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The extent to which testosterone and other androgens might affect cognitive skills in women is not yet well understood. In this chapter, Sherwin reviews changes in endogenous androgens over a woman's lifespan and research findings germane to androgens and cognitive skills in women. For younger women, there is evidence that cyclical changes during the menstrual cycle affect cognitive performance, although it is not possible to tease out effects of testosterone from those of estradiol. In older women, the relation between testosterone levels and cognitive test scores is inconsistent. The ratio of estradiol to testosterone may be important in modulating sex-advantaged cognitive functions in women, with a lower ratio leading to relatively impaired performance on cognitive tasks in which women typically excel.
One of the most consistent findings in the epidemiology of mental disorders is the higher prevalence of depressive illness in women than in men. This chapter reviews neurological effects of estrogen that have been elucidated since the 1980s so as to provide a scientific basis for possible biological mechanisms of action of this sex steroid on affective states. Estrogen induces RNA and protein synthesis via genomic mechanisms, which, in turn, cause changes in levels of specific gene products, such as neurotransmitter synthesizing enzymes. The chapter discusses the clinical studies of estrogenic effects on mood in non-clinical and in clinical populations with regard to the therapeutic use of estrogen in depressive disorders in women. Although there have been few systematic investigations of the use of estrogen in treatment-resistant depression, several controlled studies and case reports serve to provide some evidence of its effects.
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