The effects of circulating testosterone and pubertal maturation on risk for disordered eating symptoms in adolescent males

Neurodevelopmental Model Explaining Associations between Sex Hormones, Personality, and Eating Pathology

Clinical scientists have been investigating the relationships between sex hormones, personality, and eating disorders for decades. However, there is a lack of direct research that addresses whether personality mediates or moderates the relationships between sex hormones and eating pathology. Moreover, the neural mechanisms that underlie the interactive associations between these variables remain unclear. This review aims to summarize the associations between these constructs, describe a neural mechanism mediating these relationships, and offer clinical strategies for the early identification and intervention of eating disorders. The gathered evidence shows that aggressiveness, impulsivity, and obsessive-compulsiveness may mediate or moderate the relationships between sex hormones and eating pathology, but only among females. Furthermore, sex hormone receptor density in the mesocorticolimbic dopamine pathway may explain the neural mechanism of these associations. Future research should use more comprehensive personality measurements and assess the mediation and moderation effects of temperament while taking the hormone levels of women across menstrual cycles into account. Additionally, electroencephalography and functional magnetic resonance imaging should be implemented to directly assess brain activity and corroborate these findings.

Disadvantage and disordered eating in boys: Examining phenotypic and genotype × environment associations across development

Socioeconomic disadvantage may be a significant risk factor for disordered eating, particularly for individuals with underlying genetic risk. However, little to nothing is known about the impact of disadvantage on disordered eating in boys during the critical developmental risk period. Crucially, risk models developed for girls may not necessarily apply to boys, as boys show different developmental patterns of disordered eating risk (i.e., earlier activation of genetic influences during adrenarche, an early stage of puberty). This is the first study to examine phenotypic and Genotype × Environment (G × E) effects of disadvantage in boys. Analyses examined 3,484 male twins ages 8-17 (Mage = 12.27, SD = 2.96) from the Michigan State University Twin Registry. Disordered eating (e.g., body dissatisfaction, binge eating) was measured using the parent-report Michigan Twins Project Eating Disorder Survey. Neighborhood disadvantage was measured using a census-tract level Area Deprivation Index, and family socioeconomic status was determined from parental income and education. Adrenarche status was determined using multiple indicators, including age and Pubertal Development Scale scores. G × E models suggested that genetic influences on disordered eating were activated earlier for boys experiencing familial or neighborhood disadvantage, with substantial genetic influences in early adrenarche, when genetic influences were low in more advantaged boys. Phenotypically, both neighborhood and familial disadvantage were associated with greater disordered eating for boys in late adrenarche, which could indicate a lasting impact of earlier activation of genetic influences on later risk. Results highlight disadvantage as a novel risk factor for disordered eating in boys, particularly those with genetic vulnerabilities. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Gonadal Hormone Influences on Sex Differences in Binge Eating Across Development

PURPOSE OF REVIEW

Binge eating is a transdiagnostic symptom that disproportionately affects females. Sexually dimorphic gonadal hormones (e.g., estradiol, testosterone) substantially impact eating behavior and may contribute to sex differences in binge eating. We examine recent evidence for the role of gonadal hormones in binge eating risk across development.

RECENT FINDINGS

Both organizational (long-lasting impact on the central nervous system (CNS)) and activational (transient influences on the CNS) hormone effects may contribute to sex differences in binge eating. Gonadal hormones also impact within-sex variability in binge eating, with higher estradiol levels in females and higher testosterone levels in males protective across development. Emerging evidence suggests that the impact of gonadal hormones may be greatest for people with other risk factors, including genetic, temperamental (e.g., high negative affect), and psychosocial (e.g., exposure to weight-based teasing) risk. Gonadal hormones contribute to sex differences and within-sex variability in binge eating across development.

A review of sex differences in the mechanisms and drivers of overeating

Disordered eating is often associated with marked psychological and emotional distress, and severe adverse impact on quality of life. Several factors can influence eating behavior and drive food consumption in excess of energy requirements for homeostasis. It is well established that stress and negative affect contribute to the aetiology of eating disorders and weight gain, and there is substantial evidence suggesting sex differences in sub-clinical and clinical types of overeating. This review will examine how negative affect and stress shape eating behaviors, and how the relationship between the physiological, endocrine, and neural responses to stress and eating behaviors differs between men and women. We will examine several drivers of overeating and explore possible mechanisms underlying sex differences in eating behavior.

