Posts Tagged ‘“low T”’

Even “Mid-low-T” Levels Make Men Depressed

Men referred for borderline testosterone levels may have high rates of depression and depressive symptoms that are under-recognized, according to the results of a new study.

“In an era where more and more men are being tested for ‘Low T’ — or lower levels of testosterone — there is very little data about the men who have borderline low testosterone levels.

We felt it important to explore the mental health of this population,” said lead author Michael S. Irwig, MD, associate professor of medicine and director of the Center for Andrology at the George Washington School of Medicine and Health Sciences in Washington, DC.

The number of testosterone prescriptions has grown exponentially over the past decade.

Along with it has been a corresponding increase in direct-to-consumer marketing about the effects of “Low T” on decreased sexual function and low energy in middle-aged men.

The study included 200 adult men, mean age 48 years, who were referred for borderline total testosterone levels between 200 and 350 ng/dL.

Doctors typically treat men for hypogonadism if they have symptoms of low testosterone and their testosterone levels are below 300 ng/dL.

The researchers gathered information on demographics, medical histories, medication use, signs and symptoms of hypogonadism, and assessments of depressive symptoms and/or a known diagnosis of depression or use of an antidepressant.

All of the study participants who were not diagnosed with depression or who were taking medications for the condition answered standardized test questions aimed at measuring mood.

More Than Half Showed Signs of Depression

The results show that more than half (56%) of the men had depression or depressive symptoms, which is significantly higher than rates seen in general populations.

A recent survey of US adults found that 6% of those who are overweight or obese were depressed.

One-quarter of the men used antidepressants.

Rates of depression were 62% for those in their 20s and 30s, 65% for those in their 40s, 51% for those in their 50s, and 45% for those who were age 60 and higher.

Notably, the men had high rates of overweight or obesity and physical inactivity.

Common symptoms were erectile dysfunction, decreased libido, fewer morning erections, low energy, and sleep disturbances.

Sexual and nonspecific symptoms, such as fatigue, likely prompted measurements of testosterone in this selected population, the researchers pointed out.

They concluded that “clinicians should consider screening for depression/depressive symptoms and overweight and unhealthy lifestyle risk factors in men referred for tertiary care for potential hypogonadism.”

Testosterone replacement therapy can improve the signs and symptoms of low testosterone in these men, the researchers said.

The researchers published their results online on July 1, 2015 in the Journal of Sexual Medicine.

Evidence on Testosterone Therapy Does Not Support Cardiac Risk

Does testosterone therapy to treat testosterone deficiency, or “low T,” increase a man’s risk of cardiovascular disease?

No, says a provocative editorial that asserts there are flaws in the cardiovascular risks quoted in recent articles in the scientific literature and mass media.

The public judgment of the overselling of testosterone therapy demands a response, stated the lead author, Martin Miner, MD, Clinical Associate Professor of Family Medicine and Urology, Warren Alpert Medical School of Brown University.

The editorial appeared in the April 8, 2014 issue of Journal of Men’s Health.

NO CREDIBLE EVIDENCE

“As researchers and clinicians with extensive experience with testosterone deficiency and its treatment, we do not find any credible evidence that testosterone prescriptions increase health risks.

We find the assertion that testosterone is prescribed to men ‘who are simply reluctant to accept the fact that they are getting older’ is without foundation, and we object to comments that question the reality of testosterone deficiency, regardless of whether it is called hypogonadism or, as in advertisements, ‘low T,’” Dr. Miner stated.

“In addition, in our opinion, the idea that physicians prescribe testosterone due to pressure from drug companies is irresponsible and not supported by scientific evidence.”

OVER-THE-TOP COMMENTS

Over-the-top comments tend to scare both patients and physicians.

“The FDA announcement that it is investigating the reports of increased cardiovascular risks has only added to the impression that a major study has determined serious problems with testosterone therapy,” he stated.

A case in point is a recent report published in PLoS ONE that investigated the risk of acute nonfatal myocardial infarction (MI), or heart attack, in a retrospective cohort study of a health-claims database.

The authors compared the rates of heart attack within the first 90 days of an initial prescription for testosterone with the rates of heart attack for the 12 prior months in nearly 56,000 men.

They also examined pre- and post-prescription incidence rates for nonfatal heart attack in another large cohort of more than 167,000 men for whom only phosphodiesterase-5 inhibitor (PDE5i) medications (such as Viagra) were prescribed, and after adjusting for potential confounders, compared these results to those of men who received testosterone prescriptions.

The authors concluded that the risk of heart attack following testosterone prescription was “substantially” increased (at least twofold) in older men and younger men with preexisting, diagnosed heart disease.

STUDY IS “TOO FLAWED”

“A close examination reveals that this study is too flawed to provide meaningful information on the cardiovascular risk of testosterone therapy,” stated Dr. Miner.

“First, the overall rate of nonfatal MI in the testosterone-treated group increased in all ages from 3.48 to 4.75 per 1,000 person-years.

This amounts to just greater than 1 additional MI in 1,000 years of exposure to testosterone.

It is misleading to characterize this increase as ‘substantial’ based on relative risk when the absolute risk is so small and clinically meaningless.”

Also, the study duration (90 days) was short, and a true control group would have consisted of men with untreated testosterone deficiency, not those who received PDE5i medications.

The overall risk was low, and the number of events in subgroups was remarkably few, he noted.

More data from larger, longer term studies are needed to assess the potential effects of testosterone therapy on cardiovascular events in men.

Based on the current evidence, he stated, “we can find no foundation for suggesting new restrictions on testosterone therapy in men with cardiac disease.”