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COGNITIVE DECLINE IN THE ANDROPAUSE:

EXPLORING THE ANDROGEN CONNECTION

Dr. Robert Tan,

Associate Professor, University of Texas-Houston,USA

Studies demonstrate a decline in androgens with age and this results in the andropause. Basic studies suggest tau protein and beta amyloid formation is influenced by testosterone. There are also androgen receptors in certain parts of the brain. The objective of this paper is to review the literature on hormonal changes that occur in the aging males and determine if there are associations between decreased testosterone, dehydroepiandosterone (DHEA) and decreased cognitive function.

Trials of androgen replacement and its impact on cognitive function will also be analyzed. Method of analysis will be by a thorough search of articles on MEDLINE, the Internet and major abstract databases. Results of the author’s own research in 302 men of the association of memory loss as a symptom of the andropause will be presented. In addition, the author’s open trial of testosterone replacement in hypogonadal men with Alzheimer’s disease will also be presented. The results of the author’s trial will be compared with other investigators.

High endogenous testosterone predicted better performance on visual spatial tests in several studies, but not all studies. Likewise, testosterone replacement in hypogonadal patients improved cognitive functions in some but not all studies. Testosterone has also been shown to improve cognitive function in eugonadal men. Several studies have shown that declines in DHEA may contribute to Alzheimer’s disease and the results of double blind studies with DHEA replacement and its effect on cognition will also be presented.

In summary, there is still no consensus that androgen replacement is beneficial in cognitive decline but this option may prove promising in some patients.

Dr Robert Tan, MD

Associate Professor (geraiatrics), University of Texas, Houston, USA

Email: robert.s.tan@uth.tmc.edu

Currently an Associate Professor (Geriatrics) at the Medical School in the University of Texas Health Sciences Center in Houston, USA., he is also Medical Director of the Garden Terrace Alzheimer’s Center of Excellence in Houston and Co-Director of the Geriatric Medicine Fellowship program. He is board certified in Geriatric Medicine, Family Practice and Medical Administration, and a Fellow of the American Geriatrics Society, and Fellow of the Australian College of General Practitioners. He is also a founding Board member & Advisory Board member to the International Society for Men’s Health, as well as a member of the American Society for Andrology among other societies. In the medical community, he is recognized as an expert and consultant in Aging Andrology. His work in this area resulted in him appearing in Woodward White’s “Best Doctors in America” list for 2001-2002. He maintains an active practice of Geriatrics, Andrology and Family Practice in addition to his academic activities of student/resident/fellow teaching, research and administration.

Recent References:

Tan RS. Andropause and testosterone supplementation for cognitive loss.

J.Androl 2002;23:45-6.

2.         Tan RS. Andropause: introducing the concept of 'relative hypogonadism' in aging males. Int.J Impot.Res. 2002;14.

3.         Tan RS,.Pu SJ. Impact of obesity on hypogonadism in the andropause. Int J Androl. 2002;25:195-201.

4.         Tan RS,.Pu SJ. The andropause and memory loss: is there a link between androgen decline and dementia in the aging male? Asian J.Androl 2001;3:169-74.

5.         Tan RS. Memory loss as a reported symptom of andropause. Arch.Androl 2001;47:185-9.

6.         Anderson RA, Martin CW, Kung AW, Everington D, Pun TC, Tan KC et al. 7Alpha-methyl-19-nortestosterone maintains sexual behavior and mood in hypogonadal men. J Clin Endocrinol Metab 1999;84:3556-62.

7.         Tan KC, Shiu SW, Kung AW. Alterations in hepatic lipase and lipoprotein subfractions with transdermal testosterone replacement therapy. Clin.Endocrinol.(Oxf) 1999;51:765-9.

8.         Tan, R. S. Testosterone improves cognition in demented hypogonadic patients in a nursing home.  18. 1999. American Medical Directors Association Meeting.

Ref Type: Conference Proceeding

9.         Tan RS,.Philip PS. Perceptions of and risk factors for andropause. Arch.Androl 1999;43:227-33.