SummaryThe effects of testosterone (T) and estradiol (E 2 ) on cognition in men are confounded in extant studies. This randomized, placebo-controlled trial was undertaken to investigate the possible effects of E 2 on cognition in older men. Twenty-five men with prostate cancer (mean age: 71.0 ± 8.8 years) who required combined androgen blockade treatment were enrolled. Performance on cognitive tests was evaluated at pre-treatment baseline and following 12 weeks of treatment with a gonadotropin-releasing hormone analog and the nonsteroidal antiandrogen bicalutamide to determine whether specific cognitive functions would decline when the production of both T and E 2 were suppressed. In the second phase of the study, either micronized E 2 1 mg/day or an oral daily placebo was randomly added to the combined androgen blockade for an additional 12 weeks to determine whether E 2 would enhance performance in specific cognitive domains (verbal memory, spatial ability, visuomotor abilities and working memory). Compared to pretreatment, no differences in scores occurred on any cognitive test following 12 weeks of combined androgen blockade. In the add-back phase of the study (Visit 3), the placebo-treated men, but not the E 2 -treated men, exhibited a trend towards improvement in their scores on both the immediate (p = . 075) and delayed recall (p = .095) portions of a verbal memory task compared to baseline. Moreover, at Visit 3, placebo-treated men performed significantly better than the E 2 -treated men on both the immediate (p = .020) and delayed recall (p = .016) portions of the verbal memory task. Thus, combined androgen blockade plus add-back E 2 failed to improve short-or long-term verbal memory performance in this sample of older men being treated for prostate cancer.
KeywordsGonadotropin-releasing hormone analog; Estrogen; Cognition; Prostate cancer; Randomized controlled trial; Combined androgen blockade In healthy males, decreases in total, free, and bioavailable testosterone levels occur with advancing age (Nankin and Calkins, 1986;Gray et al., 1991;Morley et al., 1997;Morley, 2000;Harman et al., 2001;Snyder, 2001;Vermeulen, 2001
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CIHR Author ManuscriptCIHR Author Manuscript studies of changing hormone levels in elderly men have consistently found a 1-2% annual decline in free or bioavailable testosterone (Morley et al., 1997;Harman et al., 2001;Snyder, 2001;Vermeulen, 2001;Feldman et al., 2002), with the incidence of hypogonadism rising from 20% in 60-69-year-old men to 50% in those over 80 years of age (Harman et al., 2001). Moreover, since approximately 80% of circulating estradiol (E 2 ), the most potent estrogen, is aromatized from testosterone (T) in men (Kaufman and Vermeulen, 2005), there is a corresponding decline in total and bioavailable E 2 with increasing age (Ferrini and Barrett-Connor, 1998;Khosla et al., 1998;Van den Beld et al., 2000;Vermeulen et al., 2003).Estrogen (E) and T mediate aspects of learning and memory in rodents (Bimonte and Denenberg, 1999;Gibbs, 2000;Dohan...