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2. Women with Higher Levels of DHEAS Have Better Cognitive Function

3. Female-to-Male Transsexuals Have Higher Androgen Levels, Not PCOS

4. Piecing the Puzzle Together: Commentary on ACCORD Trail

5. Premature Ovarian Failure: New Hormone Foundation Bilingual Patient Fact Sheet

1. Intranasal Insulin May Lower Food Intake in Men, Improve Memory Function in Women

Insulin administered intranasally, acutely decreases food intake in men but not women and in contrast, the compound improves memory function in women but not men according to a new study accepted for publication in the Journal of Clinical Endocrinology & Metabolism (JCEM).

“Our findings indicate that gender is a critical factor in brain insulin signaling that affects both food intake and cognitive functions,” said Dr. Christian Benedict of the University of Lubeck in Germany. “They further suggest that intranasal insulin may be helpful in the treatment of cognitive and metabolic disorders like Alzheimer’s disease and obesity that are assumed to derive at least in part from malfunctions of central nervous insulin signaling.”

Previous studies have shown that insulin plays a pivotal role in the regulation of central nervous functions such as energy metabolism and memory processing. This study set out to assess the effects of a single dose of intranasal insulin on these functions and to determine any gender differences.

For this study, 14 men and 18 women were administered regular human insulin intranasally before performing a battery of cognitive tests. Subsequently, study subjects took part in a breakfast buffet and their food intake was measured.

The nasal spray device used in this study atomizes the insulin solution before inhalation so that it penetrates the nasal cavities more effectively.

The pancreatic hormone insulin plays a pivotal role in the regulation of central nervous functions such as the neuroendocrine control of energy metabolism and memory processing. Insulin reaches the brain via a saturable transport system, and binds to receptors primarily located in cerebral cortex, olfactory bulb, hippocampus, cerebellum, and hypothalamus.

“Our findings show that men are more sensitive to the central anorexigenic actions of insulin whereas women benefit to a greater extent from its acute cognitive effects,” said Benedict. “Gender differences will have to be considered in the possible future development of intranasal insulin therapeutics.”

Other researchers working on the study include Werner Kern, Jan Born, and Manfred Hallschmid of the University of Lubeck in Germany; and Bernd Schultes of the Interdisciplinary Obesity Center East-Switzerland, Kantonsspital St. Gallen in Switzerland.

A rapid release version of this paper has been published on-line and will appear in the April 2008 issue of JCEM, a publication of The Endocrine Society.

2. Women with Higher Levels of DHEAS Have Better Cognitive Function

Women with naturally higher levels of the hormone precursor DHEAS were found to have better cognitive function than women with lower levels, according to a new study appearing in the March issue of the Journal of Clinical Endocrinology & Metabolism (JCEM). The study revealed that cognitively intact women with higher circulating levels of DHEA (dehydroepiandrosterone)—in the form of DHEA sulfate (DHEAS)—performed better on tests of executive function, concentration, and working memory.

“This study provides the first evidence that DHEAS is favorably associated with cognitive function,” said Dr. Susan Davis of the Monash University in Victoria, Australia, and lead author of the study. “My colleagues and I found that circulating DHEAS was significantly positively associated with a higher score for a test of executive function, and in the areas of simple concentration and working memory higher DHEAS levels were positively associated with higher scores for women with at least 12 years of education.”

DHEA is a steroid precursor, which means that it is converted in the body to steroid hormones such as testosterone and estrogen. It is the most abundant circulating sex steroid in women.

Previous studies suggest that DHEA and DHEAS may have neuroprotective effects. These studies also suggest that the decline in the production of these steroids with healthy aging may contribute to neuronal dysfunction and degeneration, and thus cognitive decline.

Maintenance of cognitive function in elderly women is influenced by a number of health variables, including diabetes, hypertension, and smoking. Other studies have reported association between these factors and progression to dementia in elderly individuals. “In our study we were specifically interested in the associations between cognitive function and DHEAS, social circumstances, and leisure activities,” said Dr. Davis.

For this study, “Endogenous Androgen Levels in Women across the Adult Life Span,” 295 women, ages 21 to 77 (mean age 55), were recruited from an Australian community-based dataset. Each participant underwent a battery of tests known to measure a wide range of cognitive abilities, including verbal, visual, spatial and working memory, attention and concentration, speed, and accuracy. Women were excluded if they reported any health condition that might potentially adversely affect cognitive function.

In addition to the DHEA and DHEAS findings, the study also found that activities such as living with other people, doing crosswords, and playing a musical instrument were positively associated with cognitive performance. Circulating DHEAS levels were not associated in this study with performance on tests of verbal and non-verbal learning and retention or focused attention.

The researchers speculate that there may be a number of explanations for their findings, including direct action of DHEA and DHEAS, DHEAS being a marker of androgen and estrogen production in women, or simply DHEA and DHEAS levels being markers of general good health.

