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To the Editor: The study by Ms Rosario and colleagues¹ reports a relationship between low postmortem brain testosterone levels and preceding dementia in men. To be able to interpret these data it would have been valuable to know the potential impact on their results of body mass index, the intensity of care over the interval immediately preceding death, and recent opioid use.

Obesity is associated with diminished serum testosterone and elevated serum estradiol.² Expectant care, with no therapeutic interventions for several days immediately preceding death, may have modified tissue hormone levels in comparison with the levels of patients dying while undergoing active therapy. Opioid-induced androgen deficiency usually develops within a few hours of administration of relatively small doses of opioid medications, with plasma testosterone levels occasionally reaching near-castrate range within 24 hours.^3-5 These low levels are maintained during continued opioid administration. Although tissue concentrations of sex hormones have not been . . . [Full Text of this Article]

Harry W. Daniell, MD
hwdaniell@aol.com
University of California Medical School at Davis
Redding

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