Age-associated hypogonadism (testosterone deficit) can occurs in 30% of men after the age of 55 (1). Low testosterone is associated with decreased muscle mass, bone mineral density, and libido, and with anorexia, fatigue, and irritability. Although some of these symptoms overlap with those of depression, results from multiple randomized-controlled clinical trials on the association of testosterone level and depression are conflicting.
On the other hand studies (2) have shown the efficacy of testosterone as an effective treatment for depression management in followings
- Hypogonadal men
- Antidepressant-resistant men
- Men with early onset depression, and/or
- HIV-infected men.
- FDA defines hypogonadism as testosterone level ≤300 ng/dL.
- According to the International Society of Andrology (ISA), International Society for the Study of Ageing Male (ISSAM), European Association of Urology (EAU), European Academy of Andrology (EAA), American Society of Andrology (ASA) defines as testosterone level ≤230 ng/dL.
For patients with total testosterone levels between 230 and 350 ng/dl:-
- repeat measurement of total testosterone + measure SHBG (sex hormone-binding globulin) concentrations to calculate free testosterone levels, or measure free testosterone levels directly by equilibrium analysis.
- Shores MM, Sloan KL, Matsumoto AM, Moceri VM, Felker B, Kivlahan DR. Increased incidence of diagnosed depressive illness in hypogonadal older men. Arch Gen Psychiatry. 2004 Feb;61(2):162-7. (PMID: 14757592)
- Amiaz R, Seidman SN. Testosterone and depression in men. Curr Opin Endocrinol Diabetes Obes. 2008 Jun;15(3):278-83. (PMID: 18438177)
- Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS, Montori VM; Task Force, Endocrine Society. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010 Jun;95(6):2536-59. doi: 10.1210/jc.2009-2354. Erratum in: J Clin Endocrinol Metab. 2021 Jun 16;106(7):e2848. (PMID: 20525905)
Hypogonadism/Low Testosterone: Evaluation, Diagnosis & Treatment
This lecture series includes the following clinically relevant topics:
- How to make the diagnosis?
- Which scale can help with screening of symptoms?
- What is cutoff value for testosterones level?
- Role of measuring FSH and LH?
- Treatment and available testosterone formulations.
- Contraindications and precaution with testosterone treatment.
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