Several lines of previous evidence have suggested that androgens affect cognitive abilities. In an effort to characterize this defect, we compared 19 men with idiopathic hypogonadotropic hypogonadism with 19 control men and with five men with acquired hypergonadotropic hypogonadism that had developed after puberty. The 19 patients with idiopathic hypogonadism had markedly impaired spatial ability in comparison to either controls or subjects with acquired hypogonadism (P less than 0.05). Moreover, the spatial ability of the patients correlated positively with their testicular volume (P less than 0.05). Androgen-replacement therapy in six of the patients did not improve their spatial ability. The impairment in spatial ability in men with the idiopathic form of hypogonadotropic hypogonadism, the lack of such an impairment in men with the acquired form, and the failure to exogenous androgens to correct the deficits in the idiopathic form suggest that androgens exert a permanent organizing influence on the brain before or at puberty in boys.
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