Testosterone Therapy in Late-Life Major Depression in Males
J Clin Psychiatry 2002;63:1096-1101
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Major depression associated with
aging in males may improve with anabolic/androgenic steroid
therapy. The efficacy and safety of testosterone therapy in the
treatment of depression in elderly hypogonadal males is
inconclusive. The following study identifies a subgroup of
elderly depressed males who may benefit from testosterone
Method: Participants included 16 elderly
eugonadal males with major depressive disorder (DSM-IV criteria)
and a Hamilton Rating Scale for Depression (HAM-D) score >18.
Following a single-blind 2-week placebo lead-in, patients were
randomly assigned to treatment with either a physiologic dose of
testosterone cypionate (TC), 100 mg/week, or supraphysiologic
dose of 200 mg/week IM for 6 weeks. Psychometric testing was
carried out at entry into the study, at the TC injection
baseline, and every 2 weeks thereafter. Tests included an
objective measurement, the HAM-D, and the Buss-Durkee Hostility
Results: One patient meeting inclusion criteria
responded during the placebo lead-in; thus, 15 patients were
randomly assigned to treatment (100 mg/week, N=8; 200 mg/week,
N=7). There was a 42% decrease in the mean HAM-D scores from 20.1
to 11.9 (p=45 years old)
depression patients, whose mean HAM-D score decreased from 19.8
to 9.3 (53%), versus the 5 early-onset depression patients, whose
mean HAM-D score decreased from 20.8 to 17.0 (18%) (p=.0110). The
TC dose did not affect the response. Similar HAM-D decreases of
43% and 41% occurred for the respective 100- and 200-mg/week
doses. The HAM-D responder analysis found that none of 5
early-onset patients had HAM-D response, whereas 6 (60%) of 10
late-onset patients responded (p=.025). Similarly, none of the
early-onset patients experienced a remission whereas 5 (50%) of
the late-onset patients were categorized as remitters (p=.053).
Correlations between the peak and mean total testosterone
concentrations and HAM-D change scores suggested that only
minimal TC doses were required to produce an antidepressant
Conclusion: These data suggest that testosterone
therapy would best be limited to men with late-onset depression.
The findings suggest that short-term therapy with TC is safe.
Long-term treatment safety is unknown. Psychiatrists using
testosterone therapy should ascertain that patients have been
recently valuated for prostate cancer. If testosterone therapy is
initiated, serial serum prostate-specific antigen sampling should
be used for monitoring patients' prostate status.