Role of sex steroid hormone on hand grip strength and cognitive function in the elderly

Main Article Content

Edy Parwanto
David Tjahyadi
Husnun Amalia
Nany Hairunisa
Hosea Jaya Edy
Ashaolu Victoria Oladimeji
Noureddine Djebli


The aging process is associated with changes in hormone levels. There is a noticeable change in estrogen levels in women, while in men, there is a change in testosterone levels. In the elderly, as a result of the aging process, changes in these hormone levels affect handgrip strength, and cognitive function. In both women and men, the function of several organs is influenced by sex steroid hormones, namely Oestrogen and androgens. There are two theories of steroid action mechanism on target cells, namely steroid hormone action mechanism genomically and non-genomically. The function and action mechanism of steroid hormone is important because it is the basis of the hormonal aspect for muscle mass, handgrip strength, and cognitive function. Due to the aging process, hormonal changes in the elderly are different compared to the previous period. This has consequences for changes in metabolic processes that affect the body’s condition, including changes in the composition of bones, muscles, and other tissues, such as the brain. In the aging process, it is important to pay attention to nutritional factors because they contribute to hormone levels that help maintain muscle mass, body mass index, hand grip strength, and cognitive function. In the brain, the sex steroid hormone has activating and organizational effects mediated by intracellular or transmembrane G-protein-coupled receptors. Articles published in English in the last 9 years (from 2014 to 2023) were retrieved from Science Direct, PubMed, Springer link, Oxford and Nature using relevant searching terms. The fact that testosterone bioavailability is predominated in the brain in relation to its activity and significant positive association with processing speed, sustained attention, and working memory in older men. To obtain a better quality of life for the elderly, nutritional factors must be considered to maintain optimal sex steroid hormone levels, hand grip strength, and cognitive function.

Article Details

How to Cite
Parwanto, E., Tjahyadi, D. ., Amalia, H. ., Hairunisa, N. ., Edy, H. J. ., Oladimeji, A. V. ., & Djebli, N. . (2023). Role of sex steroid hormone on hand grip strength and cognitive function in the elderly. Universa Medicina, 42(3), 329–345.
Review Article


Gharahdaghi N, Phillips BE, Szewczyk NJ, et al. Links between testosterone, oestrogen, and the growth hormone/insulin-like growth factor axis and resistance exercise muscle adaptations. Front Physiol 2021;11: 621226. doi: 10.3389/fphys.2020.621226.

Sharma G, Prossnitz ER. Assessment of metabolic regulation by estrogen receptors. Methods Mol Biol 2022;2418:383-404. doi: 10.1007/978-1-0716-1920-9_21.

Hammes SR, Levin ER. Impact of estrogens in males and androgens in females. J Clin Invest 2019;129:1818-1826.

Delgado BJ, Lopez-Ojeda W. Estrogen. Treasure Island (FL) : StatPearls Publishing;2022.

Hamilton KJ, Hewitt SC, Arao Y, et al. Estrogen hormone biology. Curr Top Dev Biol 2017;125:109-46. doi: 10.1016/bs.ctdb.2016.12.005.

Cappelletti M, Wallen K. Increasing women’s sexual desire: the comparative effectiveness of estrogens and androgens. Horm Behav 2016;78:178-93. doi: 10.1016/j.yhbeh.2015.11.003.

Smith T, Batur P. Prescribing testosterone and DHEA: The role of androgens in women. Cleve Clin J Med 2021;88:35-43. doi: 10.3949/ccjm.88a.20030.

Yesiladali M, Yazici MGK, Attar E, et al. Differentiating polycystic ovary syndrome from adrenal disorders. Diagnostics (Basel) 2022;12:2045. doi: 10.3390/diagnostics12092045.

Leinonen JT, Mars N, Lehtonen LE, et al. Genetic analyses implicate complex links between adult testosterone levels and health and disease. Comm Med 2023;3:4. doi: 10.1038/s43856-022-00226-0

Gu X, DeFalco T. In vitro differentiation of Leydig cells from hiPSCs: a first step towards a cellular therapy for hypogonadism?. Endocrinol 2022;163:1-3.

Guyansyah A, Parwanto MLE. Protein pengikat hormon seks: sex hormone binding globulin (SHBG) dan aksi steroid seks. J Biomed Kes 2019;2:45-50. DOI:

Keevil BG, Adaway J. Assessment of free testosterone concentration. J Steroid Biochem Mol Biol 2019;190: 207-11.

