Hormones

Sex hormones definitely affect memory; this is true for men as well as women. With age, estrogen levels in women and testosterone levels in men fall, and this decline undoubtedly contributes to age-related memory loss.

Many women notice problems with memory during menopause, when their estrogen levels drop dramatically. It could be that estrogen benefits memory by protecting neurons, as some laboratory studies suggest. As for men, those with high levels of testosterone in their blood have better visual and verbal memory than men with low testosterone levels, according to a large study reported by the National Institute on Aging. Low testosterone may increase the risk of memory disorders. Men with low testosterone were more likely to develop Alzheimer's disease in a study reported in the journal Neurology in 2004.

A logical question to ask is whether hormone supplements can help prevent age-related memory loss or Alzheimer's disease. For years, doctors thought that the answer was yes, at least for women. But that assumption was disproved by a large clinical trial, the Women's Health Initiative Memory Study (WHIMS).

Researchers from the WHIMS group reported in 2003 that combination estrogen-progestin therapy (Prempro) not only failed to improve memory in postmenopausal women but actually doubled the women's risk for dementia. Research in 2004 established that estrogen therapy by itself was also associated with an increased incidence of dementia. The Women's Health Initiative found that estrogen increased the risk of stroke in healthy women, and a related study found that it might also increase the risk of mild cognitive impairment, a condition that many experts consider to be a precursor of Alzheimer's disease.

Although all of the pieces of the estrogen puzzle are not yet in place as critics have questioned aspects of the WHIMS study design and resulting conclusions, menopausal hormone therapies now bear warning labels stating that they do not prevent memory loss and do slightly increase the risk of developing dementia.

The jury is still out on the benefit of testosterone supplementation in men; we still don't know much about its long-term effects. A study in the Journal of Cognitive Neuroscience in 2000 found that men improved their working memory after taking testosterone supplements. But as with postmenopausal estrogen and estrogen-progestin replacement, testosterone therapy can increase the risk of certain types of cancers and has been linked to a higher incidence of stroke in some men. When I have a male patient with symptoms of low testosterone—decreased libido, lowered overall drive, general malaise—I recommend that he have his hormone levels checked by his primary care physician or an endocrine specialist. These doctors can knowledgeably discuss the pros and cons of testosterone treatment.

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