Depression rates high among men referred for borderline testosterone

SAN DIEGO — Men who are referred for borderline testosterone levels have higher rates of depression and depressive symptoms compared with the general population, according to research presented at The Endocrine Society annual meeting.

“There’s been a dramatic increase in testing for testosterone levels,” Michael Scott Irwig, MD, FACE, director, Center for Andrology, George Washington University, Washington, DC, said in a press conference. “There are many men who end up having borderline testosterone levels, which are close to the lower end of the reference range.”

Recognizing a lack of studies looking at men who seek medical care for borderline testosterone levels, Irwig and colleagues set out to describe this population and assess for comorbidities.

The researchers analyzed 200 adult men aged 20 to 77 years referred for management of borderline testosterone levels; total testosterone from 200 to 350 ng/dL, or 6.9 to 12 nmol/L, were used to define borderline.

“Nobody really knows what a low testosterone is; there’s no clear agreement on this,” Irwig said.

The researchers performed a repeat measurement of total testosterone. Depressive symptoms or depression scores were assessed through validated Patient Health Questionnaire 9 (PHQ-9) and/or an established depression diagnosis or current antidepressant use. The investigators collected data on demographics, medical histories, medication use, and hypogonadism signs and symptoms.

Based on PHQ-9 criteria that identifies depressive symptoms (scores ≥ 10), 56% of the population had significant depressive symptoms and/or a depression diagnosis and/or antidepressant use; the test identified 7% of men who reported no depressive symptoms or having depression with scores in the range.

“The men referred definitely are a select sample because they probably had some symptoms that prompted them getting tested,” Irwig said. “Therefore our findings cannot be generalized to men with borderline testosterone levels who do not seek medical care.

An ethnically diverse sample of primary care patients demonstrated rates of depressive symptoms between 15% and 22% based on PHQ-9 scores, and the rate was 5.6% among U.S. adults with overweight and obesity in the National Health and Nutrition Examination Survey (2005-2006).

In the men studied, there was also a high prevalence of overweight (39%) and obesity (40%); further, physical inactivity was common, with more than half (51%) engaging in no regular exercise other than walking. The most frequently reported symptoms were erectile dysfunction (78%), low libido (69%) and low energy (52%).

“We as clinicians should consider managing some of these common comorbidities, such as obesity and sedentary lifestyle,” Irwig said. “There’s practically no risk to getting a man to lose weight, which will have a lot of health benefits, but there are potential risks to testosterone therapy.” – by Allegra Tiver

Reference:

Westley C. Poster Board SAT-130. Presented at: The Endocrine Society Annual Meeting; March 5-8, 2015, San Diego.

Disclosure: Westley reports no relevant financial disclosures.