Food cravings and loss-of-control eating in youth: Associations with gonadal hormone concentrations

OBJECTIVE

Among youth with overweight, food cravings (FC) are associated with loss-of-control (LOC)-eating, but the impact of sex-associated biological characteristics on this relationship is unknown. We examined whether sex and gonadal hormone concentrations moderated the relationships between FC and LOC-eating severity among healthy boys and girls across the weight strata in natural and laboratory environments.

METHOD

Using ecological momentary assessment (EMA), FC, and LOC-eating severity were reported 3-5 times a day for 2 weeks. In the laboratory, participants reported FC, consumed lunch from a buffet test meal designed to simulate LOC-eating, and rated LOC-eating severity during the meal.

RESULTS

Eighty-seven youth (13.0 ± 2.7 years, 58.6% female, 32.2% with overweight/obesity) participated. EMA measured general and momentary FC were positively associated with LOC-eating severity (ps < .01), with no differences by sex (ps = .21-.93). Estradiol and progesterone significantly moderated the relationships between FC and LOC-eating such that general FC and LOC-eating severity were only positively associated among girls with greater (vs. lower) estradiol (p = .01), and momentary FC and LOC-eating severity were only positively associated among girls with greater (vs. lower) progesterone (p = .01). Boys' testosterone did not significantly moderate the associations between FC and LOC-eating severity (ps = .36-.97). At the test meal, pre-meal FC were positively related to LOC-eating severity (p < .01), without sex or hormonal moderation (ps = .20-.64).

DISCUSSION

FC were related to LOC-eating severity in boys and girls. In the natural environment, gonadal hormones moderated this relationship in girls, but not boys. The mechanisms through which gonadal hormones might affect the relationship between FC and LOC-eating warrant investigation.

An association between body image dissatisfaction and digit ratio among Chinese children and adolescents

Body image dissatisfaction (BID) is a negative evaluation of personal physical characteristics, including dissatisfaction with body shape, gender, sexual organs, appearance and so forth, and it plays an important role in growth and development. The second-to-fourth digit ratio (2D:4D) is recognized as a putative indicator of intra-uterine testosterone to estrogen ratio exposure, and it has been observed that higher levels of fetal testosterone exposure are associated with a lower 2D:4D. The present paper contributes to a better understanding of the biological underpinnings of BID by analyzing BID and the digit ratio (2D:4D). We found that the 2D:4D was positively related to appearance dissatisfaction in boys with first spermatorrhea, which means that low prenatal androgen exposure may increase boys’ dissatisfaction with their appearance. In girls with breast development being lower than Tanner stage II, their 2D:4D was negatively related to their body shape dissatisfaction, which means that high prenatal androgen exposure may increase girls’ dissatisfaction with their body shape. These results suggest that the prenatal androgen exposure level might play an important role in the body image dissatisfaction of the offspring.

Gender-specific approach in psychiatric diseases: Because sex matters

In both animals and human beings, males and females differ in their genetic background and hormonally driven behaviour and show sex-related differences in brain activity and response to internal and external stimuli. Gender-specific medicine has been a neglected dimension of medicine for long time, and only in the last three decades it is receiving the due scientific and clinical attention. Research has recently begun to identify factors that could provide a neurobiological basis for gender-based differences in health and disease and to point to gonadal hormones as important determinants of male-female differences. Animal studies have been of great help in understanding factors contributing to sex-dependent differences and sex hormones action. Here we review and discuss evidence provided by clinical and animal studies in the last two decades showing gender (in humans) and sex (in animals) differences in selected psychiatric disorders, namely eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder), schizophrenia, mood disorders (anxiety, depression, obsessive-compulsive disorder) and neurodevelopmental disorders (autism spectrum disorders, attention-deficit/hyperactivity disorder).

A Narrative Review of Sex Differences in Eating Disorders: Is There a Biological Basis?

PURPOSE

Eating disorders and their core symptoms (eg, binge eating, body weight/shape concerns) disproportionately affect females, and these sex-differentiated effects become prominent during and after puberty. Although psychosocial influences such as heightened sociocultural pressures for thinness in girls and women contribute to this sex imbalance, biological factors could also play an important role.

METHODS

This narrative review summarizes evidence of biological factors underlying the sex-differentiated prevalence of eating pathology as well as within-sex variability in risk.

