Exogenous testosterone alone or with finasteride does not improve measurements of cognition in healthy older men with low serum testosterone
Exogenous testosterone alone or with finasteride does not improve measurements of cognition in healthy older men with low serum testosterone
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DOI：
10.2164/jandrol.107.002931
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发表时间：
2007-11-01
影响因子：
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通讯作者：
Tenover, J. Lisa
中科院分区：
文献类型：
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作者：
Vaughan, Camille;Goldstein, Felicia C.;Tenover, J. Lisa
随着男性年龄的增长，睾酮（T）水平下降，但目前还不清楚这是否对认知有影响。一些研究表明，较低的T水平与记忆丧失有关;因此，保持较高的T水平可能对认知功能方面产生积极影响。然而，人们担心T治疗对老年男性前列腺的影响。我们假设，T水平低的老年男性的T替代会改善认知功能的各个方面，并且添加非那肽不会影响T诱导的认知改善。健康男性，65至83岁，基线总T低于350 ng/dL，并且没有认知障碍的证据，被随机分配到3种方案之一：每2周一次肌内注射200 mg T，每日一次安慰剂药丸（仅T），每2周一次肌内注射200 mg T，每日一次5 mg非那肽（T+F），或安慰剂注射剂和药丸（安慰剂）。69名男性完成了基线认知测试; 65名完成了至少4个月的研究，46名完成了所有36个月的研究。参与者在基线、4个月和36个月时接受了一系列认知评估，沿着测量了血清激素水平。在整个治疗期间，仅T组和T+F组的血清总T、生物可利用T和雌二醇水平显著增加，而安慰剂组的这些激素水平没有变化。无论是在短期（4个月）还是长期（36个月）分析中，3组之间在认知表现的任何评价中均仅观察到极轻微的显著差异。这些结果表明，在基线时无认知障碍的健康老年男性中，T替代治疗（无论是单独给药还是与非那肽联合给药）持续36个月对认知功能测试无临床显著影响。进一步的研究是必要的，以确定是否激素替代男性与预先存在的认知障碍是有益的。
Testosterone (T) levels decline as men age, but it is unclear whether this has an effect on cognition. Some studies indicate that lower T levels are associated with memory loss; thus, maintaining a higher T level could have positive effects on aspects of cognitive function. Concerns exist, however, about the effect of T therapy on the prostate in older men. We hypothesized that T replacement in older men with low T levels would improve aspects of cognitive function and that the addition of finasteride would not affect the T-induced cognitive improvements. Healthy men, 65 to 83 years of age, with baseline total T below 350 ng/dL and no evidence of cognitive impairment were randomly assigned to 1 of 3 regimens: 200 mg of T every 2 weeks by intramuscular injection with placebo pill daily (T-only), 200 mg of T every 2 weeks by intramuscular injection with 5 mg of finasteride daily (T+F), or placebo injections and pills (placebo). Sixty-nine men completed baseline cognitive testing; 65 completed at least 4 months, and 46 completed all 36 months of the study. Participants were given a battery of cognitive evaluations at baseline, 4 months, and 36 months, along with measurement of serum hormone levels. Serum total T, bioavailable T, and estradiol levels in the T-only and T+F groups significantly increased throughout the treatment period, whereas these hormone levels did not change in the placebo group. Only minimally significant differences were seen among the 3 groups in any evaluation of cognitive performance, either in the short-term (4 months) or the long-term (36 months) analysis. These results indicate that T replacement, whether given alone or in combination with finasteride, for 36 months in healthy older men without cognitive impairment at baseline has no clinically significant effect on tests of cognitive function. Further studies are warranted to determine whether hormone replacement in men with preexisting cognitive impairment is beneficial.