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Depression May Be Related to Testosterone Levels in Men: Presented at CPA

By Marvin Ross

TORONTO, CANADA -- November 13, 2006 -- Untreated depressed middle aged men may exhibit hypothalamic-pituitary-gonadal axis hypofunctioning as indicated by the presence of low bioavailable testosterone (BT) levels according to a poster presented by Dr. Roger McIntyre at the 56^th Annual Conference of the Canadian Psychiatric Association (CPA) meeting here.

Dr. McIntyre is an Associate Professor of Psychiatry and Pharmacology at the University of Toronto and Head of the Mood Disorders Psychopharmacology Unit at the University Health Network, Toronto, Ontario, Canada.

Total testosterone (TT) levels are known to decline linearly with age and it is estimated that a significant proportion of men over 30 are hypogonadal. This decline in TT produces a set of symptoms that are similar to a major depressive episode characterized by fatigue, irritability, dysphoria and loss of libido. It is therefore conceivable that testosterone may play a role in depression.

BT is the bioactive fraction of circulating TT that is not tightly bound to SHGB and is considered to more accurately reflect the clinical androgen status of the individual. Consequently, it was hypothesized that calculated BT levels would be significantly lower among depressed untreated middle aged men than among a matched non depressed control group.

The study compared 44 depressed men aged 40 to 65 years with a mean score of 20.8 on the 17-question Hamilton Rating Scale for Depression (HAM-D 17) and 50 controls with a mean HAM-D 17 score of 0.1. All subjects were in good health and had a body mass index of BMI of 20 to 29.

For the study, the researchers collected overnight fasting blood sample between 8 and 11 in the morning. Psychometric measures used were Diagnostic and Statistical Manual Fourth Edition, Text Revision and a HAM-D-17 total score greater than 16 and the second version of the Beck Depression Inventory.

Biochemical hypogonadism was defined as bioavailable testosterone (BT) no greater than 2.4 nmol/L and total testosterone (TT) no greater than 12.14 nmol/L.

Levels of TT were 11.94 among patients with major depression and 17.64 among healthy controls (P < .001). Bioavailable testosterone measures were 3.51 among patients with depression and 4.69 among controls (P = .008). The proportions of subjects with BT-defined hypogonadism were 34% and 6%, respectively (P < .001). Using TT as an indicator of hypogonadism, the differences were even more pronounced -- 61.4% and 14%, respectively (P < .001).

Men with depression have a significantly lower BT level than do non-depressed men but using TT as the threshold to define hypogonadism revealed an even greater difference between the 2 groups in this study, according to the researchers. This suggests use of TT may overestimate the number of men who have hypogonadism. Nonetheless, the results do suggest that depression may be related to testosterone levels in men.


[Presentation title: Calculated Bioavailable Testosterone Levels and Depression in Middle Aged Men. Poster P22]

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