Personality Changes Caused by Low T TherapyWe aimed inyeccion intraarticular de esteroides evaluate the effect of testosterone replacement therapy TRT testosterone therapy mental side effects cognitive function and depression in men with testpsterone deficiency syndrome. The age among patients in the TRT and control groups was At baseline, no significant differences between the TRT and control groups were noted regarding serum testosterone or prostate-specific antigen levels, or regarding the scores for aging symptoms Aging Males' Symptoms scaleerectile function 5-item International Index of Erectile Function questionnairecognitive function Korean Mini-Mental State Examinationand depression Testosterone therapy mental side effects Depression Inventory. TRT may be considered in men with testosterone deficiency syndrome if low testosterone levels are associated with depression or cognitive impairment. Testosterone deficiency syndrome TDS represents a clinical and biochemical syndrome associated with advancing age, and is characterized by a total level of serum testosterone below the reference range calculated based on the levels noted among healthy adult men.
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We aimed to evaluate the effect of testosterone replacement therapy TRT on cognitive function and depression in men with testosterone deficiency syndrome. The age among patients in the TRT and control groups was At baseline, no significant differences between the TRT and control groups were noted regarding serum testosterone or prostate-specific antigen levels, or regarding the scores for aging symptoms Aging Males' Symptoms scale , erectile function 5-item International Index of Erectile Function questionnaire , cognitive function Korean Mini-Mental State Examination , and depression Beck Depression Inventory.
TRT may be considered in men with testosterone deficiency syndrome if low testosterone levels are associated with depression or cognitive impairment.
Testosterone deficiency syndrome TDS represents a clinical and biochemical syndrome associated with advancing age, and is characterized by a total level of serum testosterone below the reference range calculated based on the levels noted among healthy adult men.
TDS may have adverse effects on the function of multiple organ systems. Common symptoms of TDS include low libido, decreased vitality, fatigue, mood changes, insomnia, anemia, flushes, erectile dysfunction, decreased muscle mass, increased visceral body fat, ejaculatory dysfunction, and loss of concentration [ 2 ].
Low testosterone levels have also been associated with impaired quality of life due to symptoms such as depression and cognitive impairment [ 3 ], as well as poorer sense of psychological well-being [ 4 ] and subsyndromal levels of depression and anxiety in otherwise healthy older men [ 5 ]. Testosterone replacement therapy TRT is a widely-used treatment for men with TDS, with well documented beneficial effects on libido, energy levels, bone density, strength, and muscle mass [ 6 ].
While a meta-analysis has suggested that TRT may improve depression scores [ 7 ], reports regarding the beneficial effects of TRT on quality of life and depressive mood have not been consistent across trials [ 8 ]. Lower levels of testosterone appear to affect spatial abilities, verbal abilities and cognitive function [ 9 ]. Reports regarding the effects of TRT on cognitive function and memory scores have described mixed results [ 10 , 11 ].
In the present study, we investigated the efficacy and safety of TRT in patients with TDS, as well as its effect on cognitive performance and depression.
The present study was conducted as a prospective, placebo-controlled study. The study protocol was approved by the Institutional Review Board of Daegu Catholic University Medicine Center and all participants provided informed consent. The exclusion criteria were: Use of concomitant medication involving alpha adrenergic blockers, 5-alpha reductase inhibitors, and phosphodiesterase type 5 inhibitors, which can influence urination and the function of sexual hormones, was not permitted during the study.
A total of patients mean age, The blood sampling for the measurement of serum total testosterone was performed between 9: TRT was performed in the form of several injections of 1, mg testosterone undecanoate. The patients from the TRT group were injected upon enrollment, at 8 weeks, and then every 3 months; these patients also received recommendations for lifestyle modification.
The patients from the control group received recommendations to change their lifestyle, but did not undergo any treatment with injections. The study outcomes were evaluated in terms of efficacy and safety of the TRT treatment. The parameters describing efficacy were the total serum testosterone levels measured between To assess the condition of the prostate, the following evaluations were performed at baseline and at the 8-month follow-up: Cognitive function was assessed at baseline and at the 8-month follow-up using the Korean Mini-Mental State Examination K-MMSE , which represents an established instrument to screen for cognitive impairment or dementia in a community setting [ 12 ].
