AT ENDO 2015

SAN DIEGO – More than half of adult males referred for borderline testosterone levels have depression or depressive symptoms, judging from results from a single-center study.

“Men diagnosed with depressive symptoms should be referred to a mental health professional for formal evaluation and treatment,” Dr. Michael S. Irwig said during a press briefing at the 2015 annual meeting of the Endocrine Society. “We as clinicians should consider managing common comorbidities in this sample population such as obesity and sedentary lifestyle. For example, there’s practically no risk to getting men to lose weight, which would have a lot of health benefits, but there are potential risks to testosterone therapy. I’ll tell men that if they lose weight, that will increase their body’s production of testosterone.”

In the wake of multi-million dollar pharmaceutical advertising campaigns geared to educate the public about low testosterone, Dr. Irwig and his associates set out to describe the population of men referred for borderline testosterone levels and to assess comorbidities. They hypothesized that men referred for borderline testosterone levels would have higher rates of depression and depressive symptoms than the general population.

“There’s been a dramatic increase in testing for testosterone levels,” said Dr. Irwig, director of the Center for Andrology in the division of endocrinology at George Washington University, Washington. “There are many men who wind up having borderline testosterone levels that are closer to the lower end of the reference range. Nobody really knows what a low testosterone level is; there’s no clear agreement on this. There are virtually no published studies looking at this group of men who seek medical care for borderline testosterone levels.”

The researchers recruited 200 men aged 20-77 years who were referred for management of borderline-to-low testosterone levels. They defined borderline testosterone levels as between 200 ng/dL and 350 ng/dL (which corresponds to 6.9-12 nmol/L) and assessed depressive symptoms with the validated Patient Health Questionnaire 9 (PHQ-9), with scores 10 or greater considered positive. They also collected data on demographics, medical history, what medications they were taking, and any signs and symptoms of hypogonadism.

Dr. Irwig reported that 56% of men had either depressive symptoms based on the PHQ-9, a known diagnosis of depression, and/or they were already on an antidepressant. By comparison, previous studies of PHQ-9 scores have demonstrated that the rate of depression in the general population is 15%-20% among ethnically diverse primary care patients and 5.6% of overweight and obese adults who participated in the National Health and Nutrition Examination Survey. “So clearly, this population [of men referred for borderline testosterone levels] has a much higher rate of depression and depressive symptoms,” he said.

When the study participants were asked if they engaged in exercise other than walking, 51% reported that they weren’t doing any exercise, 27% were exercising 1-3 times per week, and 22% were exercising 4 times per week or more. Only 16% of the study participants were normal weight based on their body mass index, while 39% were overweight, 43% were obese, and 2% were underweight.

As for symptoms that prompted the men to get their testosterone levels checked in the first place, most reported erectile dysfunction (89%), followed by low libido (69%), fewer morning erections (58%), low energy (52%), sleep disturbances (42%), and decreased concentration (27%).

Dr. Irwig emphasized that the study participants “are a select sample, because they probably had some symptom that prompted them to get [their testosterone level] tested,” he said. “Therefore, our findings cannot be generalized to men with borderline testosterone levels who do not seek medical care.”

Dr. Irwig reported having no relevant financial conflicts.

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