Cognitive effects of testosterone and finasteride administration in older hypogonadal men.
Cognitive effects of testosterone and finasteride administration in older hypogonadal men.
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DOI：
10.2147/cia.s61760
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发表时间：
2014
影响因子：
3.6
通讯作者：
Shuster JJ
中科院分区：
文献类型：
--
作者：
Borst SE;Yarrow JF;Fernandez C;Conover CF;Ye F;Meuleman JR;Morrow M;Zou B;Shuster JJ
老年男性的血清神经活性雄激素浓度下降，在一些研究中，低睾酮与认知功能下降和抑郁症发病率有关。现有的研究评估睾酮管理对老年男性认知的影响在很大程度上是不确定的，一些研究报告了轻微至中度的认知益处，而另一些研究则表明没有认知影响。我们的目的是评估单用超生理剂量睾酮或联合非那肽（一种II型5α-还原酶抑制剂）治疗老年性腺功能减退男性1年的认知效果，以确定睾酮是否产生认知益处以及抑制双氢睾酮是否影响认知。采用2×2析因设计，60例年龄≥60岁、血清睾酮浓度≤300 ng/dL或生物可利用睾酮≤70 ng/dL且无认知损害证据的男性接受睾酮-庚酸酯（125 mg/周）与溶剂、与非那肽（5 mg/天）配对与安慰剂。老年抑郁量表评估的抑郁症状和中度增加的视觉空间记忆的Rey-Osterrieth复杂图形测试的回忆试验的性能进行评估，Tehramin引起了一个小的减少。Finaldade引起的性能略有增加的本顿判断线方向测试。总体而言，睾酮或芬氟拉明均未观察到认知方面的重大改善。进一步的研究是必要的，以确定睾酮替代是否可以改善其他领域的认知。
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.