Low Testosterone Levels in Patients with Mild Hypertension Recovered after Antidepressant Therapy in a Male Climacterium Clinic

Abstract

Recently, middle-aged men who have begun frequently complaining of erectile dysfunction and nonspecific symptoms similar to those of postmenopausal women, visited a male climacterium clinic in Japan. Some patients, who were already taking antihypertensive medication, discontinued or reduced their dosages of antihypertensive medication after anti-depressant therapy. Forty-nine males over the age of 40 years were studied to evaluate the relationships between blood pressure, mental stress, and testosterone levels. The systemic blood pressure (sBP) of 24 patients was higher than the criteria for mild hypertension: 140/90 mmHg (HT group) at first visit. The sBP of the other 25 patients was normal (N group). The international index of erectile function (IIEF5) score (normal >21), self-rating depression scale (SDS) score (normal <40), and plasma testosterone levels were also evaluated before and after anti-depressant therapy without androgen replacement therapy.There were no significant differences between the groups in IIEF5 or SDS scores. The plasma testosterone levels in the HT group at first visit were significantly lower than those in the N group (230±77 vs. 343±92 ng/dL, p<0.001). After treatment, the IIEF5 scores were unchanged, whereas SDS scores were lower in both groups. Mean systemic blood pressure (mBP) in the HT group significantly decreased from 112±7 to 94±7 mmHg after treatment, concomitant with the disappearance of nonspecific complaints and the increase of testosterone levels. In the N group, however, neither mBP nor testosterone levels changed. Psychotherapy can ameliorate mild systemic hypertension in climacteric men with low testosterone levels. Mental stress might suppress the hypothalamic-pituitary-gonadal axis to decrease testosterone levels.