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Cognitive effects of testosterone and finasteride administration in older hypogonadal men

Authors Borst SE, Yarrow JF, Fernandez C, Conover CF, Ye F, Meuleman JR, Morrow M, Zou B, Shuster JJ

Received 2 February 2014

Accepted for publication 16 April 2014

Published 12 August 2014 Volume 2014:9 Pages 1327—1333

DOI https://doi.org/10.2147/CIA.S61760

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 4

Stephen E Borst,1 Joshua F Yarrow,2 Carmen Fernandez,1 Christine F Conover,2 Fan Ye,2 John R Meuleman,1 Matthew Morrow,3 Baiming Zou,4 Jonathan J Shuster5

1Geriatric Research, Education and Clinical Center, 2Research Service, 3Pharmacy Service, Malcom Randall VA Medical Center, Gainesville Florida; 4Department of Biostatistics, 5Department of Health Outcomes and Policy, University of Florida, Gainesville, FL, USA

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.

Keywords: cognition, depression, 5 alpha reductase, testosterone enanthate

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