Age-Associated Testosterone Decline in Men: Clinical Issues for Psychiatry

Sternbach, Harvey

doi:10.1176/ajp.155.10.1310

Cited by 180 publications

(80 citation statements)

References 79 publications

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“…The clinical manifestations of androgen deficiency in men may include decreased muscle mass and strength, increased fat mass, decreased hematocrit, decreased libido, erectile dysfunction, infertility, osteoporosis, anxiety, irritability, insomnia, depressed mood. Androgen replacement therapy with testosterone has been proposed to be a safe and effective treatment for testosterone deficiency (Sternbach, 1998;Winters, 1999). However, there are only a limited number of testosterone replacement studies with sometimes conflicting results (Sih et al, 1997;Tenover, 1992;Snyder et al, 1999a,b).…”

Section: Hormone Replacement Therapy In Humansmentioning

confidence: 99%

“…In particular, in hypogonadal men, testosterone therapy may offer benefit, but long-term studies on its efficacy and safety are still lacking. One study has reported that testosterone replacement therapy may improve depression and promote verbal and spatial memory in aging men (Sternbach, 1998). Supplementation of healthy older men with testosterone for 3 months enhanced their spatial cognition, but did not significantly influence verbal and visual memory, cognitive flexibility and mood (Janowsky et al, 1994).…”

Section: Hormone Replacement Therapy In Humansmentioning

confidence: 99%

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Steroid hormones and neurosteroids in normal and pathological aging of the nervous system

Schumacher

Weill-Engerer

Lière

et al. 2003

Progress in Neurobiology

270

171

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Without medical progress, dementing diseases such as Alzheimer's disease will become one of the main causes of disability. Preventing or delaying them has thus become a real challenge for biomedical research. Steroids offer interesting therapeutical opportunities for promoting successful aging because of their pleiotropic effects in the nervous system: they regulate main neurotransmitter systems, promote the viability of neurons, play an important role in myelination and influence cognitive processes, in particular learning and memory. Preclinical research has provided evidence that the normally aging nervous system maintains some capacity for regeneration and that age-dependent changes in the nervous system and cognitive dysfunctions can be reversed to some extent by the administration of steroids. The aging nervous system also remains sensitive to the neuroprotective effects of steroids. In contrast to the large number of studies documenting beneficial effects of steroids on the nervous system in young and aged animals, the results from hormone replacement studies in the elderly are so far not conclusive. There is also little information concerning changes of steroid levels in the aging human brain. As steroids present in nervous tissues originate from the endocrine glands (steroid hormones) and from local synthesis (neurosteroids), changes in blood levels of steroids with age do not necessarily reflect changes in their brain levels. There is indeed strong evidence that neurosteroids are also synthesized in human brain and peripheral nerves. The development of a very sensitive and precise method for the analysis of steroids by gas chromatography/mass spectrometry (GC/MS) offers new possibilities for the study of neurosteroids. The concentrations of a range of neurosteroids have recently been measured in various brain regions of aged Alzheimer's disease patients and aged non-demented controls by GC/MS, providing reference values. In Alzheimer's patients, there was a general trend toward lower levels of neurosteroids in different brain regions, and neurosteroid levels were negatively correlated with two biochemical markers of Alzheimer's disease, the phosphorylated tau protein and the ␤-amyloid peptides. The metabolism of dehydroepiandrosterone has also been analyzed for the first time in the aging brain from Alzheimer patients and non-demented controls. The conversion of dehydroepiandrosterone to 5-androstene-3␤,17␤-diol and to 7␣-OH-dehydroepiandrosterone occurred in frontal cortex, hippocampus, amygdala, cerebellum and striatum of both Alzheimer's patients and controls. The formation of these metabolites within distinct brain regions negatively correlated with the density of ␤-amyloid deposits.

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Section: Hormone Replacement Therapy In Humansmentioning

confidence: 99%

Section: Hormone Replacement Therapy In Humansmentioning

confidence: 99%

Steroid hormones and neurosteroids in normal and pathological aging of the nervous system

Schumacher

Weill-Engerer

Lière

et al. 2003

Progress in Neurobiology

270

171

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“…Anterior pituitary hormone deficiencies are associated with cognitive impairment, depression, anxiety, fatigue, apathy, and impaired quality of life (15)(16)(17), problems that are also frequently reported by TBI patients (18). Therefore, abnormal anterior pituitary hormone levels after TBI might contribute to the problems reported by TBI patients.…”

Section: Introductionmentioning

confidence: 99%

Should anterior pituitary function be tested during follow-up of all patients presenting at the emergency department because of traumatic brain injury?

Eerden¹,

Twickler

Sweep³

et al. 2010

European Journal of Endocrinology

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Context: A wide range (15-56%) of prevalences of anterior pituitary insufficiency are reported in patients after traumatic brain injury (TBI). However, different study populations, study designs, and diagnostic procedures were used. No data are available on emergency-department-based cohorts of TBI patients. Objective: To assess the prevalence of pituitary dysfunction in an emergency-department-based cohort of TBI patients using strict endocrinological diagnostic criteria. Methods: Of all the patients presenting in the emergency department with TBI over a 2-year period, 516 matched the inclusion criteria. One hundred and seven patients (77 with mild TBI and 30 with moderate/severe TBI) agreed to participate. They were screened for anterior pituitary insufficiency by GHRH-arginine testing, evaluation of fasting morning hormone levels (cortisol, TSH, free thyroxine, FSH, LH, and 17b-estradiol or testosterone), and menstrual history 3-30 months after TBI. Abnormal screening results were defined as low peak GH to GHRH-arginine, or low levels of any of the end-organ hormones with low or normal pituitary hormone levels. Patients with abnormal screening results were extensively evaluated, including additional hormone provocation tests (insulin tolerance test, ACTH stimulation test, and repeated GHRH-arginine test) and assessment of free testosterone levels. Results: Screening results were abnormal in 15 of 107 patients. In a subsequent extensive endocrine evaluation, anterior pituitary dysfunction was diagnosed in only one patient (partial hypocortisolism). Conclusion: By applying strict diagnostic criteria to an emergency-department-based cohort of TBI patients, it was shown that anterior pituitary dysfunction is rare (!1%). Routine pituitary screening in unselected patients after TBI is unlikely to be cost-effective.

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“…Basic neuroscience research has demonstrated multiple genomic and nongenomic estradiol effects in the central nervous system (CNS) in areas known to be important for cognitive performance (McEwen et al, 1997;1998;McEwen and Alves, 1999;Rubinow and Schmidt, 1996;Sternbach, 1998). Testosterone on the other hand can influence cognitive performance directly by acting on the androgen receptor, or after being converted to estradiol in the CNS (Rubinow and Schmidt, 1996;Sternbach, 1998).…”

Section: Introductionmentioning

confidence: 99%

Endogenous Estradiol and Testosterone Levels Are Associated with Cognitive Performance in Older Women and Men

Wolf

Kirschbaum

2002

Hormones and Behavior

217

140

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Age-Associated Testosterone Decline in Men: Clinical Issues for Psychiatry

Abstract: Testosterone decline/deficiency is not a state strictly analogous to female menopause and may exhibit considerable overlap with primary and other secondary psychiatric disorders.

Cited by 180 publications

References 79 publications

Steroid hormones and neurosteroids in normal and pathological aging of the nervous system

Steroid hormones and neurosteroids in normal and pathological aging of the nervous system

Should anterior pituitary function be tested during follow-up of all patients presenting at the emergency department because of traumatic brain injury?

Endogenous Estradiol and Testosterone Levels Are Associated with Cognitive Performance in Older Women and Men

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