideation and self-harm. Compounding these mental health problems are the effects of social exclusion (including educational and employment), which often places TGNC people at risk, especially during transitioning. Transgender people should have access to expert guideline-based care that allows them to transition safely and to optimise their health and well-being.

Hormones were hailed in the early twentieth century as one of the most promising explanations for physiological function. This chapter shows how hormone treatments – not just those carried out by medical practitioners – influenced public perceptions of youth and ageing. Laboratory and clinical research influenced the marketing of commercial rejuvenation therapies, and commercial entities produced an enticing range of products containing hormones. The widely publicised research of gland-manipulating surgeons – particularly Eugen Steinach and Serge Voronoff – who gained notoriety by performing rejuvenating operations designed to restore bodily hormonal balance, attracted considerable press interest. The press carried numerous reports of procedures carried out on prominent society figures, yet for many these expensive and highly specialised treatments were out of reach. I argue the main contribution by the work of Voronoff and Steinach to British public life was to sustain a significant market of new hormone-based products, from dietary supplements and skin creams which claimed to restore natural bodily balance to medical hormone preparations designed to address fertility problems.