FINDINGS

There are sex differences in the pubertal emergence of genetic effects on eating pathology (adrenarche in males; gonadarche in females), and at least some genetic contributions to eating pathology seem to vary between the sexes. Furthermore, sex steroid hormones (eg, testosterone, estradiol, progesterone) are leading contributors to differential risk for eating pathology in males and females across the life span. Emerging data suggest that between-sex and within-sex variability in risk might occur via hormone-driven modulation (activation/deactivation) of genetic influences and neural responsiveness to food-related cues.

IMPLICATIONS

There is a biological basis to heightened risk for eating pathology in females, relative to males, as well as unique biological influences within each sex. Findings from this review highlight the importance of studying both sexes and considering sex-specific biological mechanisms that may underlie differential risk for eating pathology.

Momentary associations between positive affect dimensions and dysregulated eating during puberty in a diverse sample of youth with overweight/obesity

OBJECTIVE

The link between dysregulated positive affect and binge-eating behavior in youth with obesity is poorly understood. In addition, it is unclear how putative associations differ across developmental periods of rapid biological and emotional change, such as puberty, and in racial and ethnic minority youth, who are more likely to be overweight but are underrepresented in the literature.

METHOD

This study used a 2-week ecological momentary assessment protocol to examine independent and interactive effects of positive affect intensity/instability, and pubertal stage on two components of binge-eating behavior, loss of control eating (LOCE), and overeating.

RESULTS

Participants were 38 youth with overweight/obesity (ages 8-14 years; 78% African American/Hispanic). Positive affect instability was calculated using probability of acute change (PAC), representing the likelihood of extreme affective changes, and mean squared successive difference (MSSD), representing the average change in affect over successive recordings. There were no main effects of positive affect intensity on LOCE or overeating, but positive affect instability was negatively associated with overeating severity using both MSSD (p = .005) and PAC metrics (p = .001). However, moderation analyses including interactions with pubertal status revealed more extreme changes in positive affect (i.e., higher PAC) were related to greater overeating (p = .001) and LOCE severity (p = .043) in mid-late pubertal youth but not in pre-early pubertal youth.

DISCUSSION

Pubertal status may influence the association between disruptions in positive affect and dysregulated eating in youth, and positive affect instability may be important to consider in order to understand the emotional correlates of binge eating in youth with overweight/obesity.

Low testosterone is associated with dysregulated eating symptoms in young adult men

OBJECTIVE

Extant animal and human data indicate that natural variation in circulating levels of testosterone may contribute to differential risk for dysregulated eating among males. Indeed, testosterone ablation in postpubertal male rodents results in stimulatory effects on sweet-taste preferences, and lower levels of circulating testosterone in adolescent boys have been found to predict dysregulated eating symptoms during mid-to-late puberty. Nonetheless, no prior study has examined whether lower testosterone is associated with dysregulated eating in adulthood. The current study examined this possibility.

METHOD

Participants were 154 young adult men (ages = 18-33) from a large Southwestern University. The Eating Disorder Examination Questionnaire, Eating Pathology Symptoms Inventory, and Loss of Control Over Eating Scale were used to assess three types of dysregulated eating symptoms: eating concerns, binge eating, and loss-of-control eating. Afternoon saliva samples were assayed for testosterone using high-sensitive enzyme immunoassays.

RESULTS

Consistent with animal data and prior research in adolescent boys, men with lower testosterone reported significantly higher levels of dysregulated eating symptoms even after controlling for depressive symptoms, body mass index, and age.

DISCUSSION

Lower testosterone concentrations might serve as a sex-specific biological factor that contributes to dysregulated eating among men.

The Disruptive Effects of Estrogen Removal before Puberty on Risk for Binge Eating in Female Rats

Recent research suggests that estrogen is protective against binge eating in adult females, and that pubertal estrogen may be critical for these effects. Nonetheless, to date, no study has examined the role of pubertal estrogen in adult binge eating phenotypes in females, potentially due to difficulties experimentally manipulating estrogen in humans to examine causal effects. We used a novel animal model to examine whether estrogen removal prior to puberty (via pre-pubertal ovariectomy (P-OVX)) increases rates of binge eating prone (BEP) phenotypes in adulthood in females. A total of 77 P-OVX and 79 intact rats were followed from pre-puberty into adulthood and phenotyped for BEP status in adulthood. Results showed significantly increased rates (~2-8x higher) of adult BEP phenotypes in P-OVX as compared to intact rats. Findings confirm that estrogen removal substantially increases later risk for binge eating in females, potentially by disrupting typical adolescent brain development.

