Testosterone influences spatial cognition in older men

Altered cognitive function in men treated for prostate cancer with luteinizing hormone-releasing hormone analogues and cyproterone acetate: a randomized controlled trial

OBJECTIVE

To report the first systematic investigation of the cognitive effects of luteinizing hormone-releasing hormone (LHRH) analogues in male patients, as LHRH analogues have been associated with memory impairments in women using these drugs for gynaecological conditions.

PATIENTS AND METHODS

Eighty-two men with extraprostatic prostate cancer were randomly assigned to receive either continuous leuprorelin, goserelin (both LHRH analogues), cyproterone acetate (a steroidal antiandrogen) or close clinical monitoring. These patients underwent cognitive assessments at baseline and before starting treatment (77), and then 6 months later (65).

RESULTS

Compared with the baseline assessments, men receiving androgen suppression monotherapy performed worse in two of 12 tests of attention and memory; 24 of 50 men randomized to active treatment and assessed 6 months later had a clinically significant decline in one or more cognitive tests but not one patient randomized to close monitoring showed a decline in any test performance.

CONCLUSION

Pharmacological androgen suppression monotherapy for prostate cancer may be associated with impaired memory, attention and executive functions.

Estrogen and cognitive functioning in men with mild cognitive impairment

Although men do not experience an abrupt cessation of gonadal hormone production at midlife as do women, levels of testosterone (T) decrease gradually with aging. Because estradiol (E2) arises mainly from the conversion of T in men, the availability of E2 also decreases with increasing age. In randomized clinical trials, E2 replacement therapy has been shown to maintain aspects of cognition in postmenopausal women, specifically with regard to verbal memory. The present prospective, randomized, cross-over trial is being undertaken in order to determine whether E2 will enhance verbal memory in men with Mild Cognitive Impairment (MCI). Men with MCI will randomly receive E2 or placebo for the first 3 mo of treatment and will then be crossed-over to the other treatment for an additional 3 mo. A battery of neuropsychological tests will be administered at pretreatment and, again, following each 3-mo treatment phase. It is hypothesized that elderly men with MCI will perform better on tests of explicit memory when they are being treated with E2 compared to their performance under placebo conditions.

Androgens protect against apolipoprotein E4-induced cognitive deficits

Compared with apolipoprotein (apo) E2 and E3, apoE4 increases the risk of Alzheimer's disease (AD), but it remains unknown how apoE4 affects neuronal function. ApoE4 interacts with female gender, further increasing the risk of AD and decreasing treatment response. Female mice are also more susceptible to apoE4-induced impairments of spatial learning and memory than male mice. To assess the role of sex steroids in this process, we studied mice deficient in mouse apoE (Apoe(-/-)) and expressing human apoE4 or apoE3 in the brain at comparable levels. Even brief periods of androgen treatment improved the memory deficits of female apoE4 mice. Female apoE3 mice had no memory deficits and did not benefit from the treatment. ApoE4 male mice, which performed normally in a water-maze test at baseline, developed prominent deficits in spatial learning and memory after blockade of androgen receptors (ARs), whereas apoE3 male mice did not. Untreated apoE4 mice had significantly lower cytosolic AR levels in the neocortex than wild-type, Apoe(-/-), and apoE3 mice. Improved memory in androgen-treated female apoE4 mice was associated with increased cytosolic AR levels. Our findings suggest that apoE4 contributes to cognitive decline by reducing AR levels in the brain, and that stimulating AR-dependent pathways can reverse apoE4-induced cognitive deficits.

Sex differences in androgen receptor immunoreactivity in basal forebrain nuclei of elderly and Alzheimer patients

The vertical limb of the diagonal band of Broca (VDB or Ch2) and the nucleus basalis of Meynert (NBM or Ch4) are major cholinergic nuclei of the human basal forebrain, a complex that is affected in Alzheimer's disease (AD). Sex hormones influence the function of these cholinergic neurons in animals and humans and we showed earlier that estrogen and androgen receptors (AR) are present in both the VDB and the NBM of young patients of 20-39 years of age. The aim of the present study was to investigate whether AR expression changes in relation to aging and AD. In both brain areas of male and female patients over the age of 56 nuclear staining had almost disappeared and cytoplasmic AR expression was decreased. This decrease was most pronounced in the VDB of men. In addition, the proportion of neurons showing cytoplasmic AR expression was higher in control aged women than in control aged men in both the VDB and the NBM. Surprisingly, cytoplasmic ARs were significantly decreased in the VDB and the NBM only in AD women and not in AD men. These observations suggest the possible involvement of androgens in the functional changes of the basal forebrain nuclei in aging and AD.

Cognitive effects of short-term manipulation of serum sex steroids in healthy young men

We examined the effects of sex steroids on cognitive functioning by exogenously manipulating circulating T levels in a group of healthy young men. Thirty-two men were randomized to receive 8 wk of treatment including: 1) im T enanthate 100 mg/wk plus daily oral placebo (T); 2) im placebo/wk plus 125 microg daily oral levonorgestrel (LNG); 3) im T enanthate 100 mg/wk plus 125 microg daily oral LNG (T + LNG); 4) im placebo/wk plus daily oral placebo. Cognitive functions were assessed at baseline and twice during treatment. Serum T and E2 levels were significantly increased in the T and T + LNG groups compared with baseline (P < 0.01) and T levels were significantly decreased in the LNG group (P < 0.05). Verbal memory significantly decreased in the LNG group (P < 0.01) and was maintained by coadministration of T in the T + LNG group. Divided attention was unaffected in the LNG group but improved significantly in the T + LNG group. In summary, decreased serum T levels induced by LNG or direct effects of the progestin, LNG, adversely affects verbal memory in normal young men. These results suggest that short-term changes in sex steroid levels have effects on cognitive function in healthy young men.

