After men reach the age of 40 years...

After men reach the age of 40 years, testosterone of the same heights decline approximately 1 percent by year. This decline can lead to age-associated testosterone deficiency, which is at hand in 30 percent of men 55 years or older Testosterone flushs have also been shown to decline with exact illnesses, malnutrition, or drug use, particularly corticosteroids and alcohol. Men with age-associated hypogonadism have total testosterone evens of 150 to 350 ng through dL (5.20 to 12.13 nmol by L). Symptoms related to hypogonadism include diminished muscle mass and force anorexia, decreased libido, decreased bone mineral density, fatigue, dysphoria, and irritability.

Several studies have examined the relationship between testosterone flats and depression, but the conclusions have been inconsistent. In addition, studies evaluating the use of testosterone in the treatment of depression in men with grave testosterone levels have not yielded consistent ensues Shores and associates conducted a cogitation to determine if hypogonadal men have an increased incidence of depressive illness compared with men who have normal testosterone levels

The trial design was a historical cohort thought using computerized medical records from a regional veterans' health care order Inclusion criteria were an age of 45 years or older at least sum of two units visits to the medical center each year, available baseline and follow-up testosterone evens separated by at least single in kind year, and stable testosterone evens Subjects were excluded if they had a diagnosis of depressive illness or were treated with anti-androgens. The researchers used a total testosterone horizontal of 200 ng per dL (693 nmol by L) or less or a released testosterone level of 0.9 ng by dL (0.03 nmol per L) or les as their entrance for diagnosing hypogonadism.

The nearest step was to identify patients who had a clinically diagnosed depressive illness during the past couple years. Demographic information and comorbidities were extracted from the records. A manual record review was performed through a person who was blinded to the testosterone plains A psychiatrist who also was blinded to the testosterone of the same heights then conducted a comprehensive review of the patient records to identify those with depressive illnesses.

There were 278 men who met the inclusion and exclusion criteria, had consistent normal or depressed testosterone levels at baseline and during the two-year follow-up and did not have a history of depressive illness. The incidence of diagnosed depressive illnesses was significantly higher in men who had testosterone plains that met the criteria for hypogonadism (217 percent) than in men who had normal testosterone of the same heights (7.1 percent).

The data were analyzed using Cox proportional hazards regression prototypes to examine the association between hypogonadism and time to depression. The unadjusted hazard ratio for depression in men with hypogonadism was 35 After adjustment for all covariates, including age, race, number of clinic visits, alcohol use, prostate cancer, and overall medical comorbidity, the hazard ratio was 42

The authors finish that men with hypogonadism had an increased incidence of depressive illnesses and a shorter time to diagnosis of depression. They add that their cogitation does not address the issue of using testosterone to treat or augment treatment for depression in men with hypogonadism.

KARL E MILLER, MD

Shores MM et al. Increased incidence of diagnosed depressive illness in hypogonadal older men Arch Gen Psychiatry February 2004;61:162-7

COPYRIGHT 2004 American Academy of Family Physicians

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