Exogenous testosterone therapy has psychotropic effects and has been proposed as an antidepressant augmentation strategy for depressed men. We sought to assess the antidepressant effects of testosterone augmentation of a serotonergic antidepressant in depressed, hypogonadal men. For this study, we recruited 100 medically healthy adult men with major depressive disorder showing partial response or no response to an adequate serotonergic antidepressant trial during the current episode and a screening total testosterone level of 350 ng/dL or lower. We randomized these men to receive testosterone gel or placebo gel in addition to their existing antidepressant regimen. The primary outcome measure was the Hamilton Depression Rating Scale (HDRS) score. Secondary measures included the Montgomery-Asberg Depression Rating Scale, the Clinical Global Impression Scale, and the Quality of Life Scale. Our primary analysis, using a mixed effects linear regression model to compare rate of change of scores between groups on the outcome measures, failed to show a significant difference between groups (mean [95% confidence interval] 6-week change in HDRS for testosterone vs placebo, -0.4 [-2.6 to 1.8]). However, in one exploratory analysis of treatment responders, we found a possible trend in favor of testosterone on the HDRS. Our findings, combined with the conflicting data from earlier smaller studies, suggest that testosterone is not generally effective for depressed men. The possibility remains that testosterone might benefit a particular subgroup of depressed men, but if so, the characteristics of this subgroup would still need to be established.
Mid-life onset male dysthymic disorder (DD) seems to be a distinct clinical condition with limited therapeutic options. Testosterone replacement is mood-enhancing and has been proposed as an antidepressant therapy, though this strategy has received limited systematic study. We therefore conducted a six-week double-blind placebo-controlled clinical trial in 23 men with DD and with low or low-normal testosterone (T) level (i.e, screening total serum testosterone<350 ng/dL). Enrolled men were randomized to receive intramuscular injections of 200 mg of testosterone cypionate or placebo every 10 days. The primary outcome measures were the Clinical Global Impression (CGI) improvement score and the 21-item Hamilton Depression Rating Scale (HDRS) score.Twenty-three patients were randomized. The mean (SD) age of the enrolled patients was 50.6 (7.0) years and that of total testosterone level was 339 (93) ng/dL. The median duration of the current dysthymic episode was 3.6 (2.3) years, and the mean (SD) HDRS was 14.0 (2.9). After the intervention, the mean HDRS score decreased significantly more in the testosterone group (7.46 [4.56]) than in the placebo group (1.8 [4.13], t21 = -3.07, P = 0.006). Remission, defined as a CGI improvement score of 1 or 2 and a final HDRS score lower than 8, was achieved by 7 (53.8%) of 13 in the testosterone group and 1 (10%) of 10 in the placebo group (P = 0.03). Testosterone replacement may be an effective antidepressant strategy for late-onset male dysthymia.
strains of fungi, tentatively considered to be members of the genus Sporotrichum, have been isolated from soil and from other sources in nature. The striking morphological similarity of these isolates to strains of S. schenckii led to a comparative study of their biological properties. Nine strains of Sporotrichum from nature were compared with twelve strains of S. schenckii isolated from cases of clinical sporotrichosis. The nine saprophytic isolates were indistinguishable microscopically and macroscopically from strains of pathogenic S. schenckii when cultures were prepared on a variety of media incubated at 28 C. Only two of the nine saprophytic isolates were able to grow at 37 C. These two strains partially converted, at this temperature, to a yeast-cell phase of growth. The blastospores comprising this phase of growth were similar to those produced by S. schenckii under the same circumstances. Six of the nine saprophytes were essentially avirulent for mice. The remaining three strains had a very limited capacity to produce disease in experimental animals. The isolates are currently regarded as variants of S. schenckii. The saprophytic existence of Sporotrichum schenckii has been established by the circumstances surrounding recorded cases of sporotrichosis and by isolations of the fungus from
A new genus of the Gymnoascaceae, Auxarthron, is established to include certain species previously excluded from Gymnoascus and Myxolrichum. The genus is characterized by the presence of (1) enlargements at the septa in the peridial hyphae; (2) ascospores globose, subglobose to ovoid, asperulate to echinulate-reticulate, and hyaline to pale orange-yellow-brown; (3) the presence of either short spines or elongate appendages, or both; (4) lightly colored, elongate appendages which are non-septate except for one, two, or three basal septa with characteristic swellings at such septa; (5) orange-yellow-brown colored to brown ascocarps with a peridial network of more or less dichotomously anastomosed hyphae. Seven species are included in the genus as follows: Auxarthron californiense sp. nov. (the type species), A. reticulatum (Zukal) comb, nov., A. zuffianum (Morini) comb, nov., A. umbrinum (Boudier) comb, nov., A. brunneum (Rostrup) comb, nov., A. conjugatum (Kuehn) comb, nov., and A. conipactum sp. nov.
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