Testosterone and nonverbal intelligence in right-handed men with successful and unsuccessful educational levels

The relationship between serum total testosterone (T) concentration and fluid intelligence (nonverbal, spatial) was studied in consistently right-handed men with successful (S) or unsuccessful educational levels (NS). Hand preference was assessed by the Edinburgh Handedness Inventory. Nonverbal intelligence was measured by Cattell's Culture Fair Intelligence Test. Serum T level was determined using chemiluminescence enzyme-immunoassay on hormone autoanalyzer. There was no significant difference between the mean T levels of the S subjects and NS subjects, although S-men tended to have higher T levels than NS-men. The mean IQ was found to be significantly higher in S-men than NS-men. In the total sample (S + NS men), the correlation between T to IQ was best described by a polynomial regression (3rd order), exhibiting an inverse U-shaped regression. In S-men, the relationship between T and IQ was best described by a polynomial regression equation of the 3rd order; however, the relationship was not U-shaped, but rather a positive correlation (low T: low IQ and high T high IQ). In NS-men, there was an inverse U-shaped correlation between T and IQ (low and very high T: low IQ and moderate T: high IQ). The present data suggest that (i) very low and very high serum T concentrations may be disadvantageous, (ii) moderate T levels may be advantageous for general fluid intelligence, and (iii) a prewired cerebral organization may be essential for the T effects on cognitive abilities.

Androgen supplementation in older women: too much hype, not enough data

Androgen supplementation in women has received enormous attention in the scientific and lay communities. That it enhances some aspects of cognitive function, sexual function, muscle mass, strength, and sense of well-being is not in question. What is not known is whether physiological testosterone replacement can improve health-related outcome in older women without its virilizing side effects. Although it is assumed that the testosterone dose-response relationship is different in women than in men and that clinically relevant outcomes on the above-mentioned effects can be achieved at lower testosterone doses, these assumptions have not been tested rigorously. Androgen deficiency has no clear-cut definition. Clinical features may include impaired sexual function, low energy, depression, and a total testosterone level of less than 15 ng/dL, the lower end of the normal range. Measurement of free testosterone is ideal, because it provides a better estimate of the biologically relevant fraction. It is not widely used in clinical practice, because some methods of measuring free testosterone assay are hampered by methodological difficulties. In marked contrast to the abrupt decline in estrogen and progesterone production at menopause, serum testosterone is lower in older women than in menstruating women, with the decline becoming apparent a decade before menopause. This article reviews testosterone's effects on sexual function, cognitive function, muscle mass, body composition, and immune function in postmenopausal women.

Effects of transdermal testosterone on cognitive function and health perception in older men with low bioavailable testosterone levels

BACKGROUND

Many men older than 50 years have bioavailable testosterone levels below the reference range for young adult men. The impact of the decreased androgen levels on cognition and health perception has received little attention.

METHODS

Sixty-seven men (mean age 76 +/- 4 years, range 65-87) with bioavailable testosterone levels below 128 ng/dl (lower limit for adult normal range) were randomized to receive transdermal testosterone (2-2.5 mg patches/d) or placebo patches for 1 year. All men received 500 mg supplemental calcium and 400 IU vitamin D. Outcome measures included sex hormones [testosterone, bioavailable testosterone, sex hormone binding globulin (SHBG), estradiol, and estrone], cognitive tests (Digit Symbol, Digit Span, Trailmaking A and B), health perception (Medical Outcome Survey Short-form 36 or SF-36), lower extremity muscle strength and power, and calcium intake.

RESULTS

Twenty-three men (34%) withdrew from the study; 44 men completed the trial. Bioavailable testosterone levels increased from 93 +/- 34 (SD) to 162 +/- 100 ng/dl (p <.002) at 12 months in the testosterone group (n = 24) while no change occurred in the control group (n = 20). While there was no change in estradiol levels in either group, estrone levels increased in the testosterone group (28 +/- 7 to 32 +/- 9 pg/dl, p =.017). Scores on the Digit Symbol test improved in both the testosterone and placebo groups. Scores on Trailmaking B improved in men treated with testosterone (p <.005), although the changes were not statistically different from the changes seen in the placebo group. Twelve-month scores on Trailmaking B for the entire group were correlated with 12-month testosterone levels (p =.016). Scores for health perception measured by SF-36 did not change significantly, though scores of mental and general health declined in both groups during the 12-month intervention. Twelve-month bioavailable testosterone scores were directly correlated with scores for physical role (p =.022), vitality (p =.036), and the physical composite score (p =.010).

CONCLUSIONS

Transdermal testosterone treatment in men with low bioavailable testosterone levels does not impair and may improve cognitive function. Treatment did not improve health perception but this may have been due to the side effects of skin irritation suggested by similar reactions in both the testosterone and placebo groups.

Endogenous estradiol and testosterone levels are associated with cognitive performance in older women and men

Relatively few studies have investigated the relationship between endogenous sex steroid levels and cognition in older people and the reported results have been inconsistent. A number of experimental hormone replacement studies have suggested that estrogen replacement in older women enhances cognition, especially verbal memory. In contrast, little research has been done focusing on men. In the current study the association between endogenous sex steroids (estradiol and testosterone) and cognition was investigated in 38 healthy older women (mean age 68 years) and 30 healthy older men (mean age 69 years). Five cognitive tests measuring verbal memory, spatial memory, verbal fluency, mental rotation, and susceptibility to interference were administered. Results revealed that in women higher estradiol levels as well as testosterone levels were associated with better verbal memory (paired associates and estradiol; r =.38, P < 0.05; paired associates and testosterone; r =.33, P < 0.05;). Moreover estradiol, but not testosterone was associated with less susceptibility to interference (Stroop color word test; r = -0.34, P < 0.05). In men the only significant association was a negative correlation between testosterone and verbal fluency (r = -0.38, P < 0.05). The associations observed in this small study support the notion that estradiol is protecting verbal memory and possibly also frontal lobe mediated functions in older women. In contrast to the positive findings in women endogenous sex steroids do not appear to be closely linked to better cognition in older men.

Sex hormones and cognitive function in older men

OBJECTIVES

Recent studies have suggested that estrogen may improve cognitive function or prevent cognitive decline in older women. Little research has been conducted on exogenous or endogenous sex hormones and cognition in older men, yet it has been hypothesized that testosterone, either directly or by conversion to estrogens, may improve cognitive function. We investigated whether serum level of testosterone and estradiol is associated with cognition in older community-dwelling men.