Worsley R, Santoro N, Miller KK, et al. Hormones and female sexual dysfunction: beyond estrogens and androgens—findings from the Fourth International Consultation on Sexual Medicine. J Sex Med 2016;13:283-90. doi: 10.1016/j.jsxm.2015.12.014.

Venkatesh VS, Grossmann M, Zajac JD, et al. The role of the androgen receptor in the pathogenesis of obesity and its utility as a target for obesity treatments. Obesity Rev 2022;23:e13429:1-21. doi: 10.1111/obr.13429.

Thiebaut C, Vlaeminck-Guillem V, Tr´edan O, et al. Non-genomic signaling of steroid receptors in cancer. Mol Cell Endocrinol 2021;538:111453. doi: 10.1016/j.mce.2021.111453

Wilkenfeld SR, Lin C, Frigo DE. Communication between genomic and non-genomic signaling events coordinate steroid hormone actions. Steroids 2018;133:2-7. doi: 10.1016/j.steroids.2017.11.005.

Lucas-Herald AK, Alves-Lopes R, Montezano AC, et al. Genomic and non-genomic effects of androgens in the cardiovascular system: clinical implications. Clin Science 2017;131:1405-18. DOI: 10.1042/CS20170090.

Pataky MW, Young WF, Nair KS. Hormonal and Metabolic Changes of aging and the influence of lifestyle modifications. Mayo Clin Proc 2021;96:788-814. doi: 10.1016/j.mayocp.2020.07.033.

van den Beld AW, Kaufman JM, Zillikens MC, et al. The physiology of endocrine systems with ageing. Lancet Diabetes Endocrinol 2018;6:647-58. doi: 10.1016/S2213-8587(18)30026-3.

Chidi-Ogbolu N, Baar K. Effect of estrogen on musculoskeletal performance and injury risk. Front Physiol 2019; 9:1834. doi: 10.3389/fphys.2018.01834.

Murman DL. The impact of age on cognition. Semin Hear 2015;36:111-21. doi: 10.1055/s-0035-1555115.

Hansen, M. Female hormones: do they influence muscle and tendon protein metabolism? Proc Nutr Soc 2018;77:32-41. doi:10.1017/S0029665117001951.

Critchlow AJ, Hiam D, Williams R, et al. The role of oestrogen in female skeletal muscle ageing: a systematic review. medRxiv preprint 2023. doi:

Counts BR, Fix DK, Hetzler KL, et al. The effect of Estradiol Administration on Muscle Mass Loss and Cachexia Progression in Female ApcMin/+ Mice. Front Endocrinol 2019;10:1-16.

Hansen M, Kjaer M. Influence of sex and estrogen on musculotendinous protein turnover at rest and after exercise. Exerc Sport Sci Rev 2014;42:183-92. doi: 10.1249/JES.0000000000000026.

Smith GI, Yoshino J, Reeds DN, et al. Testosterone and progesterone, but not estradiol, stimulate muscle protein synthesis in postmenopausal women. J Clin Endocrinol Metab 2014;99:256-65.

De Paoli M, Zakharia A, Werstuck GH. The role of estrogen in insulin resistance a review of clinical and preclinical data. American J Pathol 2021;191:1490-8.

Leblanc DR, Schneider M, Angele P, et al. The effect of estrogen on tendon and ligament metabolism and function. J Steroid Biochem Mol Biol 2017;172:106-16.

Khapre S, Deshmukh U, Jain S. The impact of soy isoflavone supplementation on the menopausal symptoms in perimenopausal and postmenopausal women. J Mid-life Health 2022;13:175-84. DOI: 10.4103/jmh.jmh_190_21.

Vechin FC, Vingren JL, Telles GD, et al. Acute changes in serum and skeletal muscle steroids in resistance-trained men. Front Endocrinol (Lausanne) 2023;14:1081056. doi: 10.3389/fendo.2023.1081056.

Juppi HK, Sipilä S, Cronin NJ, et al. Role of menopausal transition and physical activity in loss of lean and muscle mass: a follow-up study in middle-aged Finnish women. J Clin Med 2020;9:1588.

Kitajima Y, Ono Y. Estrogens maintain skeletal muscle and satellite cell functions. J Endocrinol 2016;229:267-75. doi: 10.1530/JOE-15-0476.

Wen Z, Gu J, Chen R., et al. Handgrip strength and muscle quality: results from the National Health and Nutrition Examination Survey Database. J Clin Med 2023;12:3184.

