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Mind Games: How Hormones Affect Cognition?

All the body’s attributes change with age, and mental function is no exception. Memory is the most fragile mental function.

With age, new learning is slower, new information is processed less carefully, and details often slip. Short-term memory typically weakens, but long-term memory is well preserved. These changes give rise to “the senior moment” in healthy elders and to cognitive impairment and dementia in those who are not so lucky.

Testosterone levels decline with age, just when memory begins to slow.

Might falling hormone levels account for some of the problems?

Perhaps. The data are far from conclusive, but some studies suggest a link:

A 2005 study of 565 World War II veterans found that higher testosterone levels in midlife were linked to better preservation of brain tissue in some, but not all, regions of the brain in late life.

A 2004 study of 400 men of age 40 to 80 found that higher testosterone levels were associated with better cognitive performance in older men. No link was observed in younger individuals.

A 2004 report from the Baltimore Longitudinal Study of Aging evaluated 574 men over a 19-year period. Low free testosterone levels predicted an increased risk of developing Alzheimer’s disease, even after other dementia risk factors were taken into account.

A 2002 study of 310 men with an average age of 73 found that higher levels of bioavailable testosterone were associated with better scores on three tests of cognitive function.

A 2002 study of 407 men between the ages of 51 and 91 found that men with higher free testosterone levels achieved higher scores on four cognitive function tests, including visual and verbal memory.

A 1999 study of 547 men between the ages of 59 and 89 found that high testosterone levels in older men were associated with better performance on several cognitive function tests.

Can testosterone therapy improve mental function in older men who are healthy or in those with cognitive impairment? A few short-term studies have examined this question. For now, testosterone replacement therapy is recommended for men suffering from officially diagnosed hypogonadism, extremely low levels of testosterone (low T) resulting in significant health disorders.

Testosterone and Mood

Some research suggests that men with abnormally low testosterone levels, either because of hypogonadism or androgen deprivation therapy (a treatment provided for treating men with advanced prostate cancer and as an adjunct to radiation therapy for locally advanced prostate cancer), have an increased incidence of depression.

Short-term studies suggest that testosterone therapy may help alleviate symptoms of depression in some men but that very high doses may promote aggressive or manic behavior. This means that the therapy should be started and provided only based on proper lab evaluation and diagnosis confirming the low T as well as should be given to a patient under regular medical control throughout a full cycle. Only low T can be a true indication for providing the replacement therapy.

Testosterone Therapy: Diagnosis and Indications

Men who are truly testosterone deficient should receive replacement therapy. The Institute of Medicine estimates that four to five million men are in this category but that only 5% of them are receiving testosterone.

As we’ve already mentioned, testosterone deficiency is called hypogonadism. Causes include testicular failure due to genetic errors, mumps, severe trauma, alcoholism, cancer chemotherapy, and radiation.

In other cases, the problem originates in the pituitary gland of the brain; causes include tumors (almost all benign), head trauma, brain surgery, various medications, some hereditary disorders, severe malnutrition, and chronic illnesses.

How do doctors diagnose testosterone deficiency? According to the Endocrine Society, men over 50 years of age who have total testosterone levels of 200 ng/dL or lower are hypogonadal; they require an evaluation of pituitary function before beginning testosterone therapy.

Men with testosterone levels between 200 and 400 ng/dL are borderline and should have additional testing before considering therapy, and men with levels above 400 ng/dL don’t need further tests or therapy.

Until recently, men who needed testosterone required injections of the hormone every one to three weeks. That’s changed dramatically. Now, most men use skin patches, gels, or tablets that are placed on the surface of the gum, where they form a gel that releases the hormone so it can be absorbed across the mouth’s membranes (Striant). All these products require a doctor’s prescription and, except for injections, all are expensive.

Injections are considered to be the most affordable by price and most risk-free type of testosterone replacement therapy.

Possible risks of testosterone therapy occur in case if a man is disposed toward any illnesses or if he currently has a chronic disease (for instance a cardiovascular disorder or sleep apnea because of excess weight) but starts the therapy without undergoing the preliminary detailed diagnostics before receiving the treatment.

Consult a doctor to learn if you’ve got any contraindications to the therapy and discuss a proper dosage per injection if required. A proper approach to your treatment is going to reduce the risk of getting any unwanted side effects.

For now, keep your mind young and supple with mental activity, physical exercise, good nutrition, and regular medical care.

Get in touch with one of our experts to get the answers to any questions you’ve probably got.

25 January 2021 Hormones
About Dr. Nil Hoppins

Dr. Nil Hoppins is a consultant dermatologist and professor of medical dermatology specializing in the diagnosis and treatment of skin disorders, treatment of severe scarring, and photodermatology. He has a strong background in translational research, and expertise in genetic skin disorders.

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