DESIGN

A cross-sectional study.

SETTING

Population-based listings in the Monongahela Valley near Pittsburgh, Pennsylvania.

PARTICIPANTS

Three hundred ten men (mean age +/- standard deviation = 73.0 +/- 7.1) who were part of a cohort study.

MEASUREMENTS

We measured cognitive function using the Mini-Mental State Examination (MMSE), Trails B, and Digit Symbol. Sex hormone levels were determined by radioimmunoassay from serum obtained at the time of cognitive testing and analyzed by tertile.

RESULTS

No consistent association between total testosterone level and cognitive test scores was observed. However, men with high bioavailable (loosely protein-bound) testosterone had better cognitive test scores on all three tests (P < or =.001). Total estradiol levels were associated with worse cognitive scores on Digit Symbol (P <.001) and Trails B (P =.002), but bioavailable estradiol levels were not associated with cognitive function. Level of sex hormone binding globulin (SHBG) was negatively associated with cognitive scores on all three tests (P < or =.001). After adjusting for age and education, the statistical significance lessened for bioavailable testosterone (MMSE, P =.086; Digit Symbol, P =.047; Trails B, P =.076) and became nonsignificant for SHBG (all cognitive tests P>.10).

CONCLUSIONS

Our findings support the hypothesis that higher levels of bioavailable testosterone, but not of bioavailable estradiol, are associated with better cognitive function in older men. In addition, bioavailable measures of testosterone may better reflect hormone levels available to the brain and thus be more closely associated with central nervous system outcomes such as cognition. Future studies, especially randomized trials, should be undertaken to determine whether testosterone may protect against cognitive decline in older men.

Alzheimer's disease through the eye of a mouse. Acceptance lecture for the 2001 Gayle A. Olson and Richard D. Olson prize

There is now ample evidence that beta-amyloid proteins decrease memory. The SAMP8 mouse (P8) develops an early decline in the ability to learn and to retain new information. The studies reviewed here suggest that this is due to overproduction of beta-amyloid. Both antibodies to beta-amyloid and specific antisense to the amyloid precursor protein reverse these deficits in the P8 mouse. This antisense can cross the blood brain barrier. It is hypothesized that the overproduction of beta-amyloid leads to a decline in Delta(9) desaturase activity with an alteration in membrane fatty acids. This results in altered membrane mobility leading to a decline in neurotransmitter activity and a decreased release of acetylcholine. This decreased cholinergic activity results in a decreased ability of the P8 mouse to learn and retain new information.

Activational effects of testosterone on cognitive function in men

OBJECTIVES

The effect of testosterone (T) on sexual function in men is well established. However, less is known about its effects on cognitive function. The aim of this study is to investigate the relationship between T levels and sex-typed cognitive abilities in both eugonadal and hypogonadal men.

DESIGN

A single-blind placebo-controlled design was employed in this study.

METHODS

Thirty healthy eugonadal men and seven hypogonadal men participated in the study. Eugonadal men were randomised into one of two treatment regimens: (1) active group--receiving 200 mg of T enanthate i.m. weekly for 8 weeks (raising T levels into the supraphysiological range) or (2) placebo group--receiving 200 mg of sodium chloride i.m. weekly for 8 weeks. The hypogonadal group received the physiological replacement dose of 200 mg T enanthate i.m. bi-weekly for 8 weeks. All groups underwent a battery of neuropsychological tests and had circulating T measured at baseline, and at weeks 4 and 8 during treatment.

RESULTS

A significant time by group interaction effect was found in the measure of spatial ability (i.e., block design test) indicating that the active group's performance declined significantly at week 4, compared to placebo group (F(4,64)=3.78, P<0.01). Conversely, the active group performed significantly better than the placebo group in the measure of verbal fluency (i.e., the Controlled Oral Word Association Test) at week 4 (F(4,64)=2.54, P<0.05). No significant changes were found on any of the other tests. Generally, the hypogonadal group performed less well than the eugonadal groups on all tests.

CONCLUSIONS

These results offer support to the notion that increased T has a differential effect on cognitive function, inhibiting spatial abilities while improving verbal fluency in eugonadal men.

Androgen deficiency and the aging male: new urologic perspectives

Among the most prominent health care issues of the 21st century are those relating to aging. Indeed, the elderly represent the fastest growing segment of our population. Typically, a urology practice includes a significant number of elderly males, providing the physician with both a challenge and an opportunity. Androgen deficiency in the aging male, with its detrimental effects on bone, muscle and body composition, sexual function, and psychological well-being, is an area of increasing interest in both the lay press and the medical community. The urologist must understand the pathophysiology of androgen deficiency in the male, recognize and investigate the subtle signs and symptoms of hypogonadism, determine the appropriateness of treatment, and offer informed options to the patient. Health care professionals have a responsibility to make "healthy" aging a priority.

Testosterone increases analgesia, anxiolysis, and cognitive performance of male rats

Preliminary evidence suggests that testosterone (T) may have anxiety-reducing and cognitive-enhancing properties in animals and people. Performance in a number of affective and cognitive behavioral tasks was examined in intact, T-depleted, and T-depleted and T-replaced male rats. Rats that were gonadally intact (n = 33), gonadectomized (GDX; n = 30), or GDX with silastic capsules of T implanted (n = 28) were tested through a battery of affective tasks (horizontal crossing, open field, elevated plus-maze, emergence, holeboard, social interaction, tailflick, pawlick, and defensive burying) and in the inhibitory avoidance task for cognitive performance. An additional 6 rats per group had plasma androgen concentrations measured and were determined to be physiological for intact rats, supraphysiological for T-implanted rats, and near the nadir for GDX rats. Testosterone implants produced analgesia as shown by the increased tailflick latencies of the GDX rats with silastic capsules of T implanted, relative to intact or GDX rats. Testosterone also produced anxiolysis. Intact rats spent more time interacting with a conspecific and less time burying an electrified prod than did the GDX or T-implanted rats. Intact rats or GDX rats with T implants also spent more time on the open arms of the elevated plus-maze than did GDX rats. Testosterone also enhanced cognitive performance in the inhibitory avoidance task. Intact rats had longer crossover latencies in the inhibitory avoidance task relative to GDX rats; GDX rats with T implants had longer crossover latencies relative to GDX or intact rats. Together, these data demonstrate that endogenous T or administration of T produced analgesia and enhanced affect and cognitive performance of adult male rats.

