Additional clinical variables

Aging is associated with a deterioration of multiple aspects of cognitive performance. Hypogonadal men tend to show diminished spatial skills, but the findings of observational studies on the relationship between spatial skills and endogenous androgen levels in elderly men have been inconsistent, whereas in several, but not all intervention studies, androgen administration to elderly men has resulted in improved spatial cognition and working memory, with decreased verbal fluency (Muller et al. 2003; Gruenewald and Matsumoto 2003 for review; see also Chapter 4).

Endogenous bio-available testosterone levels were reported to be inversely associated with depressive mood assessed with the Beck Depression Inventory in older men in the Rancho Bernardo Study (Barrett-Connor et al. 1999). In a study of selected men aged 50 to 70 years, who participated in a screening program on prostate cancer and 'andropause', there was an inverse correlation between free testosterone and depressive symptoms assessed on the Carroll Rating Scale, but serum free testosterone was not related to the prevalence of a significant score for depression (Delhez et al. 2003). In contrast others reported that declining bio-available testosterone levels were associated with lower levels of depressive symptoms on the Hamilton Depression Scale in men 55 to 76 years old (Perry et al. 2001).

T'Sjoen et al. (2003) failed to observe a relationship between (free or bio-available) testosterone and health-related quality of life as assessed with the SF-36 questionnaire in ambulant community-dwelling men over 70 years, which is in accordance with findings by Dunbar etal. (2001). Snyder etal. (1999b) found significantly less worsening of the perception of physical functioning according to a sub-score of the SF-36 questionnaire during testosterone treatment as compared to placebo in elderly men, the largest treatment effect being observed in men with the lowest initial serum testosterone; in the latter study there was no treatment effect for any other sub-score of the SF-36 questionnaire. In studies with androgen administration to elderly men with low or (low) normal serum testosterone, there were no significant effects over placebo for mood and/or overall quality of life (Gruenewald and Matsumoto 2003; Kunelius etal. 2002; Ly etal. 2001; Steidle etal. 2003); improvement of quality of life as measured with a questionnaire intended for patients with osteoporosis and vertebral fracture was reported for testosterone administration in glucocorticoid-treated men (Crawford etal. 2003).

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