Abstract
Depression and hypogonadism are associated with erectile dysfunction (ED). We evaluated the prevalence of both conditions in men presenting to an ED specialty clinic, and tested whether hypogonadism correlated with the presence of depressive symptoms using a validated questionnaire. From July 2001 to June 2003, 157 men referred to an ED specialty clinic prospectively filled the Center for Epidemiologic Studies Depression Scale (CES-D), the abbreviated International Index of Erectile Function (IIEF-5) and had testosterone serum levels drawn. Median age was 53 (range=21–85 years). Hypogonadism, defined as serum T (testosterone)<300 mg/dl, was present in 36% of patients. This proportion was higher in men over the median age compared to younger patients (45 and 26%, respectively, P=0.002). Overt depression symptoms, defined as a CES-D⩾22, were found in 24% of men. Mean age of men with overt depression was 49.9±10.1 years vs 55.1±15.8 years for those with CES-D<22 (P=0.02). Hypogonadal men were more likely to have overt depression scores compared to eugonadal counterparts (35 vs 18%, P=0.02). This association was statistically stronger after correcting for age in a multivariate linear model (P=0.005). The relative risk of having overt depression was 1.94 times higher in men with hypogonadal testosterone level (95% confidence interval: 1.13 to 3.7). We conclude that in an ED referral population, symptoms of hypogonadism and depression symptoms are fairly prevalent, and that overt depression symptoms are strongly associated with hypogonadism. Clinicians should consider testosterone measurements in all men with high depression symptom scores.
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References
Harman SM, Metter EJ, Tobin JD, Pearson J, Blackman MR . Baltimore Longitudinal Study of Aging. Longitudinal effects of aging on serum total and free testosterone levels in healthy men. Baltimore Longitudinal Study of Aging. J Clin Endocrinol Metab 2001; 86: 724–731.
Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB . Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994; 151: 54–61.
Shabsigh R, Kaufman JM, Steidle C, Padma-Nathan H . Randomized study of testosterone gel as adjunctive therapy to sildenafil in hypogonadal men with erectile dysfunction who do not respond to sildenafil alone. J Urol 2004; 172: 658–663.
Rosenthal BD, May NR, Metro MJ, Harkaway RC, Ginsberg PC . Adjunctive use of AndroGel (testosterone gel) with sildenafil to treat erectile dysfunction in men with acquired androgen deficiency syndrome after failure using sildenafil alone. Urology 2006; 67: 571–574.
Araujo AB, Durante R, Feldman HA, Goldstein I, McKinlay JB . The relationship between depressive symptoms and male erectile dysfunction: cross-sectional results from the Massachusetts Male Aging Study. Psychosom Med 1998; 60: 458–465.
Seftel AD, Sun P, Swindle R . The prevalence of hypertension, hyperlipidemia, diabetes mellitus and depression in men with erectile dysfunction. J Urol 2004; 171 (6 Part 1): 2341–2345.
Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Pena BM . Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res 11; 319: 1999.
Shabsigh R, Klein LT, Seidman S, Kaplan SA, Lehrhoff BJ, Ritter JS . Increased incidence of depressive symptoms in men with erectile dysfunction. Urology 1998; 52: 848–852.
Mallis D, Moysidis K, Nakopoulou E, Papaharitou S, Hatzimouratidis K, Hatzichristou D . Psychiatric morbidity is frequently undetected in patients with erectile dysfunction. J Urol 2005; 174: 1913–1916.
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; 61: 162–167.
Seidman SN, Araujo AB, Roose SP, McKinlay JB . Testosterone level, androgen receptor polymorphism, and depressive symptoms in middle-aged men. Biol Psychiatry 2001; 50: 371–376.
Radloff L . The CES-D scale: a self-report depression scale for use in the general population. Appl Psychol Measure 1; 385: 1977.
Haringsma R, Engels GI, Beekman AT, Spinhoven P . The criterion validity of the Center for Epidemiological Studies Depression Scale (CES-D) in a sample of self-referred elders with depressive symptomatology. Int J Geriatr Psychiatry 2004; 19: 558–563.
R Development Core Team and the R Foundation for Statistical Computing. R: A Language and Environment for Statistical Computing. Vienna, Austria. http://www.r-project.org.
Wald M, Meacham RB, Ross LS, Niederberger CS . Testosterone replacement therapy for older men. J Androl 2006; 27: 126–132.
Almeida OP, Waterreus A, Spry N, Flicker L, Martins RN . One year follow-up study of the association between chemical castration, sex hormones, beta-amyloid, memory and depression in men. Psychoneuroendocrinology 2004; 29: 1071–1081.