Testosterone dose-response relationships in healthy young men

Testosterone increases muscle mass and strength and regulates other physiological processes, but we do not know whether testosterone effects are dose dependent and whether dose requirements for maintaining various androgen-dependent processes are similar. To determine the effects of graded doses of testosterone on body composition, muscle size, strength, power, sexual and cognitive functions, prostate-specific antigen (PSA), plasma lipids, hemoglobin, and insulin-like growth factor I (IGF-I) levels, 61 eugonadal men, 18-35 yr, were randomized to one of five groups to receive monthly injections of a long-acting gonadotropin-releasing hormone (GnRH) agonist, to suppress endogenous testosterone secretion, and weekly injections of 25, 50, 125, 300, or 600 mg of testosterone enanthate for 20 wk. Energy and protein intakes were standardized. The administration of the GnRH agonist plus graded doses of testosterone resulted in mean nadir testosterone concentrations of 253, 306, 542, 1,345, and 2,370 ng/dl at the 25-, 50-, 125-, 300-, and 600-mg doses, respectively. Fat-free mass increased dose dependently in men receiving 125, 300, or 600 mg of testosterone weekly (change +3.4, 5.2, and 7.9 kg, respectively). The changes in fat-free mass were highly dependent on testosterone dose (P = 0.0001) and correlated with log testosterone concentrations (r = 0.73, P = 0.0001). Changes in leg press strength, leg power, thigh and quadriceps muscle volumes, hemoglobin, and IGF-I were positively correlated with testosterone concentrations, whereas changes in fat mass and plasma high-density lipoprotein (HDL) cholesterol were negatively correlated. Sexual function, visual-spatial cognition and mood, and PSA levels did not change significantly at any dose. We conclude that changes in circulating testosterone concentrations, induced by GnRH agonist and testosterone administration, are associated with testosterone dose- and concentration-dependent changes in fat-free mass, muscle size, strength and power, fat mass, hemoglobin, HDL cholesterol, and IGF-I levels, in conformity with a single linear dose-response relationship. However, different androgen-dependent processes have different testosterone dose-response relationships.

Brain aging research at the close of the 20th century: from bench to bedside

Remarkable and continued growth in the field of brain aging research has been fueled by a confluence of factors. Developments in molecular biology, imaging, and genetics coupled with the imperative caused by the aging of the population has created fertile ground for improved understanding of the interaction between brain function and behavior. Aging changes in neurochemical systems may account for the spectrum of cognitive and behavioral states of successfully aged pen sons, but may also contribute to enhanced vulnerability to depressive or dementing illness. In particular, the refinement of in vivo imaging approaches to investigating the structure and function of the aging brain has provided the opportunity to strengthen our knowledge of the biological substrate of the aging brain and neuropsychiatrie disorders, and translate these into therapeutics.

Fluctuations in spatial recognition memory across the menstrual cycle in female rhesus monkeys

Findings are inconsistent regarding whether women's cognitive performance fluctuates across phases of the menstrual cycle, but differences in methodology and the use of reported cycle phase rather than precise hormonal measures may underlie these disparities. Studies in monkeys may help resolve these discrepant findings, since hormonal status can be reliably determined. We tested four young (5-7 years old) female rhesus monkeys daily during one entire menstrual cycle on three cognitive tasks displayed on a computerized touch-screen system: a Matching to Sample task with a 30 s delay (MTS-30s), a Matching to Sample task without delay (MTS-no delay) and the spatial condition of the Delayed Recognition Span Test (spatial-DRST). Blood samples were collected at specific time intervals throughout the cycle and assayed for estradiol and progesterone in order to identify hormonal status. There was a nonsignificant trend for the MTS-30s scores to be better during the follicular and luteal phases, when estradiol levels were low, than during the peri-ovulatory phase, when estradiol levels were at their highest. MTS-no delay performance did not vary as a function of hormonal status. Spatial-DRST scores were significantly better during the follicular and luteal phases than during the peri-ovulatory phase of the cycle. These data in the female rhesus monkey support the hypothesis that spatial memory performance is sensitive to estradiol variations across the menstrual cycle, with better performance associated with low estradiol levels.

Skeletal muscle dysfunction in chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a major health care problem. Formerly mainly a disease of men, women are increasingly frequently afflicted. In many of these patients, exercise intolerance is the chief complaint. Few effective therapies are available. In recent years, dysfunction of the muscles of ambulation has been identified as a source of a portion of the exercise intolerance these patients experience, and this dysfunction has been shown to be, at least in part, remediable. Mechanisms inducing muscle dysfunction include disuse atrophy, malnutrition, low levels of anabolic steroids, and myopathy from corticosteroid use. Endurance exercise training has been conclusively demonstrated to improve exercise tolerance in COPD. Recent studies suggest that strength training is beneficial as well. A new frontier of therapy for muscle dysfunction in COPD is the use of anabolic hormones. Testosterone supplementation has been shown to increase muscle mass and strength in both hypogonadal and eugonadal healthy men. Low-dose testosterone supplementation is being considered for use in postmenopausal women. Though short-term administration of testosterone in moderate doses seems to be well tolerated in both men and women, further studies are required before safety and effectiveness can be established for routine use in COPD patients.