Gonadal hormone contributions to individual differences in eating disorder risk

PURPOSE OF REVIEW

Females experience eating disorders at substantially higher rates than males. Although sociocultural factors have traditionally been thought to underlie this sex disparity, accumulating evidence implicates differential exposure to gonadal hormones early in life. Gonadal hormones also impact within-sex variability in disordered eating, helping to explain why not all women develop an eating disorder, and some men do. We review recent findings regarding these gonadal hormone effects and their implications for the etiology of eating disorders.

RECENT FINDINGS

Males are exposed to significantly higher testosterone levels than females perinatally, and this exposure appears to protect against later binge eating in males relative to females. Within-sex, higher estradiol levels among females and higher testosterone levels among males appear to be protective. Progesterone exhibits minimal direct phenotypic effects on disordered eating but appears to counteract the protective effects of estrogen in adult females. Importantly, gonadal hormone effects may be moderated by psychosocial factors.

SUMMARY

Evidence suggests that gonadal hormones play a critical role in the etiology of disordered eating. Overall, higher testosterone and estrogen appear to be protective across development. Additional research is needed to identify mechanisms underlying these effects and further explore interactions between hormonal and psychosocial risk.

Acute decrease in plasma testosterone and appetite after either glucose or protein beverages in adolescent males

OBJECTIVE

Chronic testosterone blood concentrations associate with food intake (FI), but acute effects of testosterone on appetite and effect of protein and glucose consumption on testosterone response have had little examination.

METHODS

In a randomized, crossover study, twenty-three adolescent (12-18 years old) males were given beverages containing either: (a) whey protein (1 g/kg body weight), (b) glucose (1 g/kg body weight) or (c) a calorie-free control (C). Plasma testosterone, luteinizing hormone (LH), GLP-1 (active), ghrelin (acylated), glucose, insulin and subjective appetite were measured prior (0) and at 20, 35 and 65 minutes after the consumption of the beverage. FI at an ad libitum pizza meal was assessed at 85 minutes.

RESULTS

Testosterone decreased acutely to 20 minutes after both protein and glucose with the decrease continuing after protein but not glucose to 65 minutes (P = 0.0382). LH was also decreased by both protein and glucose, but glucose had no effect at 20 minutes in contrast to protein (P < 0.001). Plasma testosterone concentration correlated positively with LH (r = 0.58762, P < 0.0001) and negatively with GLP-1 (r = -0.50656, P = 0.0003). No associations with appetite, ghrelin or glycaemic markers were found. Food intake was not affected by treatments.

CONCLUSION

Protein or glucose ingestion results in acute decreases in both plasma testosterone and LH in adolescent males. The physiological significance of this response remains to be determined as no support for testosterone's role in acute regulation of food intake was found.

Sex-Gender Comparisons in Comorbidities of Children and Adolescents With High-Functioning Autism Spectrum Disorder

Over the last few years, new studies focused their attention on the gender-related features in high-functioning autism spectrum disorder (HFA), often leading to controversial results. Another interesting aspect of these subtype of patients is linked to the complexity of clinical presentation, where besides core symptoms, other co-occurrence disorders may complicate the diagnostic evaluation. Therefore, we retrospectively studied 159 HFA patients, male and female, investigating their comorbidities and to find any gender difference. For each patient, were evaluated the presence/absence, type and gender distribution of psychopathological comorbidities, according to DSM-5 diagnostic criteria. The total sample was divided in 100 male and 59 female patients, age and intelligence quotient matched. In our sample, the psychiatric comorbidities observed were Attention Deficit Hyperactivity Disorder, Anxiety Disorders, Depressive Disorders, Bipolar Disorder, Obsessive-Compulsive Disorder, and Anorexia Nervosa. No statistical significant differences were found between male and female HFA patients comorbidities except for Anorexia Nervosa. In both male and female patients, attention deficit and hyperactivity disorder and anxiety disorders were found in high percentage. In conclusion, our investigation showed that a statistical significant difference of comorbidity between male and female HFA patients was found only for AN diagnosis. However, the question about the distinction between female and male HFA patients remains quite interesting and an open area of research for future studies.

Body Image Dissatisfaction and the Adrenarchal Transition

BACKGROUND

Puberty marks a transition in risk for body image disturbance and disordered eating. Yet few studies have examined these symptoms across puberty and none have examined links with adrenarche, the earliest phase in the pubertal hormonal cascade.