Beer TM, Bland LB, Bussiere JR, Neiss MB, Wersinger EM, Garzotto M et al. Testosterone loss and estradiol administration modify memory in men. J Urol 2006; 175: 130–135.
Wang C, Swerdloff RS, Iranmanesh A, Dobs A, Snyder PJ, Cunningham G et al. Testosterone Gel Study Group. Transdermal testosterone gel improves sexual function, mood, muscle strength, and body composition parameters in hypogonadal men. J Clin Endocrinol Metab 2000; 85: 2839–2853.
Baba K, Yajima M, Carrier S, Morgan DM, Nunes L, Lue TF et al. Delayed testosterone replacement restores nitric oxide synthase-containing nerve fibres and the erectile response in rat penis. BJU Int 2000; 85: 953–958.
Traish AM, Munarriz R, O'Connell L, Choi S, Kim SW, Kim NN et al. Effects of medical or surgical castration on erectile function in an animal model. J Androl 2003; 24: 381–387.
Rosen RC, Fisher WA, Eardley I, Niederberger C, Nadel A, Sand M . Men's Attitudes to Life Events and Sexuality (MALES) Study. The multinational Men's Attitudes to Life Events and Sexuality (MALES) study: I. Prevalence of erectile dysfunction and related health concerns in the general population. Curr Med Res Opin 2004; 20: 607–617.
Seidman SN, Roose SP, Menza MA, Shabsigh R, Rosen RC . Treatment of erectile dysfunction in men with depressive symptoms: results of a placebo-controlled trial with sildenafil citrate. Am J Psychiatry 2001; 158: 1623–1630.
Rosen R, Shabsigh R, Berber M, Assalian P, Menza M, Rodriguez-Vela L et al. Vardenafil Study Site Investigators. Efficacy and tolerability of vardenafil in men with mild depression and erectile dysfunction: the depression-related improvement with vardenafil for erectile response study. Am J Psychiatry 2006; 163: 79–87.
Kshirsagar A, Seftel A, Ross L, Mohamed M, Niederberger C . Predicting hypogonadism in men based upon age, presence of erectile dysfunction, and depression. Int J Impot Res 2006; 18: 47–51.
Schmidt PJ, Berlin KL, Danaceau MA, Neeren A, Haq NA, Roca CA et al. The effects of pharmacologically induced hypogonadism on mood in healthy men. Arch Gen Psychiatry 2004; 61: 997–1004.
Seidman SN, Spatz E, Rizzo C, Roose SP . Testosterone replacement therapy for hypogonadal men with major depressive disorder: a randomized, placebo-controlled clinical trial. J Clin Psychiatry 2001; 62: 406–412.
Hedayati SS, Bosworth HB, Kuchibhatla M, Kimmel PL, Szczech LA . The predictive value of self-report scales compared with physician diagnosis of depression in hemodialysis patients. Kidney Int 2006; 69: 1662–1668.
Lyness JM, Noel TK, Cox C, King DA, Conwell Y, Caine ED . Screening for depression in elderly primary care patients. A comparison of the Center for Epidemiologic Studies-Depression Scale and the Geriatric Depression Scale. Arch Intern Med 1997; 157: 449–454.
Murrell SA, Himmelfarb S, Wright K . Prevalence of depression and its correlates in older adults. Am J Epidemiol 1983; 117: 173–185.
Wada K, Tanaka K, Theriault G, Satoh T, Mimura M, Miyaoka H et al. Validity of the Center for Epidemiologic Studies Depression Scale as a screening instrument of major depressive disorder among Japanese workers. Am J Ind Med 2007; 50: 8–12.
Beekman AT, Deeg DJ, Van Limbeek J, Braam AW, De Vries MZ, Van Tilburg W . Criterion validity of the Center for Epidemiologic Studies Depression scale (CES-D): results from a community-based sample of older subjects in The Netherlands. Psychol Med 1997; 27: 231–235.
Delhez M, Hansenne M, Legros JJ . Andropause and psychopathology: minor symptoms rather than pathological ones. Psychoneuroendocrinology 2003; 28: 863–874.
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Makhlouf, A., Mohamed, M., Seftel, A. et al. Hypogonadism is associated with overt depression symptoms in men with erectile dysfunction. Int J Impot Res 20, 157–161 (2008). https://doi.org/10.1038/sj.ijir.3901576
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DOI: https://doi.org/10.1038/sj.ijir.3901576
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