Posttraining androgens' enhancement of cognitive performance is temporally distinct from androgens' increases in affective behavior

Steroid hormone-induced variations in spatial learning and memory tasks have been reported. In this study, androgens' effects in various cognitive and affective tasks were investigated in order to determine whether any observed differences in cognitive performance could be due to affective changes produced by the hormones. Ovariectomized rats (N = 72) received 0.0, 3.0, or 7.5 mg/kg subcutaneously, of testosterone (T), dihydrotestosterone (DHT), or 5 alpha-androstane-3 alpha,17 beta-diol (3 alpha-Diol) suspended in 10% ethanol/sesame oil v/v. For the cognitive tasks (Y maze, inhibitory avoidance, and object recognition), subjects were injected after training trials. For the affective tasks (open field, elevated plus maze, and tailflick), subjects were injected 1 or 24 h before testing. Posttraining injections that produced physiological concentrations of androgens--T, DHT, and 3 alpha-Diol--1 h later increased the percentage of correct choices in the Y maze, the latencies to cross to the shock-associated side of the inhibitory avoidance chamber, and percentage of time exploring novel objects 24 h later, when androgen levels were no longer increased. Administration of T, DHT, and 3 alpha-Diol also increased the number of entries into the center squares of a brightly lit open field, open-arm time in the elevated plus maze, and tailflick latencies 1 but not 24 h following administration. These findings suggest that these androgens, when administered following training, can enhance cognitive performance in the tasks investigated 24 h later when androgen levels nadir, but overt changes in the affective behaviors examined occurred at the time of physiological concentrations 1 h but not 24 h following androgen administration. These findings suggest posttraining androgens can enhance consolidation and cognitive performance, independent of their anxiolytic actions.

The effects of intrahippocampal testosterone and flutamide on spatial localization in the Morris water maze

The high density of the androgen receptors in fundamental centers of learning and memory, such as hippocampus, shows that there must be some relationships between the androgen receptors and cognitive aspects. To determine the role of hippocampal androgen receptors in spatial learning, the current research has been conducted to assess the effect of testosterone enanthate, as the agonist, and flutamide, as the antagonist, of these receptors on spatial discrimination of rats, using the Morris water maze (MWM). Adult male rats were bilaterally cannulated into the CA1 region of their hippocampus. Different groups received different doses of flutamide (2, 5, 10 and 20 microg/0.5 microl) or testosterone enanthate (20, 40 and 80 microg/0.5 microl) through the cannulas 30 min before training for 3 days. The results showed dose-dependent increases in latencies and traveled distances to find the invisible platform both in flutamide- and testosterone-treated groups as compared to the control group, with peak effects at doses of 5 microg/0.5 microl for flutamide and 80 microg/0.5 microl for testosterone. Therefore, it seems that both androgen receptor blockade and exogenous testosterone can effect spatial localization of adult, male rats.

Sex hormones and their impact on dementia and depression: a clinical perspective

Sex hormones have often been associated with changes in behavioural and mental abilities. This paper reviews the scientific literature published between 1990 and 2000 investigating the effects of oestrogen, testosterone and dehydroepiandrosterone (DHEA) on depression and dementia. Oestrogen seems to have a positive effect in preventing, but not treating, Alzheimer's disease. Oestrogen use may also improve mood amongst women with postnatal or perimenopausal depression; however, it may contribute to increasing depressive symptoms in women with premenstrual dysphoria. The behavioural effects of testosterone and DHEA remain unclear but the results of preliminary reports suggest that their use is associated with improved mood. At present, there is not enough hard data to support the use of sex hormones and DHEA for the treatment of depression or memory deficits.

Stereotypes and steroids: using a psychobiosocial model to understand cognitive sex differences

To further our understanding of cognitive sex differences, we studied the relationship between menstrual phase (via serum estradiol and progesterone levels) and cognitive abilities and cognitive performance in a sample of medical students in eastern Turkey. As expected, we found no sex differences on the Cattell "Culture Fair Intelligence Test" (a figural reasoning test), with females scoring significantly higher on a Turkish version of the Finding A's Test (rapid word knowledge) and males scoring significantly higher on a paper-and-pencil mental rotation test. The women showed a slight enhancement on the Finding A's Test and a slight decrement in Cattell scores during the preovulatory phase of their cycle that (probably) coincided with a rise in estrogen. There were also small cycle-related enhancements in performance for these women on the mental rotation test that may reflect cyclical increases in estrogen and progesterone. Additional analyses showed an inverted U-shaped function in level of estradiol and the Cattell Test. Finally, for women who were tested on Day 10 of their menstrual cycle, there was a negative linear relationship between their Cattell scores and level of progesterone. Stereotypes about the cognitive abilities of males and females did not correspond to performance on the mental rotation or Finding A's Test, so the sex-typical results could not be attributed to either stereotype threat or stereotype activation. For practical purposes, hormone-related effects were generally small. Variations over the menstrual cycle do not provide evidence for a "smarter" sex, but they do further our understanding of steroidal action on human cognitive performance.

The male menopause and mood: testosterone decline and depression in the aging male--is there a link?

The objective of this study was to review the literature on the hormonal changes that occur in aging males in order to determine if testosterone declines in relation to depressed mood and if testosterone might prove useful in treatment of depression. Pertinent articles were identified through a MEDLINE search from 1966 to 1999 and by careful review of the bibliographies of articles most relevant to the topic. There is a moderate decline of total testosterone and more significant decline of bioavailable testosterone in aging males. Elderly males who are depressed appear to have the lowest testosterone levels. In eugonadal males, testosterone replacement does not have a significant effect on mood; in hypogonadal males, some studies show an effect whereas others do not. In several small studies of depressed hypogonadal males, testosterone was effective in alleviating depression. Major side effects of testosterone include increased hematocrit and potential effects on the prostate and lipid metabolism. Testosterone replacement as primary or adjuvant treatment of depression may prove useful in elderly, hypogonadal males who fail to respond to conventional antidepressants. Further studies are needed to confirm these initial impressions.

Androgens and aging

This review supports the conclusion that the use of testosterone replacement therapy for the treatment of the symptoms of androgen deficiency in aging males (ADAM) may be appropriate if undertaken with due caution. The best safety data exists for using oral therapy with testosterone undeconoate. Less data exists for the treatment of postmenopausal women with testosterone. Tibolone (an estrogen--prostagen--testosterone) compound, may make the need for testosterone being added to estrogen in women unnecessary. Less data is available to support the use of DHEA or its sulfate or pregnenolone. Further studies are clearly necessary in all these areas. However, it may be tentatively concluded that we are at the dawning of the age of androgens.