METHOD

Levels of adrenal androgens (dehydroepiandrosterone, dehydroepiandrosterone sulphate, and testosterone) were measured in a population-based study of 8- to 9-year-old children (516 males and 621 females). Body dissatisfaction was measured using the Kids' Eating Disorder Scale Silhouettes. Covariates included body mass index, age, and socioeconomic status.

RESULTS

There were significant associations between adrenal androgen levels and greater body dissatisfaction in both males and females. Specifically, females with more advanced levels of dehydroepiandrosterone and testosterone relative to peers, and males with more advanced levels of testosterone relative to peers, reported greater body dissatisfaction. However, after adjusting for covariates, hormones levels were no longer associated with body dissatisfaction, and only higher body mass index had a clear association with body dissatisfaction.

CONCLUSIONS

The adrenarchal transition brings a heightened risk for body dissatisfaction. Whether this arises from the neuroendocrine effects of adrenal androgens or as a reaction to the greater body mass that accompanies adrenarche requires further exploration.

Estrogen moderates genetic influences on binge eating during puberty: Disruption of normative processes?

Puberty is a critical period for changes in genetic effects for binge eating in girls. Previous twin studies show increases in genetic influences on binge eating from prepuberty (∼0%) to midpuberty and beyond (∼50%). However, little is known about the factors that drive these shifts in genetic effects. A small pilot study showed that pubertal activation of estrogen may contribute to increases in genetic influences, possibly via hormonally induced changes in gene expression. However, large-scale studies investigating hormone effects on genetic risk are lacking. Thus, the purpose of the present study was to examine the effects of estrogen on genetic influences for binge eating in 964 female twins (ages 8-16 years) from the Michigan State University Twin Registry. Binge eating was assessed with the Minnesota Eating Behaviors Survey, whereas afternoon saliva samples were assayed for estradiol levels using standard enzyme immunoassays. Twin moderation models showed substantial differences in genetic influences on binge eating across estradiol levels. Stronger genetic effects were observed at lower (rather than higher) estradiol levels, even when controlling for the effects of age, body mass index, the physical changes of puberty, and the onset of menses. Overall, findings suggest that comparatively lower levels of estradiol during this critical period may disrupt normative developmental processes and enhance genetic influences on binge eating. (PsycINFO Database Record

[Anorexia nervosa in males]

Anorexia nervosa in males Abstract. Anorexia nervosa (AN) is a rare disorder in boys and men with limited data and studies available. The recent update of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) will in all likelihood lead to an increase in the prevalence of AN in boys and men. This study aims to give an overview of the existing data in regards to gender differences in epidemiology, etiology, and symptoms of AN. We aim to highlight the differences in AN between the sexes, from a clinical point of view, and underline the need for further research on AN in boys.

The significant effects of puberty on the genetic diathesis of binge eating in girls

OBJECTIVE

Recent data show significant phenotypic and genetic associations between ovarian hormones and binge eating in adulthood. Theories of hormonal risk focus on puberty and the possibility that hormone activation induces changes in genetic effects that then lead to differential risk for binge eating in postpuberty and adulthood. Although this theory is difficult to test in humans, an indirect test is to examine whether genetic influences on binge eating increase during the pubertal period in girls. Prior work has shown pubertal increases in genetic influences on overall disordered eating symptoms, but no study to date has examined binge eating. The present study was the first to examine these increases for binge eating.

METHODS

Participants included 1,568 female twins (aged 8-25 years) from the Michigan State University Twin Registry. Binge eating and pubertal development were assessed with self-report questionnaires.

RESULTS

Twin moderation models showed significant linear increases in genetic effects from prepuberty (5%) to postpuberty (42%), even after controlling for the effects of age and body mass index.

DISCUSSION

Results provide critical support for increased genetic influences on binge eating during puberty. Additional studies are needed to identify hormonal mechanisms and fully test contemporary models of ovarian hormone risk.