Datau EA, Kenly K, Jim E, et al. Relationship between testosterone levels with hand grip strength, calf diameter, lung function, body mass index and blood pressure in elderly men. Int J Socl Serv Resh 2023;3:1279-84. DOI:

Pillerová M, Borbélyová V, Pastorek M, et al. Molecular actions of sex hormones in the brain and their potential treatment use in anxiety disorders. Front. Psychiatry 2022; 13 :972158. doi: 10.3389/fpsyt.2022.972158.

Cai Z, Li H. An updated review: androgens and cognitive impairment in older men. Front Endocrinol 2020; 11:586909. doi: 10.3389/fendo.2020.586909.

Giannos P, Prokopidis K, Church DD, et al. Associations of bioavailable serum testosterone with cognitive function in older men: results from the National Health and Nutrition Examination Survey. J Gerontol A Biol Sci Med Sci 2023;78:151-7. doi: 10.1093/gerona/glac162.

Buskbjerg CR, Gravholt CH, Dalby HR, et al. Testosterone supplementation and cognitive functioning in men—a systematic review and meta-analysis. J Endocrin Soc 2019;3:1465-84.

Sultana F, Davis SR, Murray AM, et al. Sex hormones, SHBG and cognitive performance among older Australian women: an observational study. Climacteric 2023;26:121–8.

Wrigglesworth J, Harding IH, Islam RM, et al. The association between sex hormones and the change in brain-predicted age difference in older women. Clin Endocrinol 2023;98:692- 9. doi:10.1111/cen.14898.

Xu W, Su BJ, Shen XN, et al. Plasma sex hormone-binding globulin predicts neurodegeneration and clinical progression in prodromal Alzheimer’s disease. Aging 2020;12:14528-41.

Wang L, Wang J, Shan Q, et al. Involvement of baroreflex deficiency in the age-related loss of estrogen efficacy against cerebral ischemia. Front Aging Neurosci 2023;15:1167170. doi: 10.3389/fnagi.2023.1167170.

Lazar RM, Howard VJ, Kernan WN, et al. A primary care agenda for brain health: a scientific statement from the American Heart Association. Stroke 2021;52:e295-e308.

Duong S, Patel T, Chang F. Dementia: what pharmacists need to know. Can Pharm J (Ott) 2017;150:118-29. doi: 10.1177/1715163517690745.

World Health Organization. Dementia. Geneva : World Health Organization;2022.

Lang L, Clifford A, Wei L, et al. Prevalence and determinants of undetected dementia in the community: a systematic literature review and a meta-analysis. BMJ Open 2017;7e011146. DOI: 10.1136/bmjopen-2016-011146.

Luthfiana A, Harliansyah H. Pemeriksaan indeks memori, MMSE (Mini Mental State Examination) dan MoCA-Ina (Montreal Cognitive Assestment Versi Indonesia) pada karyawan Universitas Yarsi. J Ked YARSI 2019;27:62-8. DOI:

DeTure MA, Dickson DW. The neuropathological diagnosis of Alzheimer’s disease. Mol Neurodeg 2019;14:1-18.

Soria Lopez JA, González HM, Léger GC. Alzheimer’s disease. Handb Clin Neurol 2019;67:231-55. doi: 10.1016/B978-0-12-804766-8.00013-3.

Song R, Fan X, Seo J. Physical and cognitive function to explain the quality of life among older adults with cognitive impairment: exploring cognitive function as a mediator. BMC Psychol 2023;11:51. doi: 10.1186/s40359-023-01087-5. Erratum in: BMC Psychol 2023 ;11:63.

Johansson MM, Marcusson J, Wressle E. Cognitive impairment and its consequences in everyday life: experiences of people with mild cognitive impairment or mild dementia and their relatives. Int Psychogeriatr 2015;27:949-58. doi: 10.1017/S1041610215000058.

Ehsani H, Mohler MJ, O’Connor K, et al. The association between cognition and dual-tasking among older adults: the effect of motor function type and cognition task difficulty. Clin Intervent Aging 2019;14:659–669. DOI

Filardi M, Barone R, Bramato G, et al. The relationship between muscle strength and cognitive performance across Alzheimer’s disease clinical continuum. Front Neurol 2022;13:833087. doi: 10.3389/fneur.2022.833087.

Saputra DG, Dewi NR, Ayubana S. Penerapan terapi menggenggam bola karet terhadap perubahan kekuatan otot pada pasien stroke dengan hemiparase di kota Metro. J Cendikia Muda 2022,2:308-12.

Bodilsen AC, Juul-Larsen HG, Petersen J, et al. Feasibility, and inter-rater reliability of physical performance measures in acutely admitted older medical patients. PLoS One 2015;10:e0118248. doi: 10.1371/journal.pone.0118248.

