November 14, 2018

expert reaction to study looking at testosterone treatment and depressive symptoms in men

Research published in JAMA Psychiatry demonstrates that testosterone treatment appears to be effective in reducing depressive symptoms in men.

Prof Joe Herbert, Emeritus Professor of Neuroscience, University of Cambridge, said:

“Depression in well-known to be more common in women, though why this should be is uncertain.  One possibility is that testosterone is protective in men, though there are many other interpretations.

“This paper is not a new study, but an analysis of 27 previous ones, using a complex statistical method (meta-analysis).  The advantage of this is that it increases the numbers of subjects available for analysis: the disadvantage is that different studies use different methods, which therefore have to be reconciled.  This is where the complex statistics plays its part.

“Their analysis shows three striking results.  Firstly, that testosterone administration is an effective treatment for depression in men.  As effective, in fact, as standard anti-depressants.

“Secondly, that higher doses are more effective.  This is what one would expect if testosterone is a genuine therapy.

“Thirdly, there is no relation between initial levels of testosterone and depression.  That is, low testosterone is not a risk for depression.

“This is a very careful analysis, and it has considerable implications.  However, it does point to the need for a properly constituted trial of testosterone (previous ones have often been too small, or not well carried out).  Suicide is now a leading cause of death in men: many of these will have been the result of depression.  This paper suggests that treatment with testosterone may well become a valuable addition to the management of a disorder which badly needs additional therapies.  One question that remains: would testosterone treatment also be effective in women?”

Dr Michael Bloomfield, Clinical Lecturer in Psychiatry, MRC Clinical Sciences Centre, UCL, said:

“This is a well conducted study in a respected journal pooling together results of exciting medical research into a meta-analysis.  Depression, whilst common, can be potentially fatal when severe and medical research into potential new treatments are very welcome.

“At the moment testosterone isn’t routinely used to treat depression.  This new study shows that testosterone may be helpful in some male patients.  However, we need more medical research to understand which patients might benefit from testosterone treatment and how this might fit in with existing treatments including medicines and psychotherapies.

“Anyone who is experiencing severe depressive symptoms should discuss their current treatment with their general practitioner or psychiatrist.”

Prof Allan Young, psychopharmacological committee at the Royal College of Psychiatrists, and Professor of Mood Disorders, Institute of Psychiatry Psychology & Neuroscience, King’s College London, said:

“Previous work has suggested a role for testosterone in treating mood disorders.  This analysis provides important new evidence that testosterone treatment may also be helpful for depressive symptoms in men, even where their testosterone levels were not low.  Although as the authors suggest, these results should be treated with caution because of a lack of data about long term safety, this review sets the scene for trials of testosterone as a treatment in men with depression.”

‘Association of Testosterone Treatment With Alleviation of Depressive Symptoms in Men: A Systematic Review and Meta-analysis’ by AndreasWalther et al. was published in JAMA Psychiatry at 16:00 UK time on Wednesday 14 November 2018.

Declared interests

Prof Joe Herbert: “No competing interests.”

Dr Michael Bloomfield: “Dr Bloomfield is funded by a UCL Excellence Fellowship and supported by the NIHR University College London Hospitals Biomedical Research Centre. Otherwise there are no conflicts of interest to declare.”

Prof Allan Young: “Nothing to declare.”