Joe (not his real name), a 45 year old male presented to the practice concerned about his memory. He had found that over the last couple of months that he had been forgetting to complete job’s at work and at home, even once forgetting to pick up his children from school, usually a regular task.
He had not been in any trouble at work yet but had heard one of his managers talking to a colleague about how his quality of work was not what it used to be. He also said that his partner was getting frustrated with him as he was not paying bills on time and was not exercising as often.
Joe was married, had 2 young children, and used to exercise a couple for times a week. He felt that he was getting fatter, had less energy and snored on occasion, being banished to the back room by his partner.
Through the course of the interview and examination, it was found that Joe was obese with an abdominal circumference of 110cm, though muscled, had some evidence of depression, though mild, and there was no evidence of sleep apnea. The snoring he attributed to the weight around my stomach. His diet was reasonable, and he drunk little alcohol. He stated he enjoyed work and had a good relationship with is partner. He was a nonsmoker and denied illicit drug use.
“Doc, I was talking to some of the boys at the gym and they reckon some testosterone would help my memory and give me a bit of zing!”
Testosterone is one of many hormones that effect our short-term working memory and long-term memory. There is strong evidence that as men age, with the age-related decline in their sex hormones, there is a decline in long term memory, indeed replacing testosterone in males with Alzheimer’s has shown some improvement in cognition testing. There is little trial data to support this in younger men with low normal testosterone.
There is a concept of the andropause (male menopause), which in the media is described as like menopause, however, is an unhelpful non-scientific term. Men have a decline in testosterone as they get older, rather than precipitous drop in hormones that many women experience. Due to this decline in testosterone men can develop issues like:
- mood swings and irritability
- loss of muscle mass and reduced ability to exercise
- fat redistribution, such as developing a large belly or “man boobs” (gynaecomastia)
- a general lack of enthusiasm or energy
- difficulty sleeping (insomnia) or increased tiredness
- poor concentration and short-term memory
A testosterone deficiency that develops later in life, also known as late-onset hypogonadism, can sometimes be responsible for these symptoms. Joe underwent some blood testes to assess his level of testosterone. It was found to be at the very low end of normal. A variety of interventions were offered to Joe. Resistance exercise can he helpful in assisting with an increase in testosterone. Joe was very keen to explore the use of testosterone, mainly it seems from the information given to him by. Following discussion on the various types of testosterone, methods of administration, indications, legal restrictions, risks, benefits and costs associated with them he decided on using a testosterone gel for a period of six months.
At the end of the six months, Joe has returned to the gym, is going well at the workplace and return to the bedroom with his partner. The testosterone gel was ceased and he on with no further issues.
Bibliography
Jeri S. Janowsky, (2006), Thinking with your gonads: testosterone and cognition, Trends in Cognitive Sciences, Volume 10, Issue 2, Pages 77-82.
Stuart N Seidman (2003), Testosterone Deficiency and Mood in Aging Men: Pathogenic and Therapeutic Interactions, The World Journal of Biological Psychiatry, 4:1, 14-20,
Tan RS, Pu SJ. (2001) The andropause and memory loss: is there a link between androgen decline and dementia in the aging male?. Asian J Androl.;3(3):169-174.o