Increased Incidence of Diagnosed Depressive Illness in HypogonadalOlder Men

Shores, Molly M.; Sloan, Kevin L.; Matsumoto, Alvin M.; Moceri, Victoria M.; Felker, Bradford; Kivlahan, Daniel R.

doi:10.1001/archpsyc.61.2.162

Cited by 211 publications

(121 citation statements)

References 38 publications

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“…The trend toward higher opioid dosage for hypogonadal patients is consistent with previous reports, 45 including our own, 44,49 of hypogonadism among cancer survivors without evidence of recurrent disease who use opioid therapy for chronic pain. Our patients with autonomic dysfunction did not seem to have a greater frequency of fatigue or, indeed, of any major symptoms except for dyspnea.…”

Section: Discussionsupporting

confidence: 91%

“…28,29 The finding of a strong association between hypogonadism and negative mood, as documented by the HADS-A, HADS-D, and FACT Emotional Well-Being subscale, is consistent with the reported impact of hypogonadism on mood in elderly men, 45 in individuals with HIV wasting, 41 or in patients with ischemic heart disease. 46 Patients undergoing therapeutic elimination of testosterone, mainly for prostate carcinoma, often experience negative mood changes, including depression and anxiety.…”

Section: Discussionsupporting

confidence: 79%

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The impact of hypogonadism and autonomic dysfunction on fatigue, emotional function, and sexual desire in male patients with advanced cancer

Strasser

Palmer

Schover

et al. 2006

Cancer

106

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BACKGROUND.The objective of this study was to determine whether hypogonadism and autonomic dysfunction contribute substantially to cancer‐related fatigue, decreased sexual desire, and depression in male patients with advanced, incurable cancer.METHODS.Forty‐eight patients who had received no major antineoplastic intervention for at least 2 weeks were tested for autonomic dysfunction by using Ewing tests. Total and free testosterone levels were measured. Multivariate analyses were performed to test the relation of these factors with the Functional Assessment of Cancer Therapy (FACT) (the Functional Assessment of Anorexia/Cachexia Therapy [FAACT] scale and the Functional Assessment of Chronic Illness Therapy‐Fatigue [FACIT‐F] subscale), the Hospital Anxiety and Depression Scale (HADS), the Edmonton Symptom Assessment Scale, the Sexual Desire Inventory, and sexual function (Cancer Rehabilitation Evaluation System subscale). Common causes for fatigue (anemia, depression, malnutrition, symptom distress, and medications) also were considered.RESULTS.Thirty‐eight of 47 patients (81%) had autonomic dysfunction, although it was not associated significantly with the other variables examined. Twenty‐nine of 45 patients (64%) had a low level of free testosterone (hypogonadism), which was correlated with the HADS Anxiety score (P = .002), the FACT Emotional Well‐Being score (P = .02), and the HADS Depression score (P = .04). Hypogonadal men also had lower scores on the FACT Functional Well‐Being scale (P = .01) and the FACIT‐F subscale (P = .05). Men who reported symptoms related to weight loss (FAACT scale) had significantly lower levels of free testosterone (r = 0.34; P = .02) but did not differ from the other group in actual weight loss (P = .22). The total testosterone level was not appropriate for screening of hypogonadism unless the patients had values <100 ng/ mL. Logistic regression analysis failed to reveal a distinct multivariate model of autonomic dysfunction or hypogonadism that predicted clinical outcomes.CONCLUSIONS.Hypogonadism is a frequent condition in patients with advanced, incurable cancer and is associated with negative mood, fatigue, and symptoms related to anorexia/cachexia. Cancer 2006. © 2006 American Cancer Society.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 79%

The impact of hypogonadism and autonomic dysfunction on fatigue, emotional function, and sexual desire in male patients with advanced cancer

Strasser

Palmer

Schover

et al. 2006

Cancer

106

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“…One study has found that men with hypogonadal testosterone values are at higher risk of developing depression, 10 while others have not. 5,11 In this paper, we examine the correlation between depression symptoms and hypogonadsim in men attending an ED clinic.…”

