High Rates of Depression and Depressive Symptoms Among Men Referred for Borderline Testosterone Levels

Abstract

Introduction Men referred for borderline testosterone levels represent an increasingly common clinical scenario, yet there is little literature on this population. Aim We hypothesized that men referred for borderline testosterone levels would have higher rates of depression and depressive symptoms than the general population. Methods Subjects included 200 adult men (mean age of 48 years old) referred for borderline total testosterone levels between 200 and 350 ng/dL (6.9–12 nmol/L). Collected data included demographic information, medical histories, medication use, signs and symptoms of hypogonadism, and assessments of depressive symptoms and/or a known diagnosis of depression or use of an antidepressant. Main Outcome Measures The main outcome measure was a combination of known depression, current use of an antidepressant, and/or depressive symptoms according to the Patient Health Questionnaire 9 (PHQ-9) with scores ≥10 considered positive. Results Depression and/or depressive symptoms were present in 56% of the subjects. This rate was significantly higher than rates of 6–23% (PHQ-9 scores ≥10) seen in general populations. Antidepressant use was 25%. The population was notable for high rates of overweight/obesity and physical inactivity. Common symptoms were erectile dysfunction, decreased libido, fewer AM erections, low energy, and sleep disturbances. Conclusions While sexual and nonspecific symptoms (i.e., fatigue) likely prompted measurements of testosterone in this selected population, clinicians should recognize the high rates of depression and depressive symptoms in men referred for borderline testosterone levels. Clinicians should consider screening for depression/depressive symptoms and overweight and unhealthy lifestyle risk factors in men referred for tertiary care for potential hypogonadism.

Testosterone therapy in men with testosterone deficiency: Are we beyond the point of no return?

“…The adverse impact of TD on mood and depressive symptoms has been reported in several studies [355565758596061]. Although the magnitude of improvements differed among the various studies, a link between TD, mood and depressive symptoms exists.…”

“…In another study in which men (n=886) participating in the Diabetes Prevention Program were treated with metformin, T levels were associated with improvements in mood [59]. In another study Westley et al [60] showed that depression and/or depressive symptoms were present in 56% of the subjects. In a meta-analysis of 16 randomized trials, Amanatkar et al [55] found that T therapy had a significant effect on mood in men with TD.…”

Neuroendocrinology of a Male-Specific Pattern for Depression Linked to Alcohol Use Disorder and Suicidal Behavior

“…Studies indicate that hypogonadal men are more likely to develop depression (15). Testosterone treatment has been shown to exhibit beneficial effects on mood in men (16, 17).…”

Geschlechtsspezifische Aspekte bei unipolarer Depression

“…Lebensjahr sinkt physiologischerweise der Testosteronspiegel, was in der Regel nicht zu gesundheitlichen Beeinträchtigungen führt. Neuere Studien haben ergeben, dass Männer mit grenzwertig erniedrigten Testosteronspiegeln ein erhöhtes Risiko zeigen, an einer Depression zu erkranken [41]. Bei depressiven Symptomen aufgrund eines Testosteronmangels sind diese o mit einem erhöhten Körpergewicht, einem ungesunden Lebensstil mit wenig Bewegung, erektiler Dysfunktion, verminderter Libido, schneller Ermüdbarkeit, einer erniedrigten Anzahl morgendlicher Erektionen und Schlafstörungen verbunden.…”

“…Bei depressiven Symptomen aufgrund eines Testosteronmangels sind diese o mit einem erhöhten Körpergewicht, einem ungesunden Lebensstil mit wenig Bewegung, erektiler Dysfunktion, verminderter Libido, schneller Ermüdbarkeit, einer erniedrigten Anzahl morgendlicher Erektionen und Schlafstörungen verbunden. Treten diese Symptome zusammen mit depressiven Symptomen auf, sollte der Testosteronspiegel überprü werden und gegebenenfalls eine Substitution erwogen werden [41].…”