Vaughan Camille, Goldstein Felicia C, Tenover J Lisa
Division of Geriatric Medicine, Wesley Woods Health Center, 1841 Clifton Road NE, Atlanta, GA 30329, USA.
J Androl. 2007 Nov-Dec;28(6):875-82. doi: 10.2164/jandrol.107.002931. Epub 2007 Jul 3.
Testosterone (T) levels decline as men age, but it is unclear whether this has an effect on cognition. Some studies indicate that lower T levels are associated with memory loss; thus, maintaining a higher T level could have positive effects on aspects of cognitive function. Concerns exist, however, about the effect of T therapy on the prostate in older men. We hypothesized that T replacement in older men with low T levels would improve aspects of cognitive function and that the addition of finasteride would not affect the T-induced cognitive improvements. Healthy men, 65 to 83 years of age, with baseline total T below 350 ng/dL and no evidence of cognitive impairment were randomly assigned to 1 of 3 regimens: 200 mg of T every 2 weeks by intramuscular injection with placebo pill daily (T-only), 200 mg of T every 2 weeks by intramuscular injection with 5 mg of finasteride daily (T+F), or placebo injections and pills (placebo). Sixty-nine men completed baseline cognitive testing; 65 completed at least 4 months, and 46 completed all 36 months of the study. Participants were given a battery of cognitive evaluations at baseline, 4 months, and 36 months, along with measurement of serum hormone levels. Serum total T, bioavailable T, and estradiol levels in the T-only and T+F groups significantly increased throughout the treatment period, whereas these hormone levels did not change in the placebo group. Only minimally significant differences were seen among the 3 groups in any evaluation of cognitive performance, either in the short-term (4 months) or the long-term (36 months) analysis. These results indicate that T replacement, whether given alone or in combination with finasteride, for 36 months in healthy older men without cognitive impairment at baseline has no clinically significant effect on tests of cognitive function. Further studies are warranted to determine whether hormone replacement in men with preexisting cognitive impairment is beneficial.
随着男性年龄增长，睾酮（T）水平会下降，但目前尚不清楚这是否会对认知产生影响。一些研究表明，较低的T水平与记忆力减退有关；因此，维持较高的T水平可能对认知功能方面有积极影响。然而，人们担心T疗法对老年男性前列腺的影响。我们假设，对T水平低的老年男性进行T替代治疗会改善认知功能，并且添加非那雄胺不会影响T诱导的认知改善。年龄在65至83岁之间、基线总T低于350 ng/dL且无认知障碍证据的健康男性被随机分配到以下3种治疗方案之一：每2周肌肉注射200 mg T并每日服用安慰剂药丸（仅T组）、每2周肌肉注射200 mg T并每日服用5 mg非那雄胺（T+F组）或安慰剂注射剂和药丸（安慰剂组）。69名男性完成了基线认知测试；65名完成了至少4个月的测试，46名完成了全部36个月的研究。在基线、4个月和36个月时，对参与者进行了一系列认知评估，并测量了血清激素水平。在整个治疗期间，仅T组和T+F组的血清总T、生物可利用T和雌二醇水平显著升高，而安慰剂组的这些激素水平没有变化。在短期（4个月）或长期（36个月）分析中，在任何认知表现评估中，3组之间仅观察到极小的显著差异。这些结果表明，在基线时无认知障碍的健康老年男性中，单独或与非那雄胺联合进行36个月的T替代治疗，对认知功能测试没有临床显著影响。有必要进行进一步研究，以确定对已有认知障碍的男性进行激素替代治疗是否有益。
