Medical professionals have been
discussing whether testosterone treatment can actually reduce depressive
symptoms in men for many years. A recent meta-analysis attempts to draw a
clearer picture.
Could testosterone therapy be the
antidepressant of the future?
Depression is a major
global concern. Per year, major depressive disorder affects an estimated 16.1 million adults
in the United States alone.
The World Health Organization
(WHO) describedepression as "the leading cause of ill health
and disability worldwide."
There are drugs available to manage
depressive symptoms, but they do not work for everyone.
In fact, a significant
percentage of people do not experience long-term relief, even
after trying multiple drugs.
Depression is roughly twice as
common in women as it is in men, which means that depression currently affects
around 100 million men.
The
testosterone debate
Scientists have been discussing
whether or not testosterone therapy could help treat
depression in men for several decades.
As a neuroactive steroid, testosterone can influence mood, making it a
reasonable hormone to study in regard to low mood.
In rodent models of depression,
testosterone therapy boosts production of serotonin, or the happy
chemical. Also, testosterone levels tend to drop as men age, and some studies
have shown that men with lower levels are more likely to
have depressive symptoms.
However, other studies have found no relationship between lower levels of
testosterone and low mood. Others still did find links between testosterone levels and depression,
but only in certain groups of men.
Due to discrepancies between
studies, healthcare professionals do not recommend testosterone treatment to
men with depression; however, there is a strong possibility that at least some
men might benefit.
Existing depression therapies only
work for a subset of the population. For this reason, it is vital to understand
whether testosterone might help in treatment-resistant cases.
To this end, some researchers
recently carried out a meta-analysis on existing studies that looked at
testosterone and depression.
According to the authors, their
analysis was the "largest examination to date of the association of
testosterone treatment with depressive symptoms in men."
Specifically,
the researchers aimed to "examine the association of testosterone
treatment with alleviation of depressive symptoms in men and to clarify
moderating effects of testosterone status, depression status, age, treatment
duration, and dosage."
They recently published their
findings in the journal JAMA Psychiatry.
Testing
testosterone
In their literature search, they
found 27 relevant randomized placebo-controlled clinical trials, which included
a total of 1,890 participants.
They found that testosterone has a
"moderate antidepressant" effect when compared
with placebo. They also found
that the beneficial effect was most pronounced at higher doses; this is the
first time that a study has ever suggested that higher doses might be necessary
to generate an antidepressant effect.
They also
saw that men who were the least depressed experienced the most benefits from
the intervention.
An earlier analysis concluded that
testosterone therapy only benefited men with particularly low testosterone
levels; interestingly, in the new analysis, there was no relationship between
antidepressant benefits and initial testosterone levels.
The
benefits were comparable, regardless of baseline testosterone measures.
The analysis also showed no
difference between younger and older men; all age groups had a similar level of
response to testosterone therapy.
The authors report:
"Testosterone treatment appears
to be effective and efficacious in reducing depressive symptoms in men, particularly
when higher-dosage regimens were applied in carefully selected samples."
This will not be the end of the
debate, however. The authors are quick to mention that, because of the diverse
character of the studies that they analyzed, "more preregistered trials
are needed that explicitly examine depression as the primary endpoint and
consider relevant moderators."
Further studies and larger pools of
data are needed before we can arrive at a definitive answer to the
testosterone-depression conundrum.
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