Although DHEA and DHEAS levels decline in both men and women with age, testosterone levels are generally well maintained in men. In contrast, testosterone levels in women are only a fraction of those found naturally in men. This may mean that even small differences in adrenal pre-androgen production may make a substantial difference to a woman’s overall androgen profile.

It should be noted that DHEA, which is commonly sold as a dietary supplement in the United States, is not available over the counter in Australia. The researchers stress that they found no evidence that taking a DHEA supplement would be at all beneficial.

Other researchers involved in this study include Sonal M. Shah, Dean P. McKenzie, Jayashri Kulkarni, Sonia L. Davison, and Robin J. Bell, all of the Monash University.

JCEM is a publication of The Endocrine Society.

3. Female-to-Male Transsexuals Have Higher Androgen Levels, Not PCOS

Contrary to previous studies, female-to-male transsexuals do not have a higher prevalence of polycystic ovary syndrome (PCOS), though they do have significantly higher androgen levels, according to a new study accepted for publication in the Journal of Clinical Endocrinology & Metabolism (JCEM).

PCOS is an endocrine disorder with a host of symptoms related to small painful cysts on the ovaries. It is marked by the overproduction of male hormones in females. Until now, it has been postulated that the prevalence of PCOS in female-to-male transsexuals is higher than normal.

“Several studies have reported a higher prevalence of PCOS in female-to-male transsexuals but the numbers of patients were small and ultrasound was not used for diagnosis,” said Dr. Andreas Mueller of Erlangen University Hospital in Erlangen, Germany. “This is the first prospective endocrine evaluation of female-to-male transsexuals using up-to-date state-of-the-art criteria incorporating transvaginal ultrasonography for diagnosing PCOS or hyperandrogenemia.”

Researchers used clinical, biochemical, and ultrasound criteria to diagnose PCOS in a group of 61 female-to-male transsexuals, using the complete diagnostic procedures described in the National Institutes of Health 1990 and Rotterdam 2003 criteria. These results were compared prospectively with those of 94 healthy unselected controls.

According to the researchers, the higher androgen levels are likely to be of ovarian origin, though it may be due to undetected self-medication with androgens before inclusion in the study. Female-to-male transsexuals were examined prospectively before receiving any androgen therapy. Only patients who confirmed that they had not taken any hormone preparation were included in the analysis.

Other researchers working on the study include Louis J. Gooren of Free University Medical Center in Amsterdam, the Netherlands; and Susanne Naton-Schotz, Susanne Cupisti, Matthias Beckmann, and Ralf Dittrich of Erlangen University Hospital in Erlangen, Germany.

A rapid release version of this paper has been published on-line and will appear in the April 2008 issue of JCEM, a publication of The Endocrine Society.

4. Piecing the Puzzle Together: Commentary on ACCORD Trail

A recent review of available data from the ACCORD (Action to Control Cardiovascular Risk in Diabetes) Trial—which is sponsored by the National Heart, Lung, and Blood Institute of the National Institutes of Health—has led investigators to halt a portion of the study due to safety concerns. The study found that patients in the treatment group with the goal of reducing their blood glucose (known as A1c) to less than 6 percent had a slightly higher risk of dying than those in the standard treatment group.

A new commentary accepted for publication in the Journal of Clinical Endocrinology & Metabolism (JCEM) discusses why it is premature to reach any definitive conclusion on this ACCORD study until the actual data are published.

“It will likely be quite some time before all of our questions are answered,” said Irl B. Hirsch, M.D., of the University of Washington School of Medicine, Seattle, and author of the commentary.

“Nevertheless, the relationship between progression of macrovascular disease and glycemic control is a much more complicated puzzle than originally appreciated.”

In his commentary, Dr. Hirsch also states that it seems clear that we may very well have different glycemic targets for different populations of patients, as opposed to our current strategy of attempting to achieve a specific A1C target for the majority of our patients.

The commentary “Piecing the Puzzle Together: ACCORDing to Whom?” will appear in the April issue of JCEM, a publication of The Endocrine Society.

5. Premature Ovarian Failure: New Hormone Foundation Bilingual Patient Fact Sheet

The Hormone Foundation has published a bilingual (English/Spanish) fact sheet on Premature Ovarian Failure. This publication describes the possible symptoms, as well as the risks associated with the condition. It also provides detailed information about how the condition is diagnosed and treated. To download free copies and other useful health resources for patients, visit the Foundation's Web site (www.hormone.org).

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Founded in 1916, The Endocrine Society is the world's oldest, largest, and most active organization devoted to research on hormones and the clinical practice of endocrinology. Today, The Endocrine Society's membership consists of over 14,000 scientists, physicians, educators, nurses and students in more than 80 countries. Together, these members represent all basic, applied, and clinical interests in endocrinology. The Endocrine Society is based in Chevy Chase, Md. To learn more about the Society, and the field of endocrinology, visit our web site at www.endo-society.org.