Menstrual cycle variation in spatial ability: relation to salivary cortisol levels

This study examined whether menstrual cycle phase was associated with performance on the Primary Mental Abilities Test of Spatial Relations, a test of mental rotation, in undergraduate students (N = 82). As cortisol levels also vary across the menstrual cycle under conditions of stress and influence cognitive performance, saliva samples were obtained before and after the test session to examine whether cortisol levels were related to between- and within-group differences in spatial performance. Men scored higher on the spatial test than all the groups of women, although the difference between men and women in the menstrual phase was not significant. Women in the luteal phase scored lower than the menstrual, follicular, and oral contraceptive user groups of women. There were no sex or menstrual cycle differences in cortisol levels, and no association between cortisol levels and spatial performance. The poorer performance of women in the luteal phase was not related to differences in ratings of perceived stress, perceived success on the test, or mood. Although menstrual cycle phase accounted for a significant proportion of the variance (15%) in performance on the spatial test, this does not explain why men outperformed women regardless of the phase of the cycle. Thus, there are clearly several other variables, sociocultural and physiological, involved in mediating individual differences in spatial performance.

Adult sex differences on a decision-making task previously shown to depend on the orbital prefrontal cortex

Monkeys and children show sex differences on tasks that depend on the orbital prefrontal cortex. To determine whether similar sex differences exist across the life span, adults were tested on an orbital-dependent decision-making task, the Iowa Card Task, as well as on a control task, the California Weather Task. In addition, estradiol, progesterone, and testosterone were assayed. The 6 groups of participants were college-age men, older men, young low-hormone (menstruating) women, young high-hormone (midluteal) women, older postmenopausal women on estrogen replacement therapy (ERT), and older postmenopausal women not on ERT. Results showed a male superiority on the Iowa Card Task. Among college-age men there was a negative correlation between performance and testosterone levels. There were no significant differences among groups of women on the card task. There were no significant sex differences or hormone correlations on the California Weather Task.

Sex hormones affect spatial abilities during the menstrual cycle

The aim of this study was (a) to show that different measures of spatial cognition are modulated by the menstrual cycle and (b) to analyze which steroid is responsible for these cognitive alterations. The authors collected blood samples in 3-day intervals over 6 weeks from 12 young women with a regular menstrual cycle to analyze concentrations of estradiol, progesterone, testosterone, luteinizing hormone, and follicle-stimulating hormone. The performance on 3 spatial tests was measured during the menstrual and the midluteal phases. A significant cycle difference in spatial ability as tested by the Mental Rotation Test was found, with high scores during the menstrual phase and low scores during the midluteal phase. Testosterone had a strong and positive influence on mental rotation performance, whereas estradiol had a negative one. These results clearly indicate that testosterone and estradiol are able to modulate spatial cognition during the menstrual cycle.

Androgen deficiency in the aging male: when to evaluate and when to treat

Aging can be associated with an abnormal decline in testosterone production, mainly due to pituitary failure, and is reflected by low serum testosterone concentrations. Manifestations of testosterone deficiency can be subtle, can be misinterpreted as consequences of normal aging, and include lack of libido and energy, mood changes, impaired strength, and development of osteoporosis. The most important factor in the evaluation and treatment of this age-related, usually unrecognized abnormality is the public awareness of its frequent occurrence that will stimulate the use of appropriate screening tests, beginning with a morning testosterone level. Replacement therapy by parenteral or transdermal testosterone administration can be highly beneficial in alleviating the manifestations of hypogonadism and improving quality of life. Careful screening and meticulous follow-up are mandatory. The long-term effects of testosterone replacement on the cardiovascular system, the prostate, and on longevity are unknown.

The effect of testosterone on health-related quality of life in elderly males - a pilot study

OBJECTIVE

To assess the effect of short-term testosterone supplementation on health-related quality of life in elderly males.

METHOD

As part of a double-blind, placebo-controlled study, healthy males > or = 65-year-old were randomised to receive a total of four doses of 200 mg testosterone enanthanate (n = 14) or placebo (n = 8) intramuscularly every 2 weeks. Health-related quality of life (HRQOL) was assessed using the Short Form 36-item (SF-36) and Psychological General Well-Being (PGWB) scales, at baseline, week 8 and during therapy withdrawal, 6 weeks after the last dose.

RESULTS

The baseline SF-36 scores were similar between the groups in seven domains; only vitality was significantly lower in the placebo group (T: 80.4, P: 65.6; P = 0.007). After the 8-week treatment period and withdrawal phase, SF-36 scores were not significantly different between the groups. The PGWB scores at baseline, on treatment and off treatment were not significantly different between the groups. Moreover, the SF-36 and PGWB scores within each group did not change significantly over time.

CONCLUSION

This pilot study suggests that intramuscular testosterone, administered at a dose of 200 mg every 2 weeks, does not affect the HRQOL of elderly males.

Handedness and professional tennis

Based on the hypothesis that as a group left-handed (LH) people have better developed right hemispheres and therefore have better developed motor, attentional, and spatial functions than right-handed people (Geschwind, 1982; Geschwind and Galaburda, 1985a, 1985b; Nass and Gazzaniga, 1987), several studies have examined a possible association between left-handedness and superior tennis ability (cited in Annett, 1985; Azemar et al., 1983; Wood and Aggleton, 1989). The conflicting findings of these studies are due to flawed research designs, very limited data, and inadequate data analyses. In this study an estimated population rate of left-handedness for racket use (8.1%) was compared with rates found among professional tennis players; and highly successful competitors over a 32-year period were analyzed for handedness frequency. Results revealed that from 1968 through 1999 LH competitors were significantly over-represented among top ranking players (World Number One and Top Ten) and among Grand Slam finalists, including champions. Rates of left-handedness ranged from two to five times higher than expected in these highly successful players. However, no difference was found in the rate of left-handedness for racket use among male (N = 1,904; LH = 6.98%) or female (N = 533; LH = 7.69%) professional tennis players compared to the general population. These findings indirectly support the notion that LH people have neuroanatomically-based advantages in performing certain neurocognitive tasks, such as visuospatial and gross (whole body) visuomotor tasks. The present findings are also consistent with a nature/nurture model of cortical development and functioning (Casey, 1996).