Alyssa NI, Parwanto E. Handgrip strength as an indicator of decreased cognitive function in the elderly. Int J Res Med Sci 2022; 10: 2978–83.

Kim KH, Park SK, Lee DR, et al. The relationship between handgrip strength and cognitive function in elderly Koreans over 8 Years: a prospective population-based study using Korean Longitudinal Study of Ageing. Korean J Fam Med 2019;40:9-15. doi: 10.4082/kjfm.17.0074.

Lee S, Oh JW, Son NH, et al. Association between handgrip strength and cognitive function in older adults: Korean Longitudinal Study of Aging (2006-2018). Int J Environ Res Public Health 2022;9:1048. doi: 10.3390/ijerph19031048.

Chang M, Geirsdottir OG, Eymundsdottir H, et al. Association between baseline handgrip strength and cognitive function assessed before and after a 12-week resistance exercise intervention among community-living older adults. J Aging Health 2022;2:100092.

Fritz NE, McCarthy CJ, Adamo DE. Handgrip strength as a means of monitoring progression of cognitive decline – a scoping review. Ageing Res Rev 2017;35:112-13.

Wreksoatmodjo BR. Pengaruh aktivitas fisik terhadap fungsi kognitif lanjut usia di Jakarta Barat. CDK 2016; 43:7-12. doi: 10.55175/cdk.v43i1.40.

McGrath R, Robinson-Lane SG, Cook S, et al. Handgrip strength is associated with poorer cognitive functioning in aging americans. J Alzheimer’s Dis 2019;70:1187-96. DOI: 10.3233/jad-190042.

Jang JY, Kim J. Association between handgrip strength and cognitive impairment in elderly Koreans: a population-based cross-sectional study. J Phys Ther Sci 2015;27:3911-5. DOI: 10.1589/jpts.27.3911.

Vancampfort D, Stubbs B, Firth J, et al. Associations between handgrip strength and mild cognitive impairment in middle-aged and older adults in six low- and middle-income countries. Int J Geriatr Psychiatry 2019;34:609-16. doi: 10.1002/gps.5061.

Kim H, Kim SH, Jeong W, et al. Association between change in handgrip strength and cognitive function in Korean adults: a longitudinal panel study. BMC Geriatr 2021;21:671. doi: 10.1186/s12877-021-02610-2.

Su H, Sun X, Li F, Guo Q. Association between handgrip strength and cognition in a Chinese population with Alzheimer’s disease and mild cognitive impairment. BMC Geriatr 2021;21:459. doi: 10.1186/s12877-021-02383-8.

Miyamura K, Fhon JRS, Bueno AA, et al. Frailty syndrome and cognitive impairment in older adults: systematic review of the literature. Rev Lat Am Enfermagem 2019;27:e3202. doi: 10.1590/1518-8345.3189.3202.

Amaral CA, Amaral TLM, Monteiro GTR, et al. Hand grip strength: reference values for adults and elderly people of Rio Branco, Acre, Brazil. PLoS One 2019;14:e0211452. doi: 10.1371/journal.pone.0211452.

Choi JY, Lee S, Min JY, et al. Asymmetrical handgrip strength is associated with lower cognitive performance in the elderly. J Clin Med 2022;11:2904.

Turusheva A, Frolova E, Degryse JM. Age-related normative values for handgrip strength and grip strength’s usefulness as a predictor of mortality and both cognitive and physical decline in older adults in northwest Russia. J Musculoskelet Neuronal Interact 2017;17:417-32.

Oliveira AS, Reiche MS, Vinescu CI, et al. The cognitive complexity of concurrent cognitive-motor tasks reveals age-related deficits in motor performance. Sci Rep 2018;8:6094. doi: 10.1038/s41598-018-24346-7.

Illán-Gala I, Falgàs N, Friedberg A, et al. Diagnostic utility of measuring cerebral atrophy in the behavioral variant of frontotemporal dementia and association with clinical deterioration. JAMA Network Open 2021; 4: e211290. doi:10.1001/jamanetworkopen.2021.1290.

Moore KM, Nicholas J, Grossman M, et al. Age at symptom onset and death and disease duration in genetic frontotemporal dementia: an international retrospective cohort study. Lancet Neurol 2020;19:145-56. doi: 10.1016/S1474-4422(19)30394-1.

Loi SM, Tsoukra P, Chen Z, et al. Risk factors to mortality and causes of death in frontotemporal dementia: An Australian perspective. Int J Geriatr Psych 2022; 37:1-10.

