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Testosterone has also been associated with general mood-elevating effects Some studies have found associations between lowered T levels and depressive symptoms [139,140] Depression is not rare in aging men, and impairs their quality of life [139]; so the effects that declining levels of androgens may have on mood and on speci c aspects of cognitive functioning in aging are well-worth researching However, although low T was recently observed to predict incident depressive illness in older men in a longitudinal study [141], and a signi cant relation between depression and androgen receptor CAG repeat length has been reported in men aged 48 79 years [142], only two of the nine RCTs that have assessed the effects of T therapy on mood in aging men found a signi cant improvement in depression scores compared with placebo [87] Combined therapy with T has also been observed to improve the ef cacy of anti-depressant agents over placebo in small groups of younger men with refractory depression [143]

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Earlier studies have questioned the relevance of estrogens in human male sexuality [144] A recent study found that estrogen replacement in an aromatase-de cient man increased libidinous aspects of sexuality [145] There is also a range of non-sexual effects of androgens on the brain and for (some of) these effects aromatization of androgen to estrogens might be relevant Indeed, effects of estrogen on the brain are increasingly being recognized [146], though studies have mainly been carried out using animal models Estrogens have been observed to in uence many processes in many regions of the brain throughout the entire life span These effects include those on cognitive function, co-ordination of movement, pain, and affective state, involving both the

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