Patients with testosterone deficit syndrome and depression.

Prevalence of depression in men increases with age, so does the prevalence of hypogonadism. Depression and anxiety are the most common psychopathological symptoms associated with male hypogonadism.The question is whether the age-related gradual decline in testosterone levels contributes to the rising rate of depression in older men. Many studies have demonstrated the improvement in depressive symptoms in hypogonadal men with testosterone supplementation. However, a subpopulation of hypogonadal men appear to be better responders to TRT when treated for depression. Testosterone deficiency is associated with numerous non-specific symptoms including decline in libido, erectile dysfunction, increased fat deposition, decreased muscle mass, decreased energy and depression. The relationship between increased depressive symptoms and declining testosterone levels is complex because many conditions are independently associated with depression and testosterone deficiency. These conditions include medical illnesses, such as HIV/AIDS, and obesity, stress, smoking, and alcohol abuse. While the literature does not support a consistent relationship between testosterone levels and depressive symptoms most studies do suggest that lower testosterone levels are associated with depressive symptoms. Furthermore, TRT has been shown to improve depressive symptoms in most men. This could be due to the fact that testosterone is a modulator of GABAA receptors and inhibits 5-HT3 receptors centrally. However there appears to be a subpopulation of depressed male patients that tend to respond best to TRT. These patients include men who have HIV/AIDS, mild depression, more severe testosterone deficiency, use transdermal testosterone as opposed to IM testosterone, and those not responding to SSRIs. However, patients taking SSRIs also experience a significant improvement in depressive symptoms once treated with TRT. Men with depressive symptoms and testosterone deficiency syndrome should be given a trial of testosterone replacement therapy for at least 3 months as TRT alone may improve clinical symptoms of depression. Furthermore, men already on SSRIs may also experience further improvement in depressive symptoms after initiating TRT.