Ryan J, Scali J, Carrière I, et al. Impact of a premature menopause on cognitive function in later life. BJOG 2014; 121:1729-39. doi: 10.1111/1471-0528.12828.

Ryu KJ, Kim HK, Lee YJ, et al. Association between vasomotor symptoms and sarcopenia assessed by L3 skeletal muscle index among Korean menopausal women. Menopause 2021;29:48-53. doi: 10.1097/GME.0000000000001879.

Navarro-Pardo E, Holland CA, Cano A. Sex hormones and healthy psychological aging in women. Front Aging Neurosci 2018;9:1-10. doi: 10.3389/fnagi.2017.00439.

Gao L, Gao D, Zhang J, et al. Age-related endoplasmic reticulum stress represses testosterone synthesis via attenuation of the circadian clock in Leydig cells. Theriogenol 2022;189:137-149. doi: 10.1016/j.theriogenology.2022.06.010.

Parwanto MLE. The negative correlation between testosterone levels and age in healthy Indonesian men residing in the special capital province of Jakarta, Indonesia. Int J Resc Med Sci 2017;5:3431-7. DOI:

Basque A, Nguyen HT, Touaibia M, et al. Gigantol improves cholesterol metabolism and progesterone biosynthesis in MA-10 Leydig cells. Curr Issues Mol Biol 2021; 44:73-93. doi: 10.3390/cimb44010006.

Davidyan A, Pathak S, Baar K, et al. Maintenance of muscle mass in adult male mice is independent of testosterone. PLoS ONE 2021;16:e0240278. doi: 10.1371/journal.pone.0240278.

Ye J, Zhai X, Yang J, et al. Association between serum testosterone levels and body composition among Men 20-59 Years of Age. Int J Endocrinol 2021;2021:7523996. doi: 10.1155/2021/7523996.

Xu Y, Wen Z, Deng K, et al. Relationships of sex hormones with muscle mass and muscle strength in male adolescents at different stages of puberty. PLoS ONE 2021;16:e0260521. doi: 10.1371/journal.pone.0260521.

Larsson L, Degens H, Li M, et al. Sarcopenia: aging-related loss of muscle mass and function. Physiol Rev 2019; 99:427-511. doi: 10.1152/physrev.00061.2017.

Cobo G, Gallar P, Di Gioia C, et al. Hypogonadism associated with muscle atrophy, physical inactivity and ESA hyporesponsiveness in men undergoing haemodialysis. Nefrologia 2017;37:54-60. doi: 10.1016/j.nefro.2016.04.009.

Ferlin A, De Toni L, Agoulnik AI, et al. Protective role of testicular hormone INSL3 from atrophy and weakness in skeletal muscle. Front Endocrinol (Lausanne) 2018;9:1-15. doi: 10.3389/fendo.2018.00562.

Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2018; 103:1715-44. doi: 10.1210/jc.2018-00229.

Rossetti ML, Steiner JL, Gordon BS. Androgen-mediated regulation of skeletal muscle protein balance. Mol Cell Endocrinol 2017;447:35-44. Doi: 10.1016/j.mce.2017.02.031.

Pasiakos SM, Berryman CE, Karl JP, et al. Effects of testosterone supplementation on body composition and lower-body muscle function during severe exercise- and diet-induced energy deficit: A proof-of-concept, single centre, randomised, double-blind, controlled trial. Ebio Medicine 2019;46:411-22. doi: 10.1016/j.ebiom.2019.07.059.

Urbano F, Chiarito M, Lattanzio C, et al. Sex hormone-binding globulin (SHBG) reduction: the alarm bell for the risk of non-alcoholic fatty liver disease in adolescents with polycystic ovary syndrome. Children (Basel) 2022; 9:1748. 10.3390/children9111748.

del Campo M, Pijnenburg YAL, Chen-Plotkin A, et al. Sex hormone-binding globulin (SHBG) in cerebrospinal fluid does not discriminate between the main FTLD pathological subtypes but correlates with cognitive decline in FTLD tauopathies. Biomolecules 2021;11:1484.

Parwanto MLE, Suweino S, Tjahjadi D, et al. The effect of sex hormone binding globulin (SHBG) protein polymorphism on the levels of SHBG, testosterone, and insulin in healthy Indonesian men. Int J Med Sci Public Health 2016;5:799-806. DOI: 10.5455/ijmsph.2016.1712201529333.

Parwanto MLE, Senjaya H. Dietary intake of mother in childbearing age with BMI <18.5 kg/m2 and has heterozygous variant D327N SHBG genotype (w/v). Int J Comm Med Public Health 2017;4:409-17. DOI: