title: Cognitive effects of testosterone and finasteride administration in older hypogonadal men.
abstract: Serum concentrations of neuroactive androgens decline in older men and, in some studies, low testosterone is associated with decreased cognitive function and incidence of depression. Existing studies evaluating the effect of testosterone administration on cognition in older men have been largely inconclusive, with some studies reporting minor to moderate cognitive benefit, while others indicate no cognitive effect. Our objective was to assess the cognitive effects of treating older hypogonadal men for 1 year with a supraphysiological dose of testosterone, either alone or in combination with finasteride (a type II 5α-reductase inhibitor), in order to determine whether testosterone produces cognitive benefit and whether suppressed dihydrotestosterone influences cognition. Sixty men aged ≥ 60 years with a serum testosterone concentration of ≤ 300 ng/dL or bioavailable testosterone ≤ 70 ng/dL and no evidence of cognitive impairment received testosterone-enanthate (125 mg/week) versus vehicle, paired with finasteride (5 mg/day) versus placebo using a 2×2 factorial design. Testosterone caused a small decrease in depressive symptoms as assessed by the Geriatric Depression Scale and a moderate increase in visuospatial memory as assessed by performance on a recall trial of the Rey-Osterrieth Complex Figure Test. Finasteride caused a small increase in performance on the Benton Judgment of Line Orientation test. In total, major improvements in cognition were not observed either with testosterone or finasteride. Further studies are warranted to determine if testosterone replacement may improve cognition in other domains.
authors.affiliation: Geriatric Research, Education and Clinical Center, Gainesville Florida.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Borst
authors.affiliation: Research Service, Malcom Randall VA Medical Center, Gainesville Florida.
authors.forename: Joshua F
authors.initials: JF
authors.lastname: Yarrow
authors.affiliation: Geriatric Research, Education and Clinical Center, Gainesville Florida.
authors.forename: Carmen
authors.initials: C
authors.lastname: Fernandez
authors.affiliation: Research Service, Malcom Randall VA Medical Center, Gainesville Florida.
authors.forename: Christine F
authors.initials: CF
authors.lastname: Conover
authors.affiliation: Research Service, Malcom Randall VA Medical Center, Gainesville Florida.
authors.forename: Fan
authors.initials: F
authors.lastname: Ye
authors.affiliation: Geriatric Research, Education and Clinical Center, Gainesville Florida.
authors.forename: John R
authors.initials: JR
authors.lastname: Meuleman
authors.affiliation: Pharmacy Service, Malcom Randall VA Medical Center, Gainesville Florida.
authors.forename: Matthew
authors.initials: M
authors.lastname: Morrow
authors.affiliation: Department of Biostatistics, University of Florida, Gainesville, FL, USA.
authors.forename: Baiming
authors.initials: B
authors.lastname: Zou
authors.affiliation: Department of Health Outcomes and Policy, University of Florida, Gainesville, FL, USA.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Shuster
mesh_terms: D058891:5-alpha Reductase Inhibitors / Q000627:therapeutic use*; D000368:Aged; D000728:Androgens / Q000627:therapeutic use*; D000886:Anthropometry; D002853:Chromatography, Liquid; D003071:Cognition / Q000187:drug effects*; D004797:Enzyme-Linked Immunosorbent Assay; D018120:Finasteride / Q000627:therapeutic use*; D015577:Geriatric Assessment; D006801:Humans; D007006:Hypogonadism / Q000188:drug therapy*; D008297:Male; D013058:Mass Spectrometry; D008875:Middle Aged; D053580:Muscle Strength / Q000187:drug effects; D013739:Testosterone / Q000031:analogs & derivatives* / Q000097:blood / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D058891:5-alpha Reductase Inhibitors; D000728:Androgens; D013739:Testosterone; D018120:Finasteride; C004648:testosterone enanthate
keywords: 5 alpha reductase; cognition; depression; testosterone enanthate