Expanding the developmental boundaries of etiologic effects: The role of adrenarche in genetic influences on disordered eating in males

Genetic influences on disordered eating (DE) increase across age and puberty in girls, an effect that is at least partially due to ovarian hormone activation. However, development shifts in genetic effects have not been detected in boys; genetic influences have been found to be relatively constant from prepuberty to adulthood, suggesting that gonadal hormones may be less important. One caveat is that studies have examined males ages 10 or older. Genetic effects on DE may emerge earlier in boys, such as during adrenarche, when androgens begin to increase but the physical changes of puberty are not yet observable. The current study investigated this hypothesis in 1,212 male twins (ages 6-28) from the Michigan State University Twin Registry. Results supported a potential role of adrenarche, as genetic influences on DE increased during middle childhood, prior to the external physical changes of puberty. Specifically, genetic influences on DE were negligible (0%) in twins during pre- to early adrenarche, but increased incrementally across advancing adrenarche (17% to 44%) and into early puberty (57%). Genetic effects then remained stable into midpuberty and postpuberty (58%), suggesting that nearly all of the genetic effects on DE become prominent during adrenarche in males. Findings suggest that genetic effects on DE emerge sooner in boys than the midpubertal activation that is consistently found in girls. These data highlight a potentially important role for adrenarche in the genetic diathesis for DE in males and a need to examine younger ages in studies of developmental effects. (PsycINFO Database Record

Sex Differences in Binge Eating: Gonadal Hormone Effects Across Development

Eating disorders are highly sexually differentiated disorders that exhibit a female predominance in risk. Most theories focus on psychosocial explanations to the exclusion of biological/genetic influences. The purpose of this descriptive review is to evaluate evidence from animal and human studies in support of gonadal hormone effects on sex differences in binge eating. Although research is in its nascent stages, findings suggest that increased prenatal testosterone exposure in males appears to protect against binge eating. Although pubertal testosterone may exert additional protective effects, the prenatal period is likely critical for the decreased risk observed in males. By contrast, studies indicate that, in females, it is the lack of prenatal testosterone coupled with the organizational effects of pubertal ovarian hormones that may lead to increased binge eating. Finally, twin data suggest that changes in genetic risk may underlie these hormone influences on sex differences across development.

Hormonal Factors and Disturbances in Eating Disorders

This review summarizes the current state of the literature regarding hormonal correlates of, and etiologic influences on, eating pathology. Several hormones (e.g., ghrelin, CCK, GLP-1, PYY, leptin, oxytocin, cortisol) are disrupted during the ill state of eating disorders and likely contribute to the maintenance of core symptoms (e.g., dietary restriction, binge eating) and/or co-occurring features (e.g., mood symptoms, attentional biases). Some of these hormones (e.g., ghrelin, cortisol) may also be related to eating pathology via links with psychological stress. Despite these effects, the role of hormonal factors in the etiology of eating disorders remains unknown. The strongest evidence for etiologic effects has emerged for ovarian hormones, as changes in ovarian hormones predict changes in phenotypic and genetic influences on disordered eating. Future studies would benefit from utilizing etiologically informative designs (e.g., high risk, behavioral genetic) and continuing to explore factors (e.g., psychological, neural responsivity) that may impact hormonal influences on eating pathology.

Is Testosterone a Food for the Brain?

INTRODUCTION

Testosterone is fundamental for psychological, sexological, cognitive, and reproductive aspects, and its lack or reduction largely impacts the quality of life in males and females.

AIM

Therefore, the aim of this review is to describe the role of testosterone in the neurophysiology of the brain and related aspects regarding the quality of general and sexual life.

METHODS

We listed and discussed the principal studies on the role of testosterone in the brain regarding sexual health, psychopathological conditions, and the elderly. The search strategies were composed by the insertion of specific terms in PubMed regarding the main studies from January 2000 to June 2015.

MAIN OUTCOME MEASURES

Using a psychoneuroendocrinologic perspective, we considered 4 main sections: brain and testosterone, sexuality and testosterone, psychopathology and testosterone, and cognitive impairment and testosterone.

RESULTS

Much evidence on the neuroendocrinology of testosterone regarding brain activity, sexual function, psychological health, and senescence was found. In any case, it is known that testosterone deficiency negatively impacts quality of life, first, but not exclusively, through a central effect. Moreover, testosterone and androgen receptors are differently expressed according to age and gender. This aspect contributes to gender differences and to the dimorphic physiological role of this hormone.

CONCLUSION

A universal role for testosterone can be recognized: low levels of testosterone are associated with mental disorders, sexual dysfunction, and cognitive impairment in both sexes. Hence, physicians should carefully assess testosterone levels, not only in the management of sexual dysfunctions but also when seeking to help patients with severe mental or organic diseases.