MedicalResearch.com Interview with:
Dr. Andreas Walther PhD
Department of Biological Psychology, Technische Universität Dresden, Dresden, Germany
Department of Clinical Psychology and Psychotherapy, University of Zurich,
Task Force on Men’s Mental Health of the World Federation of the Societies of Biological Psychiatry
MedicalResearch.com: What is the background for this study?
Response: The study situation with regard to endogenous testosterone level and depressive symptoms in men is currently very mixed. There are studies that show no association, but other studies show that low testosterone levels are associated with increased depressive symptoms. That is why several studies have tried to administer testosterone in men to treat depressive symptomatology among other conditions (e.g. erectile dysfunction, cognitive decline).
However, no clear conclusions could be drawn from the studies to date, as some studies reported positive results, while others did not show any effects. Likewise, some studies showed better results in certain subgroups of men such as dysthymic men, treatment resistant, men with low testosterone, which raised the question of relevant moderators.
MedicalResearch.com: What are the main findings?
Response: The main findings of our meta-analysis are that testosterone treatment is associated with a significant reduction in depressive symptoms. It was calculated that men receiving testosterone compared to placebo were 2.3 times more likely to show a reduction of depressive symptoms of 50% or more, which is clinically relevant – efficacious. Furthermore, testosterone was not different from placebo with regard to drop outs and therefore a good acceptability is suggested. Finally, the moderator-analysis identified higher dosage regimens to achieve better effects.
However, the risk for bias is high in several studies and therefore more high quality randomized controlled trials are needed to investigate the effect of testosterone treatment on depressive symptoms as primary endpoint.
MedicalResearch.com: What should readers take away from your report?
Response: The available data suggest that testosterone appears to be effective and efficacious and may be a clinically useful adjunct therapy for reducing depressive symptoms in men. A good acceptability was identified for testosterone treatment. In addition, the moderator analysis showed that higher dosage regimens were associated with larger effects. However, it is very important to note that in several studies the risk for bias was high and therefore, before it comes to clinical application, more high quality randomized controlled trials are needed to investigate testosterone in men for depression as the primary endpoint.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: It would be crucial that future randomized controlled trials using testosterone focus on the reduction of depressive symptoms as primary endpoint. Future studies may also work with different dosages so that the finding that higher dosages achieve larger effects can be verified within a randomized controlled trial. Furthermore, additional studies investigating testosterone’s noninferiority to active comparators (e.g. established antidepressants), or in combination with different active comparators are needed to enable further conclusions about the ideal testosterone treatment for the reduction of depressive symptoms in men.
Disclosures: None of the authors (AW, JB, RM) has any connections to industry/pharmaceutical enterprises. We therefore have no conflicts of interest to declare.
Walther A, Breidenstein J, Miller R. Association of Testosterone Treatment With Alleviation of Depressive Symptoms in MenA Systematic Review and Meta-analysis. JAMA Psychiatry. Published online November 14, 2018. doi:10.1001/jamapsychiatry.2018.2734
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