Effects of testosterone administration on selective aspects of object-location memory in healthy young women

Previous work has indicated that object-location memory is sensitive to sex differences as well as variations in the menstrual cycle. The goal of the present study was to further examine the hormonal basis of human spatial memory by assessing the effects of a single dose of exogenous testosterone in healthy young women on three recall conditions: positional reconstruction; object-to-position-assignment; and the combined condition in which subjects both have to reconstruct the precise locations and to link the different objects to the correct places. In the latter condition, delayed recall (3 min delay) improved with testosterone. Although the effects were only small and need further substantiation, they support the idea that testosterone may have an activational effect on selective aspects of cognitive functioning.

Hormonal aspects of sexual dysfunction: the therapeutic use of exogenous androgens in men and women

Hormones exert a pervasive influence on sexual activity. Androgens are involved in the initiation and maintenance of libido and spontaneous arousal. In recent years, the clinical use of exogenous androgens for treatment of sexual dysfunction has received a great deal of attention. Good evidence exists that such treatment is effective for arousal difficulties in men and women in the setting of a hypo-androgenic state. This article reviews the relationship between androgens and sexual function.

Testosterone and cognition in elderly men: a single testosterone injection blocks the practice effect in verbal fluency, but has no effect on spatial or verbal memory

BACKGROUND

The relevance of the age-associated decline in testosterone for cognition in elderly men is still poorly understood. One hypothesis is that testosterone enhances spatial abilities, while it might impair verbal skills.

METHODS

Thirty elderly men received a single testosterone (250 mg testosterone enanthate) or placebo injection. Cognitive performance was tested before and 5 days after treatment using spatial as well as verbal tests.

RESULTS

Five days after injection, testosterone and estradiol levels were still in the supraphysiologic range. In the verbal fluency task, the placebo group, but not the testosterone group, showed a practice effect. Therefore, the testosterone group performed significantly worse than the placebo group after treatment. No effects of testosterone were observed in the other verbal and spatial tasks.

CONCLUSIONS

The present finding, that testosterone blocks the practice effect in verbal fluency, partly supports the general idea that sex steroids modulate performance in tests with known gender differences. Moreover it demonstrates that these effects can occur rapidly. However, beneficial effects on spatial cognition or memory might need more time to develop and/or might only occur when a less pronounced testosterone increase is induced.

Hormone substitution in male hypogonadism

Male hypogonadism is characterised by androgen deficiency and infertility. Hypogonadism can be caused by disorders at the hypothalamic or pituitary level (hypogonadotropic forms) or by testicular dysfunction (hypergonadotropic forms). Testosterone substitution is necessary in all hypogonadal patients, because androgen deficiency causes slight anemia, changes in coagulation parameters, decreased bone density, muscle atrophy, regression of sexual function and alterations in mood and cognitive abilities. Androgen replacement comprises injectable forms of testosterone as well as implants, transdermal systems, sublingual, buccal and oral preparations. Transdermal systems provide the pharmacokinetic modality closest to natural diurnal variations in testosterone levels. New injectable forms of testosterone are currently under clinical evaluation (testosterone undecanoate, testosterone buciclate), allowing extended injection intervals. If patients with hypogonadotropic hypogonadism wish to father a child, spermatogenesis can be initiated and maintained by gonadotropin therapy (conventionally in the form of human chorionic gonadotropin (hCG) and human menopausal gonadotropin (hMG) or, more recently, purified or recombinant follicle stimulating hormone (FSH)). Apart from this option, patients with disorders at the hypothalamic level can be stimulated with pulsatile gonadotropin-releasing hormone (GnRH). Both treatment modalities have to be administered on average for 7-10 months until pregnancy is achieved. In individual cases, treatment may be necessary for up to 46 months. Testosterone treatment is interrupted for the time of GnRH of gonadotropin therapy, but resumed after cessation of this therapy.

Reference memory, anxiety and estrous cyclicity in C57BL/6NIA mice are affected by age and sex

Age-related changes in learning and memory are common in rodents. However, direct comparisons of the effects of aging on learning and memory in both males and females are lacking. The present study examined whether memory deteriorates with increasing age in C57BL/6NIA mice, and whether age-related changes in learning and memory are similar in both sexes. Male and female mice (five, 17 and 25 months of age) were tested in a battery of behavioral tasks including the Morris water maze (spatial and non-spatial reference memory), simple odor discrimination (olfactory reference memory), plus maze (anxiety/exploration), locomotor activity, and basic reflexes. Five-month-old mice learned the water maze and odor discrimination tasks rapidly. Relative to five-month-old mice, 25-month-old mice exhibited impaired spatial and olfactory reference memory, but intact non-spatial reference memory. The spatial reference memory of 17-month-old mice was also impaired, but less so than 25-month mice. Seventeen-month-old mice exhibited intact non-spatial (visual and olfactory) reference memory. Five and 25-month-old mice had similar levels of plus maze exploration and locomotor activity, whereas 17-month-old mice were more active than both groups and were slightly less exploratory than five-month-old mice. Although sex differences were not observed in the five- and 25-month groups, 17-month-old females exhibited more impaired spatial reference memory and increased anxiety relative to 17-month-old males. Estrous cycling in females deteriorated significantly with increased age; all 25-month-old females had ceased cycling and 80% of 17-month-old females displayed either irregular or absent estrous cycling. This study is the first to directly compare age-related mnemonic decline in male and female mice. The results suggest that: (i) aged mice exhibit significant deficits in spatial and olfactory reference memory relative to young mice, whereas middle-aged mice exhibit only a moderate spatial memory deficit and; (ii) spatial reference memory decline begins at an earlier age in females than in males, a finding that may be related to the cessation of estrous cycling.

