30 Jan Women’s & Men’s Health: Hormonal Disruption Across Sexes

NURS 6501 – Week 10 Case Study

In this case study, you will analyze sex-based differences in disease presentation and progression

with a specific focus on hormonal disruption across the lifespan. Hormones play a critical role in

musculoskeletal health, metabolic regulation, neurologic function, mood stability, and sexual health.

Disruption of hormonal balance whether gradual or surgically induced, can result in multisystem

symptoms that are frequently misinterpreted as normal aging, psychiatric conditions, or degenerative

disease.

This assignment requires you to apply advanced pathophysiology concepts to two patients of the same

age but different sex, comparing how hormonal changes uniquely influence symptom development,

disease risk, and diagnostic interpretation in women and men. Emphasis should be placed on

understanding how abrupt estrogen loss and androgen deficiency affect physiologic functioning,

contribute to diagnostic confusion, and increase long-term health risk.

You will critically evaluate the patients’ clinical presentations to:

• Explain the primary pathophysiological processes driving symptom development

• Analyze the role of genetic, hormonal, and reproductive factors in disease susceptibility

• Examine how sex-based assumptions, lifestyle factors, and diagnostic bias influence outcomes

This assignment is designed to strengthen your ability to synthesize complex clinical information,

distinguish hormonal pathology from normal aging, and recognize how sex-specific physiology

influences disease expression.

UNIFIED CASE STUDY SCENARIO

Students, this is not a separate case but a single integrated case identifying:

• Same age > controls for aging

• Different sex > highlights hormonal physiology

• Abrupt estrogen loss versus gradual androgen decline

• Shared misattribution (“aging,” “stress”) which is why cardiology risk factors for male and

female are over generalized for the female (stress versus cardiac risk factors)

• Different downstream risks (fracture versus muscle loss)

Paired Patients: Sex-Based Hormonal Disruption

This case involves two patients of the same age presenting with overlapping yet sex-specific symptoms

related to hormonal disruption. The comparison highlights how endocrine changes manifest differently in

women and men and how these differences influence diagnosis, diagnostic bias (failure to recognize

underlying pathology), and disease progression.

PATIENT A – FEMALE

Name: Ms. J.S.

Age: 46 years

Sex: Female

Ms. J.S. presents with progressive fatigue, diffuse joint and bone pain, hair thinning, mood instability,

cognitive fog, decreased libido, and worsening musculoskeletal discomfort over the past 18 months.

Gynecologic & STD History

At age 44, she underwent a total hysterectomy with bilateral salpingo-oophorectomy (TAH-BSO) for

severe endometriosis and persistent high-risk HPV with recurrent abnormal cervical cytology. She was

not started on hormone replacement therapy due to concerns about malignancy risk.

Post-Surgical Symptom Progression

Since surgery, she reports:

• Hot flashes and night sweats

• Vaginal dryness and dyspareunia

• Rapid weight gain

• Hair thinning at temples and crown

• Morning stiffness and diffuse joint pain

• Deep bone pain in hips and wrists

She reports being told her symptoms were “normal aging,” “depression,” or “early osteoarthritis.”

Near-Miss Outcome

Six months ago, Ms. J.S. sustained a low-impact wrist fracture after a minor fall. No further evaluation

was pursued.

She expresses concern that her hair loss may be autoimmune in origin.

PATIENT B – MALE COMPARATOR

Name: Mr. K.S.

Age: 46 years

Sex: Male

Mr. K.S. presents with chronic fatigue, decreased libido, erectile difficulty, depressed mood, reduced

muscle mass, increased central adipose, and joint aches over the past year. He was currently promoted to

CEO of a well known pharmaceutical company.

He reports:

• Reduced motivation and exercise tolerance

• Gradual weight gain

• Joint pain attributed to “getting older”

Social & Health Context

• Former competitive athlete

• Sedentary lifestyle due to fatigue

• High occupational stress

• No history of nicotine use, vaping or alcohol use

He delayed seeking care, stating:

“Men are supposed to just push through.”

CASE STUDY QUESTIONS (RUBRIC-ALIGNED) – Thoughts to consider in your writings for the

content – however, follow the entire rubric.

Rubric Criterion 1 – Primary Pathophysiological Processes (30 points)

Rubric language:

“Develop a case study analysis examining patient signs and symptoms. Discuss the primary

pathophysiological processes and their significance for symptom development and diagnosis”

1. Compare and contrast the primary pathophysiological mechanisms underlying Patient A’s and

Patient B’s symptoms.

2. Explain how sex-specific hormonal disruption (estrogen deficiency vs androgen deficiency)

contributes to:

o Musculoskeletal pain

o Mood and cognitive changes

o Sexual dysfunction

3. Identify the most likely underlying disease processes in each patient and justify your reasoning.

Rubric Criterion 2 – Genetics and Risk Factors (30 points)

Rubric language:

“Describe the role genetic mutations play in the development of the disease and the risk factors that make

the patient more susceptible”

1. Discuss how genetic, hormonal, and reproductive factors influence disease susceptibility in both

patients.

2. Compare how surgical menopause and androgen decline alter long-term health risks.

3. Explain how Patient A’s HPV history and surgical management influenced her current risk

profile.

Rubric Criterion 3 – Racial/Ethnic Variables AND History/Lifestyle (25 points)

Rubric language:

“Explain any racial/ethnic variables that may impact physiological functioning AND explain factors in

the patient’s history and lifestyle that could have contributed to the development of the disease process”

1. Analyze how diagnostic bias and sex-based assumptions affected symptom interpretation and

care in both patients.

2. Explain how lifestyle and psychosocial factors contributed to disease expression.

3. Distinguish between:

o Osteoporosis vs osteoarthritis in Patient A

o Hormonal alopecia vs autoimmune alopecia in Patient A

o Normal aging vs androgen deficiency in Patient B

REMINDERS:

• This is a case-based analysis, not a textbook discussion of menopause, hypogonadism,

osteoporosis, alopecia, or sexual dysfunction.

• Do not assume or create laboratory, imaging, or diagnostic test results. Your analysis

must be based solely on the patient’s clinical presentation and underlying

pathophysiology.

• All discussion must be explicitly tied to the patients in this case. General statements

about hormones or aging must be clearly applied to the clinical scenario.

• Avoid SOAP-note, charting, or treatment-plan language. This assignment evaluates

pathophysiologic reasoning, not management decisions.

• Use primary, peer-reviewed literature (i.e., clinical guidelines, systematic reviews,

foundational studies) to support all major claims. Overreliance on secondary summaries

(i.e., StatPearls) may result in point deductions.

• Clearly distinguish:

o Hormonal deficiency vs normal aging

o Osteoporosis vs osteoarthritis

o Hormonal alopecia vs autoimmune alopecia

• Hormonal disruption (i.e., surgically induced menopause or androgen deficiency) should

be discussed as a systemic physiologic process, not limited to reproductive symptoms

alone.

• Supplements or wellness-based interventions may be discussed only as adjunctive or

supportive, not as disease-modifying or curative.

• Sex-based differences in disease expression must be addressed. Comparison between

the female and male patient is intentional and expected.

• Body of the paper must not exceed 2 pages, per rubric. Concise, synthesis-based

writing is required.

o Papers exceeding page limits due to general disease descriptions, textbook-style

writing, or unfocused background material may lose points under written

expression criteria.

• Title page and reference list do not count toward the page limit.

• Papers exceeding page limits or relying primarily on secondary sources will lose points

NURS_6501_Week 10_Case Study_Assignment_Rubric