Depression was assessed at baseline and at the 8-month follow-up using the item Beck Depression Inventory BDI , which is one of the most popular measures of depressive symptoms worldwide [ 13 ]. For a significance level of 0. Baseline and follow-up values of continuous variables were compared using the paired t-test. The baseline testosterone levels in the TRT and control groups were 2. Korean Mini-Mental State Examination. At the 8-month follow-up, patients in the TRT group showed significantly higher levels of total serum testosterone and IIEF-5 scores compared to the baseline values.
No statistically significant differences between baseline and follow-up values were observed regarding BMI, PSA levels, prostate volume, maximal urinary flow rate, and postvoid residual volume in the TRT group. There were few serious adverse events, and the incidence of such events did not differ significantly between the TRT and control groups.
No cardiovascular events, including stroke, myocardial infarction, or unstable angina were reported in either group. The effect of testosterone administration on cognitive function and depression in hypogonadal men is believed to be related to the enhancement of brain perfusion, which is supported by the fact that there are androgen receptors in the brain, suggesting that steroid hormones play a role in neuronal function.
Zitzmann et al [ 14 ] used 18F-deoxyglucose positron emission tomography to study cerebral glucose metabolism during a standardized mental rotation task in six hypogonadal men. All patients performed the test before and during TRT. While receiving TRT, four of six patients exhibited improved visuospatial performance, which corresponded with enhanced cerebral glucose metabolism during the test.
The effects of TRT in men with mild cognitive impairment or Alzheimer's disease have been evaluated in small placebo-controlled trials. For example, Cherrier et al [ 17 ] evaluated a sample of 32 subjects, which included 17 men with mild cognitive impairment and 15 with Alzheimer's disease.
At the 6-week follow-up, patients who received TRT showed significantly better scores regarding spatial memory, constructional abilities, and verbal memory compared to those noted in the placebo group. Taken together, these results suggest that TRT has a beneficial effect on cognitive function. In the present study, patients who received TRT showed significantly improved BDI scores at 8 months after the intervention, which supports previous reports that TRT improved mood and well-being, and reduced fatigue and irritability in hypogonadal men [ 18 , 19 ].
The study by Pope et al [ 20 ] involved men with depression refractory to standard anti-depressants, and found that TRT lowered the Hamilton Depression score, which is a standard indicator of depression. Since it has been well-documented that depression tends to increase as testosterone levels decrease [ 21 ], it is highly likely that TRT improved symptoms of depression by increasing testosterone levels.
The present study has several limitations related to the fact that we did not evaluate the levels of free or bioavailable testosterone, the assessment of cognitive function did not consider specific types of skills spatial, verbal, visual, etc.
Large-scale studies with long-term follow-up are warranted to fully characterize the effect of TRT on cognitive function and depression. Therefore, TRT may be considered for men presenting with depression or cognitive impairment in addition to low testosterone levels.
This study was supported by young scientist research grants from the Korean Society for Sexual Medicine and Andrology No potential conflict of interest relevant to this article was reported.
National Center for Biotechnology Information , U. World J Mens Health. Published online Jan Find articles by Hyun Jin Jung. Find articles by Hong Seok Shin. This article has been cited by other articles in PMC. Abstract Purpose We aimed to evaluate the effect of testosterone replacement therapy TRT on cognitive function and depression in men with testosterone deficiency syndrome.
Results The age among patients in the TRT and control groups was Conclusions TRT may be considered in men with testosterone deficiency syndrome if low testosterone levels are associated with depression or cognitive impairment. Open in a separate window. Baseline characteristics of patients with testosterone deficiency syndrome. Low serum testosterone and mortality in male veterans. Effects of androgen therapy on adipose tissue and metabolism in older men. J Clin Endocrinol Metab.
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J Korean Neurol Assoc. Oxford University Press, Inc. Changes in cerebral glucose metabolism and visuospatial capability in hypogonadal males under testosterone substitution therapy.
Exp Clin Endocrinol Diabetes. Testosterone treatment enhances regional brain perfusion in hypogonadal men. Current concepts in mild cognitive impairment. Testosterone improves spatial memory in men with Alzheimer disease and mild cognitive impairment.