Hormones and cognition: current concepts and issues in neuropsychology

This article provides an extensive and comprehensive review of the effects of hormones on cognition. Studies detailing specific neurocognitive functions affected by variation in hormone levels across the life span are presented. Dysregulation of hormone levels is considered from models of both normal and diseased functioning. Patterns of cognitive dysfunction are described for a range of syndromes involving the neuroendocrine system, and evidence of specific neurophysiological mechanisms that can account for these findings is outlined. This review includes discussion of treatment outcomes and the permanency of endocrine-related cognitive dysfunction. The authors present a set of guidelines for clinical neuropsychologists to use for assessment of patients with neuroendocrine system dysfunction. Clinical and methodological issues in research and treatment settings are discussed.

Sex differences in cognition: the role of testosterone and sexual orientation

The performance of both heterosexual and homosexual males and females was compared on four cognitive tasks which have been shown to reveal evidence of sexual dimorphism. In one spatial and one verbal task, significant sex and orientation effects were found. Significant relationships were also found between salivary free-testosterone levels and performance on both spatial tasks, but no significant associations were found for performance on the two verbal tasks. The present study revealed both within- and between-sex differences in cognition and indicates that these differences may be partly accounted for by the activational effects of free testosterone.

Actions of dehydroepiandrosterone and its sulfate in the central nervous system: effects on cognition and emotion in animals and humans

Dehydroepiandrosterone (DHEA) and its sulfate ester, DHEAS, exert multiple effects in the rodent central nervous system (CNS). Most of them seem to be mediated through their non-genomic action on several neurotransmitter receptors. DHEA(S) increases neuronal excitability, enhances neuronal plasticity and also has neuroprotective properties. In line with these observations DHEA(S) treatment in rodents enhances memory in several paradigms. Even more studies show antiamnestic effects of the steroids. However, DHEA(S) has also anxiolytic and anti-aggressive properties. In humans cross-sectional and longitudinal studies suggest that DHEAS might be associated with global measures of well-being and functioning; however, a relationship with cognition could not be detected to date. Moreover, studies investigating DHEAS levels in neurodegenerative diseases have produced conflicting results. Experimental studies in elderly humans have revealed preliminary evidence for mood enhancing and antidepressant effects of DHEA treatment, while positive effects on measures of memory and attention could not be found. However, electrophysiological studies demonstrated that DHEA treatment has effects on the human CNS. Several reasons for the discrepancy between data obtained in rodents and humans are discussed and research perspectives are outlined which might help to improve interpretation of results obtained in the two species.

Testosterone levels and spatial ability in men

Testosterone (T) levels were measured by salivary assays in 59 males at times of the day when T was expected to be highest and lowest. Relationships were evaluated for mean hormone levels across the two sessions and hormone level changes between sessions with performance on three-dimensional mental rotations, a spatial test which customarily favours males. An anagrams task and the digit symbol test were used as controls. Mental rotations scores showed a significant positive relationship with mean T levels but not with changes in T. There were no significant relationships between control test scores and mean T levels. Findings are discussed in terms of their contributions to the resolution of ambiguities in prior reported data.

Endogenous sex hormones and cognitive function in older men

The objective of this study was to determine whether endogenous sex hormone levels predict cognitive function in older men. Our study design was an exploratory analysis in a population-based cohort in Rancho Bernardo, California. The study participants were 547 community-dwelling men 59-89 yr of age at baseline who were not using testosterone or estrogen therapy. Between 1984 and 1987, sera were collected for measurement of endogenous total and bioavailable testosterone and estradiol levels. Between 1988 and 1991, 12 standard neuropsychological instruments were administered, including two items from the Blessed Information-Memory-Concentration (BIMC) Test, three measures of retrieval from the Buschke-Fuld Selective Reminding Test, a category fluency test, immediate and delayed recall from the Visual Reproduction Test, the Mini-Mental State Examination with individual analysis of the Serial Sevens and the "World" Backwards components, and the Trail-Making Test Part B. In age- and education-adjusted analyses, men with higher levels of total and bioavailable estradiol had poorer scores on the BIMC Test and Mini-Mental State Examination. Men with higher levels of bioavailable testosterone had better scores on the BIMC Test and the Selective Reminding Test (long-term storage). Five associations were U-shaped: total testosterone and total and bioavailable estradiol with the BIMC Test; bioavailable testosterone with the "World" test; and total estradiol with the Trail-Making Test. All associations were relatively weak but independent of age, education, body mass index, alcohol use, cigarette smoking and depression. In these older men, low estradiol and high testosterone levels predicted better performance on several tests of cognitive function. Linear and nonlinear associations were also found, suggesting that an optimal level of sex hormones may exist for some cognitive functions.

Androgen metabolism in the juvenile oscine forebrain: a cross-species analysis at neural sites implicated in memory function

Juvenile songbirds are useful models for studying the neural bases of memory. Memory-reliant behaviors demonstrated at this stage include song learning (most songbirds) and food caching (food-storing songbirds). Sex steroids are implicated in the modulation of memory processes in several vertebrates. The songbird forebrain expresses aromatase, 5alpha-reductase and 5beta-reductase, enzymes which convert testosterone to estradiol, 5alpha-, and 5beta-dihydrotestosterone, respectively. To explore the role of local androgen metabolism on memory processes, we documented the activities of these enzymes in the anterior neostriatum (NAN), caudomedial neostriatum (NCM), and hippocampus (HP) of four species of juvenile songbird, two of which are food storers. Areas were dissected, homogenized, and provided with radiolabeled substrate; and formed estrogens, and 5alpha- and 5beta-reduced androgens were measured. In the NAN, 5beta-reductase was the predominant enzyme, suggesting that local inactivation of testosterone may preserve the sensitive period of song acquisition. In the NCM, estrogens were formed in abundance despite high 5beta-reductase, suggesting that locally high estrogen synthesis may play a role in processes of song perception. In the HP, both estrogens and 5alpha reduced androgens were formed, suggesting that HP function may be modulated by both estrogens and androgens. Finally, a derived measure of steroid-differential reveals that food-storing songbirds differ from nonstorers in the steroidal milleiu within the HP, but not in the NAN or NCM. Thus, distinct loci within the juvenile songbird forebrain are exposed to different patterns of androgen metabolites. This local conversion may play a role in the neuroendocrine modulation of memory in these birds.