Testosterone for aging and cognition?
Dr. Karram: Do you think that testosterone supplementation in the elderly can have a positive impact on aging, Alzheimer disease, and dementia?
Dr. Streicher: The jury is still out on the cognitive effects of postmenopausal androgen supplementation. There is currently insufficient evidence to support the use of testosterone to enhance cognitive performance, or to delay cognitive decline. I prescribe testosterone only to treat HSDD, but I do tell my patient that she may possibly also benefit in terms of cognitive function, musculoskeletal parameters, and well-being. Large RCTs are needed in those areas to justify prescribing for those benefits alone.
Dr. Simon: I would say this is the place for future development, but where there is very likely to be a benefit is on sarcopenia.
Dr. Glaser: There is some evidence that testosterone is neuroprotective.16 In my clinical practice I have seen “self-reported” memory issues improved on therapy, often returning toward the end of the testosterone implant cycle. Adequate amounts of bioavailable testosterone at the androgen receptor are critical for optimal health, immune function, and disease prevention.
Dr. Karram: In conclusion, this expert panel agrees that testosterone supplementation is beneficial for sexual dysfunction in postmenopausal women, with also many other potential benefits that require further investigation. Route of administration preferred by Dr. Simon and Dr. Streicher is transdermal or a transvaginal cream. Dr. Glaser uses a subcutaneous pellet approach. Thank you all for an engaging and informative discussion. ●
Is testosterone appropriate for this patient?
Dr. Karram: How would you treat the following patient? She is 56, postmenopausal, and taking estrogen. She reports decreased libido, fatigue, lack of sleep, and lack of focus. Would you consider testosterone supplementation?
Dr. Simon: For her libido, yes. I would not give it to her for the fatigue if it were simply lack of sleep and without an associated medical condition. For her lack of focus, the testosterone could be beneficial. The central nervous system effects of testosterone are thought to be related to the conversion of testosterone to estrogen in the brain; if a person’s getting enough estrogen, they shouldn’t have lack of focus. Since some women may not want more estrogen, administering a little testosterone for libido also offers focus because it adds to the estrogen in the brain. If after giving her adequate amounts of testosterone her libido is not better in 8 weeks, it wasn’t a testosterone problem. If she does report improvement, however, I would keep her on the agent as long as she is healthy. But most 56-year-old women who already met the criteria for going on estrogen should be fine with testosterone.
If this same patient were not reporting low libido but did report lack of strength, energy, or well-being I also would say, “Sure, give testosterone a try.”
Dr. Glaser: I also would treat her with testosterone—with pellet implants. The dose would depend on her body weight. I usually start with an approximate dose of 1 mg of testosterone per pound of body weight. This amount of testosterone delivered continuously from the implant also supplies estradiol (via aromatization) locally at the cellular level.
I would treat her for as long as she chooses to continue testosterone therapy. There is no end- or stop-date where a person no longer benefits from therapy or adverse events occur. Testosterone does not increase the risk of breast cancer and it has a positive effect on many of the adverse signs and symptoms of aging, including mental and physical deterioration.