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Testosterone therapy may reduce symptoms of depression in men
Clinical Question
Is testosterone treatment safe and effective for alleviating depressive symptoms in men?
Bottom line
This review found that a relatively high dose of testosterone (> 500 mg/week) may be effective in reducing depressive symptoms in men with treatment-resistant depression. Results were independent of age, baseline testosterone level, and severity of depression. The overall quality of the available evidence is low to very low, so further well-designed clinical trials are needed to reliably guide clinical decision-making. 2b
Reference
Study design: Meta-analysis (randomized controlled trials)
Funding: Unknown/not stated
Setting: Various (meta-analysis)
Synopsis
The role of supplemental testosterone for improving depressive symptoms in adult men is currently uncertain. These investigators thoroughly searched multiple databases including Medline, Embase, PsychINFO, the Cochrane Controlled Trials Register, and previous meta-analyses and systematic reviews for English-language only randomized controlled trials that evaluated testosterone treatment in men with validated psychometric depression. Two reviewers independently assessed individual trials for study inclusion criteria and methodologic quality using the Cochrane Collaboration Risk of Bias tool. Discrepancies were resolved by consensus discussion. A total of 27 studies (N = 1890 patients) met inclusion criteria, with most at high or unclear risk of bias, mainly due to incomplete reporting of randomization procedures and allocation concealment, which may significantly overestimate treatment effect. Testosterone treatment was associated with a significant improvement in depressive symptom scores compared with placebo (odds ratio = 2.30; 95% CI 1.3 - 4.06) . However, the difference met minimal criteria for a clinically relevant reduction in symptoms and only in men with treatment-resistant depression. Testosterone dose was likely to be an important factor, since only trials that used dosages higher than 500 mg per week reported significant benefits. Previous studies have reported an increased risk for cardiovascular adverse events with dosages of 100 mg per day in men 65 years and older. A formal funnel plot analysis for publication bias identified underreporting of negative trials, which may also lead to an inflated estimate of the true treatment effect. Neither age, baseline testosterone level including the presence or absence of hypogonadism, nor the severity of depression were moderators of the effect of testosterone treatment on depressive symptoms. Overall drop-out rates due to adverse events were similar between testosterone-treated and placebo-treated participants.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC
Comments
This tells us what...?
The press would take the title of this article and slap “T cures depression!!”
But the summary above says that the studies are flawed (if not biased), the doses potentially dangerous, and the benefits are small.
The premise does seem to make some sense, and further study would be great. But right now I think the sellers of testosterone products are thanking you for how this article was titled.
I agree with the above…
I agree with the above statement in general.
However, to be fair to the author of the summary, "may reduce symptoms" seems accurate to me and it is not the same as "cures".