The Hormone Factor in Mental Health; Revisiting the Book Ten Years Later

From J D Faccinetti, co-founder and chief editor – When Linda Rio first thought about writing a book about hormones and mental health, she humbly admits to knowing very little about the subject. It was in an unexpected conversation with a neighbor, who just happened to be an acromegalic patient and a patient advocate, that she first heard about the psychological, social, emotional, and relationship impact hormone conditions have on pituitary patients and people around them. She told me she was initially surprised but wanted to learn more. But it was hearing the personal, often heartbreaking stories from patients, their wives, husbands, and children that got her hooked.

And learning she did. First, about the extraordinary time delay to get an accurate pituitary disorder diagnosis which seemed to her, at the time, to contribute significantly to a patient and their family’s quality of life; the all too frequent descriptions of depression, anxiety, mood fluctuations, sexual issues, infertility, mental confusion, anger, and rage, which so often go unnoticed. These mental health symptoms lead to disruptions within families. The confusion surrounding the symptoms intensifies if there is no explanation, and affected people can feel perplexed, unsupported, unsure, or worse, doubted that what they are experiencing is real.

It seemed to Linda neither the medical nor mental health professions could adequately identify and treat these disorders, and a more holistic, comprehensive approach needed to be taken. She thought educating individuals and families on hormone disorder symptoms and mental health would be beneficial, even in cases without a confirmed diagnosis (Rio, 2014, p. 148). The disruption in the internal biological system seemed to affect the external individual, family, and social system.  “Given all that is known from history through today, it is nearly impossible for someone’s quality of life not to be impacted following the diagnosis of an endocrine disorder” (Blevins & Rio, introduction, 2014).

With the ten-year anniversary of the publication of The Hormone Factor in Mental Health: Bridging the Mind-body Gap (2013) approaching, we wanted to take a retrospective look at what has been accomplished in understanding the link between mental-physical link and pituitary disorders and what further goals need to be set for future learning.

I asked Linda to send me some background for this article on her book. First, she wanted me to underline that it was a collaborative effort with contributions from some of the world’s top medical experts, mental health, patient advocacy, and, most importantly, pituitary patients and their families. Dr. Lewis Blevins was the first one she approached to contribute. The book, she felt, needed the credentials of someone of his stature. Without his input and willingness to collaborate on the introductory chapter, “this book would never have been published,” she told me.

Another critical contribution came from Shereen Ezzat, MD, Professor of Medicine and Oncology at the University of Toronto, who wrote, “…managed to skillfully delve into the black box that guides our thoughts and feelings. With support from experts from across the globe, this book covers the history, current knowledge, and future challenges in understanding the hormonal connections. I highly recommend it for anyone with immediate or remote interest into what makes us tick.”

Publishing a book like this is not easy. Publishers like to have a clean “shelf” to identify where a book belongs. This was a problem when proposing The Hormone Factor to publishing houses since the subject matter sits in two major categories: medicine and mental health.

It didn’t fit neatly into either category. In addition, it was intended as a text for clinicians and the lay public, adding another marketing complication. She told me this was not an easy sell, and the chances of finding a publisher looked quite dim for a long time. A lot of persuading was necessary to sell the idea. Initially, publishers thought there was no apparent need for this information and doubted anyone would buy it. Even with contributions from some of the world’s top endocrine, OBGYN, men’s health, Medical Family Therapy, and patient advocates, publishers rejected the proposal time after time. Linda told me her objective was never to make money, which she told me it hasn’t, or to make the best seller list.

Thankfully, the Hormone Factor has reached many who otherwise would have never been exposed to the information. The goal was to cover a comprehensive perspective of the impact the tiny pituitary gland can have on the body and the external relationship, cognitive, spiritual, and personal world of an individual in their environs.

Since the book’s publication, we are thrilled to report that more and more research has been devoted to understanding the impact of early childhood trauma on the developing body and mind. The importance of brain structures involved in emotional health being particularly impacted when subjected to intense levels of stress hormones, termed “toxic stress” (Murphy et al., 2022), has been examined in recent years. Another 2021 study of 128 pituitary adenoma patients concluded that this disease’s traumatic nature requires applied clinical intervention (Kovler & Prevedello, May 2021). Although these studies have yet to become widespread information to mental health professionals, they are positive signs of the growing interest in crossing the medical-mental health barriers to understanding pituitary disorders from a broader perspective.

The obvious question that follows about a complex, labor-intensive project like this one is: has it provided a benefit to patients, their families and friends, mental health clinicians, and medical professionals? The answers to these questions must come from the readers. But Linda tells me she has observed since its publication that the book has opened doors for speaking and writing engagements and provided credibility for the topic to be considered valid in many areas not considered before. People with symptoms have found information in the book helpful to take to their physicians and eventually be referred to pituitary endocrinologists and neurosurgeons for treatment. She has received lots of feedback over the years from patients worldwide who found even the book’s title helpful in their search for answers. Family members and patients worldwide consistently reach out to her, some with tears, feeling validated for the emotional, cognitive, and social symptoms that their doctors never acknowledged or sadly misunderstood. Because of The Hormone Factor, Pituitary World News now dedicates an entire section to Mental Health. This is one of the only sites to acknowledge the impact pituitary disorders have so fully on mental health and vice versa.

During our recent conversation about the book, Linda told me The Hormone Factor was never intended to fulfill all the needs patients, family members, and medical and mental health professionals require to understand and treat pituitary disorders from a holistic, collaborative, comprehensive perspective. The Hormone Factor was intended as a beginning. Patients can present with symptoms of depression and neurological symptoms before a diagnosis of underlying pituitary pathology. A recent report suggests potential opportunities for early screening and diagnosis of pituitary adenomas (Cardoso et al., 2019). Of course, it is very much a wish that research is funded to look at the bi-directionality of disorders of the pituitary, causes, and treatments. We hope there will be more collaboration among all treating professionals and that patients will find the treatments and aids to help them have whole, fulfilling and happy lives. “When all is said and done, my hope, she said, is that The Hormone Factor will spur us all to listen a little better and to keep pursuing a better understanding of the complexity of the human body and mind as interconnected.”


“Linda is in private practice in Westlake Village, California, and can be reached at

Linda M. Rio, M.A., LMFT (805) 619-0950

Product DetailsThe book The Hormone Factor in Mental Health is available through and other major booksellers.



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Aas, M., Henry, C., Andreassen, O.A. et al. The role of childhood trauma in bipolar disorders. Int J Bipolar Disorder 4, 2 (2016).

Cardoso, Ff., Azizi, H., Kilpatrick, A., Olayinka, O., Kahn, T., et al (2019). Chronic atypical depression as an early feature of pituitary adenoma: a case report and literature review.

Case Reports in Psychiatry

Kovler, J.D., and Prevedello, D. (2021). Trauma symptomatology in patients successfully treated or pituitary adenoma. J of the Endocrine Society, 5.

Murphy, F., Nasa, A., Cullinane, D., Raajakesary, K., Gazzaz, A. , Sooknarine, V. et al. (2022). Childhood trauma, the HPA axis and psychiatric illnesses: a targeted literature synthesis. Child and Adolescent Psychiatry, 13.

© 2023, Pituitary World News. All rights reserved.