Section: Introductionmentioning

confidence: 99%

Hypogonadism is associated with overt depression symptoms in men with erectile dysfunction

et al. 2007

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Depression and hypogonadism are associated with erectile dysfunction (ED). We evaluated the prevalence of both conditions in men presenting to an ED specialty clinic, and tested whether hypogonadism correlated with the presence of depressive symptoms using a validated questionnaire. From July 2001 to June 2003, 157 men referred to an ED specialty clinic prospectively filled the Center for Epidemiologic Studies Depression Scale (CES-D), the abbreviated International Index of Erectile Function (IIEF-5) and had testosterone serum levels drawn. Median age was 53 (range ¼ 21-85 years). Hypogonadism, defined as serum T (testosterone)o300 mg/dl, was present in 36% of patients. This proportion was higher in men over the median age compared to younger patients (45 and 26%, respectively, P ¼ 0.002). Overt depression symptoms, defined as a CES-DX22, were found in 24% of men. Mean age of men with overt depression was 49.9710.1 years vs 55.1715.8 years for those with CES-Do22 (P ¼ 0.02). Hypogonadal men were more likely to have overt depression scores compared to eugonadal counterparts (35 vs 18%, P ¼ 0.02). This association was statistically stronger after correcting for age in a multivariate linear model (P ¼ 0.005). The relative risk of having overt depression was 1.94 times higher in men with hypogonadal testosterone level (95% confidence interval: 1.13 to 3.7). We conclude that in an ED referral population, symptoms of hypogonadism and depression symptoms are fairly prevalent, and that overt depression symptoms are strongly associated with hypogonadism. Clinicians should consider testosterone measurements in all men with high depression symptom scores.

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“…In a retrospective study by Shores et al, hypogonadal men over 45 years of age had a 3.5-fold risk increase in the incidence of depression when compared to eugonadal men. 23 It has been found that cerebral perfusion itself maybe altered in hypogonadism. Testosterone replacement in hypogonadal men has been shown to increase blood flow to the midbrain, superior frontal gyrus, and midcingulate gyrus.…”

Section: Discussionmentioning

confidence: 99%

Predicting hypogonadism in men based upon age, presence of erectile dysfunction, and depression

et al. 2005

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Hypogonadism, a disorder associated with aging, can cause significant morbidity. As clinical manifestations of hypogonadism can be subtle, the challenge and the burden of diagnosis remain the responsibility of the clinician. Four different analytic methods were used to predict hypogonadism in men based upon age, the presence of erectile dysfunction (ED) and depression. 218 men were classified by age, serum testosterone level, the presence of ED and depression. Depression was determined by the Center for Epidemiologic Studies Depression Scale (CES-D). ED was assessed by the Sexual Health Inventory for Men (SHIM). Hypogonadism was defined as a serum testosterone level o300 ng/dl. An artificial neural network (ANN) was programmed and trained to predict hypogonadism based upon age, SHIM, and CES-D scores. Subject data was randomly partitioned into a training set of 148 (67.9%) and a test set of 70 (32.1%). The ANN processed the test set only after the training was complete. The discrete predicted binary output was set to (0) if testosterone level was o300 ng/dl or (1) if 4300 ng/dl. The data was also analyzed by standard logistic regression (LR), linear and quadratic discriminant function analysis (LDFA and QDFA, respectively). Reverse regression (RR) analysis evaluated the statistical significance of each risk factor. The ANN can accurately predict hypogonadism in men based upon age, the presence of ED, and depression (receiver-operating characteristic ¼ 0.725). A four hidden node network was found to have the highest accuracy. RR revealed the depression index score to be most significant variable (P ¼ 0.0019), followed by SHIM score (P ¼ 0.00602), and then by age (P ¼ 0.015). Hypogonadism can be predicated by an ANN using the input factors of age, ED, and depression. This model can help clinicians assess the need for endocrinologic evaluation in men.

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Increased Incidence of Diagnosed Depressive Illness in HypogonadalOlder Men

Abstract: Hypogonadal men showed an increased incidence of depressive illness and a shorter time to diagnosis of depression. Further prospective studies are needed to confirm these preliminary findings and to clarify the role of testosterone in the treatment of depressive illness in older men.

Cited by 211 publications

References 38 publications

The impact of hypogonadism and autonomic dysfunction on fatigue, emotional function, and sexual desire in male patients with advanced cancer

The impact of hypogonadism and autonomic dysfunction on fatigue, emotional function, and sexual desire in male patients with advanced cancer

Hypogonadism is associated with overt depression symptoms in men with erectile dysfunction

Predicting hypogonadism in men based upon age, presence of erectile dysfunction, and depression

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