Testosterone Deficiency and Mood in Aging Men: Pathogenic and Therapeutic Interactions

Abstract

In contrast to women, men do not experience a sudden cessation of gonadal function comparable to menopause. However, there is a progressive reduction in hypothalamic-pituitary-gonadal (HPG) function in aging men: testosterone (T) levels decline through both central (pituitary) and peripheral (testicular) mechanisms and there is a loss of the circadian rhythm of T secretion. In cohorts of men 75 years of age, mean plasma T levels are 35% lower than comparable young men, and more than 25% of men over 75 appear to be T-deficient. Such age-associated T deficiency, which has been termed ‘andropause’, is thought to be responsible for a variety of symptoms experienced by elderly men, such as weakness, fatigue, reduced muscle and bone mass, impaired haematopoiesis, oligospermia, sexual dysfunction, depression, anxiety, irritability, insomnia and memory impairment. However, it has been difficult to establish correlations between these symptoms and plasma T levels. Nevertheless, there is some evidence that T replacement leads to symptom relief, particularly with respect to muscle strength, bone mineral density and haematopoiesis. Studies to date on the specific association between psychiatric symptoms, such as depressed mood, and T levels have been methodologically flawed. Overall, data suggest that although hypogonadism is not central to major depressive disorder (MDD), HPG hypofunction may have aetiological importance in mild depressive conditions, such as dysthymia.

Key Words:

• andropause
• testosterone deficiency
• depression
• male
• geriatric

Additional information

Notes on contributors

Stuart N Seidman

Joyce Laing works in the Department of Child and Family Psychiatry, Playfield House, Cupar, Fife, and is a Consultant Art Therapist to Psychiatric Hospitals and Prisons and Chairwoman of the Scottish Society of Art and Psychology.

Dr Niculescu Dan, Centrul de Reumatologie, Str. J. (F)ucick no. 5, Bucuresti, Romania

Anni Vilppula, Department of Medicine, Paimio Hospital, Preitilä, Finland

G. Tausch, Department of Rheumatology, Municipal Hospital of Vienna-Lainz, Wolkersbergenstraße 1, A-1130Wien, Austria

Dr Guido Gothoni, Medica Pharmaceutical Company Ltd., P.O. Box 325, SF-00101 Helsinki 10, Finland

A. Elman, Dept. of Rheumatology, Karolinska sjukhuset, Stockholm, Sweden

Hannu Paitälä, Rheumatism Foundation Hospital, Heinola, Finland

Jonas Jonsson, National Bacteriological Laboratory, S-105 21 Stockholm, Sweden