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Depression may cause nonclassical hypogonadism
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Among young men, depression may be an underlying cause of nonclassical hypogonadism, according to findings from a database analysis published in the Journal of the Endocrine Society.
“Nonclassical hypogonadism is closely associated with depression,” Stanley Korenman, MD, distinguished professor of medicine, endocrinology and metabolism at the David Geffen School of Medicine at UCLA, told Endocrine Today. “Rather than always blame the symptoms on hypogonadism, consider the possibility that depression may cause the hypogonadism.”
In a retrospective chart review, Korenman and colleagues analyzed data from 186 men aged 18 to 40 years with a diagnosis of eugonadotropic hypogonadism and a testosterone value of less than 10.4 nmol/L with no apparent cause, who visited an academic health system between 2013 and 2015. Researchers matched the men with 930 control participants by age, BMI, race, alcohol and drug use, and 404 unmatched population control participants with a normal testosterone value and no hypogonadism diagnosis.
Compared with the overall control population, the researchers observed that depression was nearly four times higher among men with nonclassical hypogonadism (22.6% vs. 6.6%; P < .001), for an OR of 1.13 (95% CI, 1.09-1.17). Results persisted after adjusting for age.
When compared with matched control participants, the researchers found that the rate of depression among men with nonclassical hypogonadism remained higher (22.6% vs. 13.4%), for an OR of 1.14 (95% CI, 1.08-1.19).
“These data suggest that hypogonadism relates more closely to depression than obesity,” the researchers wrote.
In univariate analysis comparing the study population with control participants with a known testosterone value (mean, 18 nmol/L), the rate of depression among control participants was higher (22.6% vs. 16.8%; P = .121); however, the relationship between case patients and control participants did not rise to significance in multivariable analysis (OR = 1.06; 95% CI, 0.98-1.15).
“The encounter diagnoses of these controls more closely resembled those of the cases than those of the remainder of the controls, reinforcing the concept that many symptoms of depression resemble those of hypogonadism and may lead to a testosterone measurement than in these controls was normal by definition,” the researchers wrote.
In the study population, 12% of men with obesity had depression vs. 9% of men with overweight or normal weight and 11% of men with underweight, suggesting a limited influence of obesity on the relationship of depression to hypogonadism, according to researchers.
“In men, young and not-so-young, referred to clinicians with low testosterone measurements and symptoms, strongly consider depression and treat it if present,” Korenman said.
Korenman added that more research is needed on effective treatments for depression in men with symptoms of hypogonadism.
“To my knowledge, no one has ever studied the impact of treating depression effectively on patients also having hypogonadism. Almost nothing has been reported on the impact of activation of the hypothalamic-pituitary-adrenal axis on [gonadotropin-releasing hormone] release and implications for gonadotropin and testosterone secretion,” he said. – by Regina Schaffer
For more information:
Stanley Korenman, MD, can be reached at the David Geffin School of Medicine at UCLA, Department of Medicine, 52-242 Center for Health Statistics, 10833 Le Conte Ave., Los Angeles, CA 90095; email: skorenman@mednet.ucla.edu.
Disclosures: The authors report no relevant financial disclosures.
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